ALLIED HEALTH SCIENCES Basic Community Health 2012 Batch

Epidemiology
Dr. N Sivarajah Faculty of medicine, University of Jaffna August 23, 2012

Dr. N Sivarajah

CH Nursing 2009

Definition
Epidemiology is 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
- Defined by J M Last in 1988
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Epidemiology was derived from the word Epidemics:

Epi: Upon Demos: People

Something that came upon the people

Dr. N Sivarajah

CH Nursing 2009

Distribution of Diseases
Person
Age, sex , race

Place
Geographic

Time
Seasonal (Dry & Rainy), different months, festivals

Dr. N Sivarajah

CH Nursing 2009

Determinants of Disease
Genetic factors

GOOD HEALTH

ILL HEALTH

Environmental factors
(Including Life style)

Dr. N Sivarajah

CH Nursing 2009

Determinants of Disease
PREVIOUS ILLNESS

FAMILIAL
ENVIRONMENT (soft water)

(Hypertension, Diabetes)

Ischaemic Heart Disease

DIET

BEHAVIOUR (Smoking, Alcohol)

LACK OF PHYSICAL EXERCISE

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CH Nursing 2009

The periodicity of occurrence of a disease is described as

Epidemic Endemic Sporadic Pandemic

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Epidemic
Increased number of cases of illness over and above the normal occurrence Sometimes even a few cases may be an epidemic Example of AIDS

Dr. N Sivarajah

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Dr. N Sivarajah

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 ENDEMIC: is the occurrence of a disease in the community continuously at a relatively low rate SPORADIC: is the occasional or infrequent occurrence of cases or disease PANDEMIC: When the disease occurs in several countries at the same time it is called a pandemic
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Epidemics may be Point source or Contagious

In a POINT SOURCE EPIDEMIC the susceptible persons are exposed more or less at the same time to one source of infection. This will result in a rapid increase in the number of cases. In a CONTAGIOUS EPIDEMIC the disease is passed from person to person and the initial rise in the number of cases is slower
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 Epidemiology is the study of distribution and determinants of disease frequency. Epidemiology mainly focuses on morbidity and mortality in Human populations Morbidity refers to illness Mortality refers to deaths In order to measure and quantify epidemiological data Tools are needed
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Incidence & Prevalence The Difference

INCIDENCE New cases appearing PREVALENCE Cases existing old & new cases at a point of time (Point Prevalence) or period (Period Prevalence) Useful indicator for chronic diseases
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Useful indicator for Acute diseases

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Factors influencing observed Prevalence Rate

Increased by
Longer duration of disease Prolongation of life of patients without cure Increase of new cases (Increase in Incidence) In-migration of cases Out migration of Healthy people In-migration of Susceptible people Improved diagnostic facilities (better Reporting, surveillance)

Decreased by
Shorter duration of disease High Case fatality rate from disease Decrease in new cases (Decreased incidence) In-migration of healthy people Out-migration of cases Improved cure rate of cases

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OTHER TOOLS OF MEASUREMENT

RATES RATIOS PROPORTIONS

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RATE
RATES: measure the occurrence of a disease or event in a specified population at a given period at a specified time period No of Births BIRTH RATE = ----------------------------X1000 Mid year Population The numerator is from the Denominator
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Incidence Rate
Number of persons who start a spell of illnesses = ------------------------------------------------------ X 1000 Population exposed to the risk of getting the illness

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Components of a Rate
Rate comprises of A numerator A denominator Time specification usually one year A multiplier usually expressed as per 1000, 10,000, or 100,000 according to convenience or conventions, to avoid fractions
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RATIOS
Ratio is an expression of a relationship in size between two random quantities.
Eg.

Males : Females is 97.9:100 (in 2001) Doctor:Population: 44.8 : 100,000 (in 2001)
Numerator is not a component of the denominator
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PROPORTIONS
Proportion is a Ratio which indicates the relationship in magnitude of a part of the whole. A Proportion is usually expressed as a Percentage Eg.
Number of children with scabies in a village at a given time x 100 Total number of children in the village at the same time

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Common Rates & Ratios

CRUDE BIRTH RATE CRUDE DEATH RATE INFANT MORTALITY RATE MATERNAL MORTALITY RATE CASE FATALITY RATE (Ratio) SURVIVAL RATE

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CRUDE BIRTH RATE

No of live Births during the year CBR = ------------------------------------------------------X1000 Mid year Population

More specific is Fertility Rate

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GENERAL FERTILITY RATE

This is the number of live births per 1000 women in the Reproductive age group (15-49 years) in a given year

Number of live births in an area during the year X 1000 GFR = ---------------------------------------------------------------------------Mid-year Female population aged 15 49 in the same area

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CRUDE DEATH RATE

Number of deaths during the year CDR = --------------------------------------- X 1000 Mid year population of that year

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Age & Sex specific Death Rates

Number of Deaths in a specific Age / Sex group = -------------------------------------------------------X 1000 Mid-year population in that Age/Sex group

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INFANT MORTALITY RATE

Number of deaths of Infants during the year

IMR = ------------------------------------------------------------X 1000 Number of live births during the year

Note: Infant is a child under one year of Age

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Pregnancy wastage / deaths between conception & one year

All fetuses over 1000 G Or 35 cms. crown to heel Or 28 weeks gestational age

INFANT NEONATE

ABORTION

STILLBIRTH

EARLYNEONATE

LATENEONATE

POST NEONATE

CONCEPTION 28 WEEKS

BIRTH 7 DAYS 28 DAYS PERINATAL PERIOD

1 YEAR

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Maternal Mortality
A maternal death is defined as the death of a women while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy or the management but not from accidental or incidental causes.

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MATERNAL MORTALITY RATE

Number of women dying of *maternal causes* X 10,000 MMR= ------------------------------------------------------------------Number of **Total Births

*Maternal

Causes refer to complications of Pregnancy, abortion, delivery & Puerperium (up to 42 days after delivery)

** Total Births includes live births and Stillbirths

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Point Prevalence Rate

Number of persons sick at a given point of time = ------------------------------------------------------ X 1000 Population exposed to risk

Period Prevalence refers to a specified period

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Case Fatality Rate (Ratio)

Total deaths due to a particular disease CFR = -------------------------------------------------X 100 Total cases due to the same disease Expressed as a Percent. CFR represents the killing power of the disease

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RATES FOR SRI LANKA

CENSUS POPULATION (2001) 18,732,256

CRUDE BIRTH RATE

CRUDE DEATH RATE INFANT MORTALITY RATE

18.9 per 1000 population

5.9 per 1000 Population 12.2 per 1000 live births

MATERNAL MORTALITY RATE 2.3 per 10.000 Live births NEONATAL MORTALITY RATE (1996) 12.9 per 1000 Live births

UNDER 5 MORTALITY RATE (1996)

4.4 per 1000 under 5 children

Source: Census of Population and Housing.2001 Department of Census & statistics. In Annual Health Bulletin. 2002 . pp ix-xii Dr. N Sivarajah Rates AHS CH 33

Individuals and Communities must be shown that disease is maintained through ignorance and folly and that its removal lies completely in their hands
- Sir Robert Philip
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