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Uses of epidemiology . Presenter : Ranjana Moderator : Dr Abhishek. Framework . History of epidemiology Definition Uses of epidemiology with examples . Definition of epidemiology.

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uses of epidemiology

Uses of epidemiology

Presenter : Ranjana

Moderator : Dr Abhishek

framework
Framework
  • History of epidemiology
  • Definition
  • Uses of epidemiology with examples
definition of epidemiology
Definition of epidemiology

Epidemiology is the study of the distribution and determinants of health-related events or states in population groups and the application of this study to the control of health problems

(Last JM ed. Dictionary of Epidemiology, Oxford University Press, 1995)

slide4

'Epidemiology is that field of medical science which is concerned with the relationship of various factors and conditions which determine the frequencies and distributions of an infectious process, a disease, or a physiologic state in a human community' (Lilienfeld 1978).

comparing the job of a clinician and the job of an epidemiologist
The clinician

Deals with patients

Takes a history

Conducts a physical

Makes a diagnosis

Proposes a treatment

Follows up the patient

The epidemiologist

Deals with populations

Frames the question

Investigates

Draws conclusions

Gives recommendations

Evaluates programmes

Comparing the job of a clinician and the job of an epidemiologist
uses of epidemiology1
Uses of epidemiology
  • Examine causation
  • Study natural history
  • Description of the health status of population
  • Determine the relative importance of causes of illness, disability and death
  • Evaluation of interventions
  • Identify risk factors
1 examine causation
1. Examine causation

Genetic factors

Good health

Ill health

Environmental factors

(Biological, chemical, physical, psychological factors)

Life style

related factors

to study historical rise and fall of disease in the population
To study historical rise and fall of disease in the population
  • The diseases wax and wane (tuberculosis ) new ones appear (encephalitis, lethargica,asbestos poisoning ,LSD psychosis) old ones are eradicated (smallpox) or just fade away (chlorosis-greenish yellow discoloration of skin-female adolescent caused by IDA,miner’s nystagmus).
a pertussis by 5 year age groups b pertussis by 1 4 year then 5 year age groups
A Pertussis by 5-Year Age Groups B. Pertussis by <1, 4-Year, Then 5-YearAge Groups
attack rate of acute hepatitis by zone of residence baripada orissa india 2004

Underground water supply

Pump from river bed

Place

Attack rate of acute hepatitis by zone of residence, Baripada, Orissa, India, 2004

Attack rate

0 - 0.9 / 1000

1 - 9.9 / 1000

10 -19.9 / 1000

20+ / 1000

Chipat river

common source interrupted exposure
Common Source, interrupted exposure :
  • A common source, but the source introduces the infection into the vehicle only interruptedly.
  • Pseudomonas aeroginosa infection in urological ward
  • A curve will show an increase in frequency but the curve will be almost flat with occasional irregular waves coinciding with the periodic introductions of infection.
seasonal fluctuations
Seasonal fluctuations :
  • Malaria and JE are commoner during immediate post monsoon season.
  • Asthma shows highest incidence during spring and autumn suggesting specific environmental factors in its causation
searching for causes and risk factors
Searching for causes and risk factors
  • Theories in Primitive and Middle Ages
  • “supernatural causes”e.g. being possessed by evil spirits, wrath of gods, punishment for evil deeds during previous births and so on). “bad air”
  • contagion theory
  • William Farr -“miasma” theory
  • Germ Theory -Henle-Koch postulates)
  • Epidemiological Wheel Theory
  • The Theory of “Necessary” and Sufficient” cause
role of the host the agent and the environment in the occurrence of disease
Role of the host, the agent and the environment in the occurrence of disease

Biologic, Chemical,

Physical (injury, trauma)

Social Psychological

AGENT

VECTOR

Sanitation

Weather

Pollution

Socio-Cultural

Political

Genotype

Nutrition

Immunity

Behaviour

ENVIRONMENT

HOST

syndrome identification
Syndrome identification
  • Epidemiologists are called “lumpers and splitters”
  • The differentiation of hepatitis A from hepatitis B and the distinction between several varieties of childhood leukemia.
  • “lumping” include the identification of many manifestations of tuberculosis.
  • Patterson-kelly syndrome of association between dysphagia and iron deficiency anaemia but when association was tested by epidemiological studies , it was not found.
measures of disease frequency
Measures of disease frequency
  • Prevalence
    • Number of cases of a disease in a defined population at specified point of time
  • Incidence
    • Number of new cases, episodes or events occurring over a defined period of time
incidence rate
Incidence rate

Number of people who get

the disease or condition

in a specified time

I =

X Factor

Total population at risk

prevalence
Prevalence

Number of people with

the disease or condition

at a specified time

P =

X Factor

Total population at risk

slide32
Identify those sections of the population which have the greatest risk from specific causes of ill health

Factors associated with anemia among pregnant women, Orissa, 2004

community diagnosis
Community diagnosis :
  • The definition of indicators is a pre-requisite Indicators - to estimate the burden of illness and the strategies for control.
  • The main health indicators are expressed in terms of crude age-adjusted or age-specific mortality rates (such as infant mortality rates, mortality for children under 5, or maternal mortality rates), disease-specific morbidity rates, and life expectancy at birth.
3 study natural history
3. Study natural history

Death

Sub-clinical disease

Clinical disease

Good health

Recovery

4 evaluation of interventions
4. Evaluation of interventions

Treatment, Medical care

Good Health

Ill Health

Health promotion

Preventive measures

Public health services

planning
Planning
  • Health service administrators should not only always think of these simple routine questions, but should be alert to less obvious potential gaps in coverage.
  • For example, the census will state the numbers of elderly persons who live alone. Is all or only a small portion of these known to the public health nurses and others who provide home surveillance and care?
  • Are all needed services available, accessible, and used appropriately?
evaluation
Evaluation
  • Evaluation is the process of determining, as systematically and objectively as possible, the relevance, effectiveness, efficiency, and impact of activities with respect to established goals.
slide39

Effectivenessrefers to the ability of a program to produce the intended or expected results in the field; effectiveness differs from efficacy, which is the ability to produce results under ideal conditions.

  • Efficiency refers to the ability of the program to r produce the intended results with a minimum expenditure of time and resources.
prevalence of anemia among adolescent girls mandla mp india 2005
Prevalence of anemia among adolescent girls, Mandla, MP, India 2005

Description of the health status of population

estimated and projected proportion of deaths due to non communicable diseases india 1990 2010

Cumulated bar chart for the breakdown of many totals in proportions

Estimated and projected proportion of deaths due to non-communicable diseases, India, 1990-2010

100%

90%

80%

Injuries

70%

60%

Communicable

Proportion (%)

50%

diseases

40%

Non communicable

30%

diseases

20%

10%

0%

1990

2000

2010

Year