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Principles of Epidemiology
Part (I)

Dr. Yassin Ibrahim

UNIVERSITY OF TABUK, FACULTY OF MEDICINE
COMMUNITY MEDICINE MODULE
(MED 402)
November 6, 2017
 Learning Outcomes
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At the end of this lecture, students should be able to:

1.Describe the accepted definition of epidemiology and its

major components.
2.Identify the main epidemiological sub-specialties.
3.Elucidate the historical evolution of the science and art of
epidemiology.
4.Determine the essential objectives and uses of epidemiology
in medicine.
5.Identify the main epidemiological function.
6.Describe the systematic epidemiological approach.
 Why Do We Need To Study Community
Medicine?
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To become a doctor, promote & maintain people safety & health, treat
patients & reduce their suffering.

Doctors responsibility:
Practice of evidence-based medicine.

Communication skills:
Patients queries & interaction skills.

Health services planning, implementation & management:

The needs of the many should take precedence over those of the few.

Equity:
Resources for health care are limited.

Health team member & leadership.

Research.
 Epidemiology
(Definition)
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Epidemiology:

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.
 Epidemiology
(Definition)
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Epidemiology:

Epidemiology is the method used to find the causes of health outcomes

and diseases in populations.

In epidemiology, the patient is the community and individuals are viewed

collectively.

By definition, epidemiology is the study (scientific, systematic, and data-

driven) of the distribution (frequency, pattern) and determinants
(causes, risk factors) of health-related states and events (not just
diseases) in specified populations (neighborhood, school, city, state,
country, global).

It is also the application of this study to the control of health problems.

(CDC: Principles of Epidemiology, 3rd Edition)
 Epidemiology
(Definition)
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Key terms in this definition

It reflects some important principles of epidemiology:

Study:
Epidemiology is a scientific discipline with sound methods of scientific
inquiry at its foundation.

Distribution:
Frequency.
Pattern: time, place, and person.

Determinants:
Any factor, whether event, characteristic, or other definable entity, that
brings about a change in a health condition or other defined characteristic.

Health-related states or events: Rrisk, CD & NCD

Specified populations.
Application. (CDC: Principles of Epidemiology, 3rd Edition)
 Parts of Epidemiology
(Descriptive Epidemiology)
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Descriptive epidemiology:

Descriptive epidemiology covers time, place, and person.

Compiling and analyzing data by time, place, and person

The 5Ws of descriptive epidemiology:

o What = health issue of concern
o Who = person
o Where = place
o When = time
o Why/how = causes, risk factors, modes of transmission
 Parts of Epidemiology
(Analytic Epidemiology)
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Analytic epidemiology:

Key feature of analytic epidemiology is comparison group.

Case & control

 Parts of Epidemiology
(Interventional Epidemiology)
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Interventional epidemiology:

The investigator determines through a controlled process

the exposure for each individual (clinical trial) or community
(community trial), and then tracks the individuals or
communities over time to detect the effects of the exposure.
 Sub-specialties of Epidemiology
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Subspecialties include:

Applied epidemiology.
Clinical epidemiology.
Environmental epidemiology.
Genetic epidemiology.
Genomic epidemiology.
Molecular epidemiology.
Social epidemiology.
Nutritional epidemiology.
Spatial epidemiology.
 Terminology & Definitions
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Community:

A group of people living in the same place or having a

particular characteristics in common.

Medicine:

The science or practice of the diagnosis, treatment, and

prevention of diseases - often surgery excluded.

Diagnosis, treatment, drugs, prevention of diseases.

 Terminology & Definitions
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Health:

A state of complete physical, mental and social well-being

and not merely the absence of disease or infirmity (WHO,
1948).

Public health:

The science & art of preventing disease, prolonging life,

promoting health & efficiency through organized community
effort (Winslow, 1920).

The application of preventive medicine principles to

population.
 Terminology & Definitions
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Disease:
A physiological or psychological dysfunction.
A condition in which body health is impaired.
A departure from a state of health.
An alteration of the human body interrupting the performance of
vital functions.

Illness:
A subjective state of not being well.
A disease or period of sickness affecting the body or mind.

Sickness:
The state of being ill.
A particular type of illness or disease
A state of social dysfunction.
 Historical Evolution of Epidemiology
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Historical Evolution of Epidemiology

 Important Dates in Epidemiology
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Epidemiologys roots are nearly 2500 years old.

400 BC:
Hippocrates published On Airs, Water, and Places which presented the
epidemiologic principles of the observation and recording of patients habits, diets,
and environments in the prediction of disease patterns.
1662:
John Graunt, London. published a landmark analysis of mortality data.

1747:
James Lind did a randomized, control trial (RCT) to establish the cause of
scurvy.

1946:
CDC was established from the Office of Malaria Control in War Areas.

1977:
The last naturally occurring case of smallpox was diagnosed in a Somali man.
 Important People in Epidemiology

Hippocrates (460 377 B.C.)

On Airs, Waters, and Places

Idea that disease might be associated

with physical environment.
 Important People in Epidemiology

Thomas Sydenham (1624 1689)

Recognized as a founder of
clinical medicine and
epidemiology.

Emphasized detailed
observations of patients &
accurate recordkeeping.
 Important People in Epidemiology

James Lind (1716 1794)

Designed first
experiments to use a
concurrently treated
control group.
 Important People in Epidemiology
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Edward Jenner (1749 1823)

Developed and tested an immunization for smallpox.

Pioneered clinical trials for vaccination to control spread

of smallpox.

Smallpox was eradicated in 1977.

Jenner's work influenced many other, including Louis

Pasteur who developed vaccines against rabies and
other infectious diseases.
 Important People in Epidemiology

Edward Jenner (1749 1823)

 Important People in Epidemiology
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Ignaz Semmelweis (1818 1865)

Pioneered hand washing to help prevent the spread of septic infections in
mothers following birth.
Dramatically reduced the rate of childbed fever by the institution of
hand-washing.
 Important People in Epidemiology

John Snow (1813 1858)

Father of epidemiology.

Careful mapping of cholera cases

in East London during cholera
epidemic of 1854.

Traced source to a single well on

Broad Street that had been
contaminated by sewage.
 Important People in Epidemiology
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John Graunt (1620 1674)

Began the collection and analysis of the Weekly Bills of

Mortality in London in the 1600s, showing the value of a
system of disease surveillance.
 Important People in Epidemiology
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P. C. A. Louis (1787 1872)

Called the father of

modern clinical
epidemiology

Responsible for the

landmark study of the none
effectiveness of
bloodletting.
Bloodletting:
The surgical removal of
some of a patient's blood for
therapeutic purposes.
 Important Places in Epidemiology
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Broad Street, London (1854):

The site where John Snows important research on cholera.

Cuba (1898):
Walter Reed conducted important research on yellow fever.

Tuskegee, Alabama (1932 1972):

The site of the famous Tuskegee Study of Untreated
Syphilis in Negro Male.

Framingham, Massachusetts (1948):

The site of Framingham Heart Study.
 Important Places in Epidemiology
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Broad Street, London (1854):

The site where John Snows important research on cholera.
 Important Diseases in Epidemiology
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Plague:
Killed one third of Europes population in the Middle Ages.

Scurvy :
The scourge of sailors, it limited the distance that ships could
travel.

Smallpox:
Caused approximately 400,000 death in the 18th century and
blinded 33% of survivors.

AIDS:
The modern plague.
It ended sexual revolution.
 Objectives of Epidemiology
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Objectives of epidemiology:

To identify the etiology or cause of disease.

To determine the extent of disease.
To study the progression of disease.
To evaluate preventive and therapeutic measures for a
disease or condition.
To develop public health policy.
 Uses of Epidemiology
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Uses of epidemiology:

Assessing the communitys health.

Making decisions about individual patients.

Completing & documenting the clinical picture of the

illness.

Searching for causes of diseases to prevent future

outbreaks.
 Core Epidemiologic Functions
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Core epidemiologic functions include:

Public health surveillance

Field investigation
Studies (descriptive & analytic)
Evaluation
Linkages (team work)
Policy development
 Core Epidemiologic Functions
(Health Surveillance)
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Public health surveillance:

Public health surveillance is the ongoing, systematic

collection, analysis, interpretation, and dissemination of
health data to help guide public health decision making and
action.
 Core Epidemiologic Functions
(Field Investigation)
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Field investigation:

Epidemic investigation

Outbreak investigation

Cluster investigation
 Core Epidemiologic Functions
(Descriptive & Analytic Studies)
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Descriptive and analytic studies:

Design

Conduct

Analyse

Interpret
 Core Epidemiologic Functions
(Evaluation)
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Evaluation and health policy development:

Effectiveness:
Refers to the ability of a program to produce the intended
or expected results in the field;

Efficacy:
Is the ability to produce results under ideal conditions.

Efficiency:
Refers to the ability of the program to produce the intended
results with a minimum expenditure of time and
resources.
 Core Epidemiologic Functions
(Multidisciplinary Team Function)
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Multidisciplinary team function:

Team formation.

Work with other team members:

Laboratorians, sanitarians, infection control personnel,

nurses & other clinical staff, & computer information
specialists.
 Core Epidemiologic Functions
(Policy Development)
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Policy development:

An epidemiologists working in public health regularly provide

input, testimony, and recommendations regarding disease
control strategies, reportable disease regulations, and health-
care policy.
 The Epidemiologic Approach
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The epidemiologic approach:

Definition

Counts: cases or health events, and describes them in terms

of time, place, and person;

Divides: the number of cases by an appropriate denominator

to calculate rates; and

Compares: these rates over time or for different groups of

people.
 Questions
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Briefly answer the following questions:

Describe the systematic epidemiological approach in

communicable disease investigation.

Describe the systematic epidemiological approach in non-

communicable disease investigation.
 References
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Main Textbook:
1. K. Park's (2015): Textbook of Preventive and Social Medicine. Banarsidas Bhanot-Jabalpur. 23rd edition.
Other references:
1. Text Book of Public Health and Community Medicine. RajVir Bhalwar, Department of Community
Medicine, Armed Forces Medical College, Pune, in collaboration with WHO, India Office, New Delhi
(2009).
2. Lucas, A. and Gilles, H. (2003): Short Textbook of Public Health Medicine for the tropic, 4th edition,
Oxford University Press Inc., New York, USA.
3. Portney, L. G. and Watkins, M. P. (2008): Foundation of Clinical Research. Applications to Practice. 3rd
edition.
4. Kumar, R. (1996): Research methodology. A step by step guide for beginners. 3rd edition.
5. Miller, D. C. (1991): Handbook of Research Design and Social Measurement. 5th edition.
6. Altman, D. G. (1991):Practical statistics for medical research. Boca Ratn, Chapman & Hall/ CRC;

Websites:
1. World Health Organization (WHO): http://www.who.ch
2. Centers for Disease Control and Prevention (CDC), USA: http://www.cdc.gov
3. The Johns Hopkins Bloomberg School of Public Health, OPENCOURSEWARE (OCW) project:
http://ocw.jhsph.edu
4. The WWW Virtual Library (Medicine and Health): Epidemiology
(http://www.epibiostat.ucsf.edu/epidem/epidem.html).
 THANK YOU
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