INTRODUCTION OF EPIDEMIOLOGY

P. Lutfi Ghazali

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DEFINITION OF EPIDEMIOLOGY
the study of how disease is distributed in populations and of the factors that influence or determine this distribution. 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. the science of occurrence of diseases in human population. the study of the distribution and determinant of diseases and injuries in human populations

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Objectives of Epidemiology

to identify the etiology or the cause of a disease and risk factors[1] to determine the extent of disease found in the community. to study the natural history and prognosis of disease. to evaluate new preventive and therapeutic measures and new modes of health care delivery. to provide the foundation for developing public policy and regulatory decisions relating in environmental problems. [1] is factors that increase a persons risk for disease

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Measurement of Morbidity and Mortality

Rates are defined as follows :
Number of events in a specified period ------------------------------------------------------------------------------ x k Population at risk of these events in a specified period

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Measurement of
A ratio expresses the relationship between two numbers in the form :
X --- x k Y

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Measurement of
A proportion is a specific type of ratio in which the numerator is include in the denominator, and the resultant value is expressed as a percentage :
X -------- x k X+Y

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Measurement of
Incidence rates measure the probability that
healthy people will develop a disease during a specified period of time or the number of new cases of a disease in a population over a period time

Number of new cases of a disease ------------------------------------------------- over a period of time Population at risk

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Measurement of
Prevalence rate measures the number of
people in a population who have the disease at a given time.

Number of existing cases of a disease ------------------------------------------------------ at a point of time Total Population

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Natural History of Disease

Preclinical Phase Clinical Phase outcome

Biological onset of disease

Symptom

Diagnosis

Therapy

Detectable by screening

Lead Time

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Stage of Suspectibility Stage of Pre-clinical Disease Stage of Clinical Disease Stage of Disability

Disease not yet developed Presence of risk factors

No disease manifestation Progression under clinical horizon (no detectable signs and symptoms) Recognizable signs and symptoms Divided based on morphological alteration, functional limitation or objective assesment .

Outcome of disease : death disease controlled with disability disease controlled without disability recover

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PREVENTION Definition

The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering, and distress. These goals are embodied in the word prevention, which is easiest to define in the context of levels, customarily called primary, secondary and tertiary.

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the protection of health by personal and community-wide effect.

Primary Prevention

e.g. preserving good nutritional status, physical fitness, emotional wellbeing, immunizing against infectious diseases, and making environment safe. Aims : altering suspectibility and reducing

exposure

Strategy : 1. General health promotions 2. Specific protective measures

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the measures available to individuals and populations for early detection and prompt and effective intervention to correct departures from good health
Aims : cure disease, slow the progression,

Secondary Prevention

prevent complication, cut off the chain of transmission

Strategy : 1. Early detection of disease (screening) 2. Prompt treatment of disease

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the measures available to reduce or eliminate long term impairments and disabilities, minimize suffering caused by existing departures from good health, and to promote the patients adjusment to irremediable conditions
Aims : alleviation of disability and restoration of

Tertiary Prevention

effective functioning

Strategy : 1. Limitation of disability 2. Rehabilitation

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Natural History of Disease

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