Epidemiological Investigations

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Unit 1

Epidemiological Investigation
Learning Objectives

By the end of this Unit you should be able to:

define epidemiology and surveillance

define and describe the purpose of analytic

and descriptive studies

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Epidemiology
the study of the distribution and
determinants of heath-related states or
events (including disease) in specific
populations, and the application of
this study to the control of health
problems

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Epidemiological Investigations
A number of distinct purposes
Approach not merely individuals but group of persons or
whole population
Purposes:
1. Distribution
Where it occurs (place)
Surveillance
When it occurs (time)
Descriptive
Who are affected (person)
Analytical study
2. Determinants /causes/risk factors
3. Application to control/prevention
Operational study
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Surveillance

Descriptive studies

Include activities to
monitor the speed
of spread of
infectious diseases

Involve activities related

to characterizing the
distribution of diseases
within a population

Analytical studies
Concerns activities related to identifying possible
causes for the occurrence of disease

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Surveillance
to watch over
Steps:
Systematic collection
Orderly consolidation
Analysis of data
Information
Application of
information

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Purpose of Surveillance

Identification of emerging health problems

Identification of affected individuals
Continued watchfulness over disease in
the population

Types of Surveillance

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Active
Passive
Sentinel health events
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Uses of Surveillance

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Trends over time

Spatial difference
Occurrence
(sporadic/endemic/epidemic)
Set goals for intervention
Verify whether health targets are
reached

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Descriptive studies
First phase of investigation
Time/space/person dimensions
Uses:
Burden (prevalence/mortality/morbidity)
Allocate resources
Hypothesis generation

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Types of Descriptive studies

1.
2.

3.

Case reports
Case series
Ecological studies

Socio-economic, behavioral and

medical characteristics
Case frequencies

Compare disease frequencies

between groups
Compare in the same group
at different time points

Group 1

Group2

Time 1 Time 2
4.

Cross sectional studies case

findings
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Analytical studies
Purpose:

To test hypothesis related to risk factor and

outcome

Magnitude of the association effect (attributable

risk)

Comparing outcome and exposure

Types:

1.

Observational (no human intervention natural)

2.

Case control
Cohort studies

Experimental (clinical trials human intervention)

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Case Control study

Disease

Exposure ?

Exposure ?

No disease

Retrospective nature
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A case control study to assess

familial clustering filarial cases
Time
On set of study

Affected

Relatives
of cases

Not affected

Affected

Relatives
of
control

Not affected
Direction of inquiry
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Cohort study

exposed
exposed

not exposed
not
exposed

Followup period

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Cohort study
Incidence among
exposed

exposed

Incidence among
non-exposed

not
exposed

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A cohort study to assess familial

clustering filarial cases
Time
On set of study

Disease
Relatives
of cases
No Disease

Eligible
subjects

Relatives
of
control

Disease

No Disease

Direction of inquiry
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Differences
Case control

Outcome to exposure
Retrospective
Cheap and quick
Techniques crude
For infrequent or rare
diseases, may be the only
practical approach
Studies are short lived
Neither incidence or
prevalence can be
calculated

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Cohort

Exposure to outcome
Prospective
Expensive & time
consuming
Techniques refined
Very large cohorts are
required and not to be
practical
Studies are long lived
Yields incidence rate

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The cohort study is the gold

standard of analytical
epidemiology
Case control studies too have their
place in epidemiology but if cohort
study is possible and situation permits
to wait, do not prefer case control
which is only next to cohort

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Experimental

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Experimental studies
Purposes:
1. To confirm an etiological hypothesis
2. To evaluate or assess the effectiveness
of therapeutic or preventive measures
before applying them to the community

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Types of experimental studies

1. Randomized controlled trials:
Single blind / double blind
2. Non- randomized controlled trials:
Natural experiments (smokers/non-smokers &
cancer)
Before and after comparison

Without control (vaccine)

With control (natural control) (legislation)
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Randomized controlled clinical trial

Experimental
Cure
DEC
Alone

Eligible
subjects

No cure

Randomize

Cure

DEC
plus
ivermectin

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No cure

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