Epidemiology

Francis Mutuku
 History of epidemiology
Hippocrates (460-377 B.C.)
On Airs, Waters, and Places

 Idea that disease might be associated with

physical environment
 Thomas Sydenham (1624-1689)
Recognized as a founder of clinical medicine and
epidemiology
Emphasized detailed observations of patients &
accurate recordkeeping
 James lind (1700’s)
• Designed first experiments to use a concurrently
treated control group
 Edward jenner (1749-1823)
 Pioneered clinical trials for vaccination to control
spread of smallpox
 Jenner's work influenced many others, including
Louis Pasteur who developed vaccines against
rabies and other infectious diseases
 Ignas Semmelweis (1840’s)
Pioneered hand washing to help prevent the
spread of septic infections in mothers following
birth
 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
 History Cont…
Vital Statistics
 John Graunt (1620-1674)
 William Farr (1807-1883)
Occupational medicine
& Industrial Hygiene
 Bernardino Ramazzini (1633-1714)
Role of carriers in transmission
 Typhoid Mary & George Soper
 Cont…
 Mary Mallon, a cook responsible for most famous outbreaks of carrier-
borne disease in medical history
 Recognized as carrier during 1904 N.Y. typhoid fever epidemic
 When source of disease was traced, Mary had disappeared only to
resurface in 1907 when more cases occurred
 Again Mary fled, but authorities led by George Soper, caught her and
had her quarantined on an island
 In 1910 the health department released her on condition that she
never accept employment involving the handling of food
 Four years later, Soper began looking for Mary again when two new
epidemics broke out; Mary had worked as a cook at both places
 She was found and returned to North Brother Island, where she
remained the rest of her life until a paralytic stroke in 1932 led to her
slow death, six years later
Typhoid Mary
 Historic Aspects of the Development of
Morbidity Statistics.
• Edgar Sydenstricker (Early 1900’s)
– Pioneer public health statistician
• Three notable studies:
– Tuskegee syphilis study (1932-1970)
– Framingham heart study (1948-present)
– Epidemiology of cigarette smoking (1950’s -
present)
 Definitions of Epidemiology
Oxford English Dictionary
THE BRANCH OF MEDICAL SCIENCE WHICH TREATS
OF EPIDEMICS
Kuller LH: Am J Epid 1991;134:1051
EPIDEMIOLOGY IS THE STUDY OF "EPIDEMICS" AND
THEIR PREVENTION
Anderson G,quoted in Rothman KJ: Modern
Epidemiology
THE STUDY OF THE OCCURRENCE OF ILLNESS
 Def cont…
Lilienfeld A: in Foundations of Epidemiology

THE STUDY OF THE DISTRIBUTION OF A DISEASE OR A

PHYSIOLOGICAL CONDITION IN HUMAN POPULATIONS
AND OF THE FACTORS THAT INFLUENCE THIS
DISTRIBUTION

Last JM: A Dictionary of Epidemiology

THE STUDY OF THE DISTRIBUTION AND DETERMINANTS

OF HEALTH RELATED STATES AND EVENTS IN
POPULATIONS AND THE APPLICATION OF THIS STUDY TO
CONTROL OF HEALTH PROBLEMS“
 definition
• Epi- on/ upoun
Demos- people
Logos- study of

The study of the distribution and determinants of

health related states or events in specified
populations and the application of this study to
control of health problems.
 Details in the definition
• Study includes; surveillance, observation, hypothesis testing,
analytic research and experiments
• Distribution refers to analysis of times, persons and places
and classes of affected people
• Determinants include factors that influence health; Biological,
chemical, physical, social, cultural, economic and behavioral
• Health-related states and events refer to disease, causes of
death, behaviors such as use of tobacco, positive health
states, reactions to preventive regimens and provision and
use of health services
• Specified populations include those with identifiable
characteristics such as occupational groups
• Application to prevention and control include the aims of
public health i.e. To promote, protect and restore health
USES of epidemiology
 Cont..
Specific objectives:

i. To identify the etiology or the cause of a disease and the

risk factors i.e. factors that increase a person’s risk for a
disease
ii. To determine the extent of disease found in the
community
iii. To study the natural history and prognosis of disease
iv. To evaluate new preventive and therapeutic measures and
new modes of healthcare delivery
v. To provide the foundation for developing public policy and
regulatory decisions relating to environmental problems
 Changing Patterns of Community Problems
A major role of epidemiology is to provide a clue
to changes that take place over time in the health
problems that present in the community e.g.
i. The cemetery in Dudley England 1839
ii. Comparison of major causes of death in the USA
in 1900 and 1990
iii. Life expectancy
 Epidemiology and Prevention
A major goal of epidemiology is to identify subgroups
in the population who are at high risk for disease.

If this group is identified, specific risk factors or

characteristics that put them at high risk will be
identified and modified ,

Preventive efforts will the be directed e.g. screening

programmes for early detection,
 Cont..
Primary prevention:
• Action taken to prevent an individual from
developing disease before exposure to the disease
in question.

i. E.g. Immunization
ii. Prevention of environmental acquired disease e.g.
lung cancer
 Cotn..
Secondary prevention:
• Identification of people who have already developed
a disease at an early stage in the disease’s natural
history through screening and early intervention e.g.
i. Breast cancer in women through self examination
and mammography
ii. Colon cancer – occult blood test
• Rationale: identification of disease in its early stage
of its natural history will enhance intervention
measures hence preventing mortality and
complications and its also less invasive and cost
• Tertiary prevention; To retard or stop further
infection
 Approaches to prevention
Population based
• Widely applied to the entire population
E.g. Advice against smoking
• Relatively inexpensive and non-invasive
• Considered public health approach
High risk
• Targets high risk group
E.g. HIV in married couple
• Expensive, more invasive and inconveniencing
• Require clinical action to identify the high risk group
 Epidemiology and clinical practice
• Epidemiology is critical to clinical practice.
• The practice of medicine is dependent on
population data.
E.g. Apical systolic murmur
• Process of diagnosis and prognosis is population
based
• Selection of appropriate therapy is also population
based
• Therefore the physician applies a population based
probability model to a patient who is lying on the
examination table
 The epidemiologic Approach
The epidemiologic reasoning is a multistep process
Determination of an association between a factor
or a characteristic and development of disease
Derive appropriate inference regarding a possible
relationship from the patterns of association that
have been found
Epidemiology begins with descriptive data
Ensure validity of the data
Then ask The following questions
WHY; WHERE; WHO
 Achievements in Epidemiology
• Small pox elimination
• Methyl mercury poisoning in minamata Japan
• Rheumatic fever and rheumatic heart disease
• Iodine deficiency diseases
• Tobacco use asbestos and lung cancer
• Hip fractures
• HIV AIDS
• SARS
• EBOLA
 Conclusion
Prevention and therapy are mutually exclusive
activities
Prevention is not only integral to public health but
also to clinical practice
Disease treatment has a major component of
prevention
Treatment leads to preventing death, complications,
a constellation of effects on the patients family
Primary, secondary and tertiary prevention to
prevent complications e.g. disability
 Cont..
Prevention should be viewed as integral to both
public health and clinical practice

Epidemiology is an invaluable tool for providing the

rational basis on which effective prevention
programmes can be planned and implemented

And for conducting clinical investigations that

contribute to the control of disease and to
amelioration of the human suffering associated with
it
 Assignment one (5 marks)
Discuss the role of epidemiology is control and
prevention of the following:
1. Ebola---Student xx
2. Severe acute respiratory syndrome (SARS)—
student yy
3. HIV/AIDs --Student xx
4. Tobacco use, asbestos and lung cancer--Student xx
5. Iodine deficiency diseases---Student xx
6. Small pox
7. Rheumatic fever and rheumatic heart disease
THANKS