Siri e-Kuliah PPPJJ, USM

Kod Kursus- JIB 533

Nama Kursus : Public Health

Nama Pengurus Kursus

Dr. Rohayu Hami

INTRODUCTION TO EPIDEMIOLOGY
 We l e a d

Learning Objective
1. Define Epidemiology
2. Identify the main issues in the definition
3. Discuss the uses of Epidemiology
4. Define cause of disease
5. Discuss the different risk factors for disease
6. Define the natural history of disease
7. Describe the levels of disease prevention
 We l e a d

Epidemiology
 We l e a d

Epidemiology
• Epidemiology is the study of the
frequency, distribution and
determinants of diseases and other
health related conditions in human
populations, and the application of this
study to the promotion of health, and to
the prevention and control of health
problems.
We l e a d
 We l e a d

Major components of the

definition
1. Population.
The main focus of epidemiology is on the
effect of disease on the population rather
than individuals.
• For example dengue affects many people in Malaysia but brain
cancer is rare. If an individual develops brain cancer, it is more likely
that he/she will die. Even though brain cancer is more killer,
epidemiology gives more emphasis to dengue since it affects many
people.
 We l e a d

2. Frequency.
This shows that epidemiology is mainly a
quantitative science. Epidemiology is
concerned with the frequency (occurrence)
of diseases and other health related
conditions. Frequency of diseases is
measured by morbidity and mortality rates.
 We l e a d

3. Health related conditions.

Epidemiology is concerned not only with disease but also
with other health related conditions because every thing
around us and what we do also affects our health.
Health related conditions are conditions which directly or
indirectly affect or influence health. These may be injuries,
births, health related behaviours like smoking,
unemployment, poverty etc.
 We l e a d

4. Distribution.
Distribution refers to the geographical
distribution of diseases, the distribution in
time, and distribution by type of persons
affected.
 We l e a d

5. Determinants.
Determinants are factors which determine
whether or not a person will get a disease
 We l e a d

6. Application of the studies to the

promotion of health and to the
prevention and control of health
problems.
This means the whole aim in studying the
frequency, distribution, and determinants of
disease is to identify effective disease
prevention and control strategies.
 We l e a d

History of Epidemiology
Edward Jenner and Small pox Vaccine
We l e a d
We l e a d
We l e a d
 We l e a d

Uses of Epidemiology
1. To make a community diagnosis.

Epidemiology helps to identify and describe

health problems in a community (for
example, the prevalence of anaemia, or the
nutrition status of children).
 We l e a d

2. To monitor continuously over a period of

time the change of health in a community.

(for example, the effect of a vaccination

programme, health education, nutritional
supplementation).
 We l e a d

3. To practice surveillance for a specific

disease in order to be able to act quickly and
so cut short any outbreak

(example cholera).
 We l e a d

4. To investigate an outbreak of a
communicable disease, analyse the reasons
for it, plan a feasible remedy and carry it out,
and monitor the effects of the remedy on the
outbreak.
 We l e a d

5. To. Effective services, interventions and

remedies all depend on accurate community
data.
 We l e a d

Disease Causation
 We l e a d

Cause of disease

• Cause of disease is an event, condition,

characteristic or a combination of these
factors which plays an important role in
producing the disease.
 We l e a d

The causes of disease can be classified in to two:

1. Primary causes – these are the factors which
are necessary for a disease to occur, in whose
absence the disease will not occur. The term
”etiologic agent” can be used instead of primary
cause for Infectious causes of diseases. For
example “Mycobacterium tuberculosis” is the
primary cause (etiologic agent) of pulmonary
tuberculosis.
 We l e a d

2. Risk factors (contributing,

predisposing, or aggravating factors).
These are not the necessary causes of disease but they
are important for a disease to occur. A factor associated
with an increased occurrence of a disease is risk factor for
the exposed group; and a factor associated with a
decreased occurrence of a disease is a risk factor for the
non exposed group. Risk factors could be related to the
agent, the host and the environment.
 We l e a d

• The etiology of a disease is the sum total

of all the factors (primary causes and risk
factors) which contribute to the occurrence
of the disease.
• It is the interaction of the agent, the host,
and the environment which determines
whether or not a disease develops, and
this can be illustrated using the
epidemiologic triangle.
 We l e a d

Epidemiology Triangle

The epidemiologic triangle, depicts the relationship among three

key factors in the occurrence of disease or injury: agent,
environment, and host.
 We l e a d

• An agent is a factor whose presence or

absence, excess or deficit is necessary for
a particular disease or injury to occur.
• The environment includes all external
factors, other than the agent, that can
influence health. These factors are further
categorized according to whether they
belong in the social, physical, or
biological environments.
 We l e a d

• The social environment encompasses a

broad range of factors, including
education, unemployment, culture
regarding diet; and many other factors
pertaining to political, legal, economic,
communications, transportation, and
health care systems
 We l e a d

• Physical environmental factors are

factors like climate, terrain, and pollution.
• Biological environmental influences
include vectors, humans and plants
serving as reservoirs of infection.
 We l e a d

• From the perspective of epidemiologic

triangle, the host, agent, and environment
can coexist harmoniously.
• Disease and injury occur only when there
is altered equilibrium between them.
 We l e a d

Levels of Prevention
 We l e a d

Natural history of disease

• The “natural history of disease” refers to
the progression of disease process in an
individual over time, in the absence of
intervention.
• There are four stages in the natural history of a disease.
These are:
1. Stage of susceptibility
2. Stage of pre-symptomatic (sub-clinical) disease
3. Stage of clinical disease
4. Stage of disability or death
 We l e a d

Stage of susceptibility
• In this stage, disease has not yet
developed, but the groundwork has been
laid by the presence of factors that favour
its occurrence.
• Example: unvaccinated child is susceptible
to measles
 We l e a d

Stage of Pre-symptomatic (sub-

clinical) disease
• In this stage there are no manifestations of
the disease but pathologic changes
(damages) have started to occur in the
body.
• The disease can only be detected through
special tests since the signs and
symptoms of the disease are not present.
 We l e a d

Examples:
• Detection of antibodies against HIV in an
apparently healthy person.
• Ova of intestinal parasite in the stool of
apparently healthy children.
The pre-symptomatic (sub-clinical) stage
may lead to the clinical stage, or may
sometimes end in recovery without
development of any signs or symptoms
 We l e a d

The Clinical stage

• At this stage the person has developed
signs and symptoms of the disease.
• The clinical stage of different diseases
differs in duration, severity and outcome.
• The outcomes of this stage may be
recovery, disability or death.
 We l e a d

Examples:
• Common cold has a short and mild clinical
stage and almost everyone recovers
quickly.
• Polio has a severe clinical stage and many
patients develop paralysis becoming
disabled for the rest of their lives.
 We l e a d

• Rabies has a relatively short but severe

clinical stage and almost always results in
death.
• Diabetes Mellitus has a relatively longer
clinical stage and eventually results in
death if the patient is not properly treated.
 We l e a d

Stage of disability or death

• Some diseases run their course and then
resolve completely either spontaneously or
by treatment.
• In others the disease may result in a
residual defect, leaving the person
disabled for a short or longer duration.
 We l e a d

• Still, other diseases will end in death.

• Disability is limitation of a person's
activities including his role as a parent,
wage earner, etc
 We l e a d

Examples:
• Trachoma may cause blindness
• Meningitis may result in blindness or
deafness. Meningitis may also result in
death.
 We l e a d

A schematic diagram of the natural history of diseases and

their expected outcomes
 We l e a d

Levels of Disease Prevention

• The major purpose in investigating the epidemiology of
diseases is to learn how to prevent and control them.
• Disease prevention means to interrupt or slow the
progression of disease.
• Epidemiology plays a central role in disease prevention
by identifying those modifiable causes.
 We l e a d

• There are three levels of prevention

1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
 We l e a d

Primary prevention
• The main objectives of primary prevention are promoting
health, preventing exposure and preventing disease.
• Primary prevention keeps the disease process from
becoming established by eliminating causes of disease
or increasing resistance to disease.
• Primary prevention has 3 components.
• These are health promotion, prevention of exposure, and
prevention of disease
 We l e a d

• A. Health promotion:- consists of general

non-specific interventions that enhance
health and the body's ability to resist
disease.
• Improvement of socioeconomic status,
provision of adequate food, housing,
clothing, and education are examples of
health promotion
 We l e a d

• B. Prevention of exposure:- is the

avoidance of factors which may cause
disease if an individual is exposed to them
• Examples can be provision of safe and
adequate water, proper excreta disposal,
and vector control.
 We l e a d

• C. Prevention of disease:- is the prevention of disease

development after the individual has become exposed to
the disease causing factors.
• Immunization is an example of prevention of
disease.Immunization acts after exposure has taken
place.
• Immunization does not prevent an infectious organism
from invading the immunized host, but does prevent it
from establishing an infection. If we take measles
vaccine, it will not prevent the virus from entering to the
body but it prevents the development of
infection/disease.
 We l e a d

Secondary prevention
• The objective of secondary prevention is to stop or slow
the progression of disease so as to prevent or limit
permanent damage.
• Secondary prevention can be achieved through
detecting people who already have the disease as early
as possible and treat them.
• It is carried out before the person is permanently
damaged
 We l e a d

• Examples:
• Prevention of blindness from Trachoma
• Early detection and treatment of breast
cancer to prevent its progression to the
invasive stage, which is the severe form of
the disease.
 We l e a d

Tertiary prevention
• Is targeted towards people with permanent
damage or disability.
• Tertiary prevention is needed in some
diseases because primary and secondary
preventions have failed, and in others
because primary and secondary
prevention are not effective.
 We l e a d

It has two objectives:

1. Treatment to prevent further disability or
death
2. To limit the physical, psychological, social,
and financial impact of disability, thereby
improving the quality of life. This can be done
through rehabilitation, which is the retraining
of the remaining functions for maximal
effectiveness.
 We l e a d

• Example: When a person becomes blind

due to vitamin A deficiency, tertiary
prevention (rehabilitation) can help the
blind or partly blind person learn to do
gainful work and be economically self
supporting.
We l e a d
 We l e a d

Terima Kasih