SPH –II

MEASURMENT OF HEALTH AND DISEASE (MHD)

Part –II

Debre Tabor University

College of Health Sciences
School of Public Health (SPH)
Department of Epidemiology and Biostatistics

Getaneh Atikilt (BSc-PH, MPH, Assistant professor of

Epidemiology)
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 COURSE CONTENTS
MHD Part –I
• Data Handling

• Probability and probability distributions

• Sampling and sampling distributions

• Sample size determination

• Statistical inference
Estimation
Hypothesis testing 2
 COURSE CONTENTS
MHD Part-II
• Introduction to Public health
• Epidemiological concepts of disease causation
• Natural history of disease and level of prevention
• Measuring disease frequency and occurrence
• Measures of morbidity, disability and mortality
• Epidemiological study designs
• Screening
• Measure of association
• Outbreak investigation and management
• Public health surveillance

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CHAPTER ONE

I. Introduction to public health

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 Introduction#1
HEALTH
 Earlier definition (leman perspective ):
• The absence of disease

 WHO (1948):
• A state of complete social, physical and mental well
being and not merely the absence of disease or
infirmity.

 Mahler (1981):
• WHO’s definition + the ability to lead a socially
acceptable and economically productive life
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 Introduction #2

• Illness- a subjective state of the person who feels

aware of not being well

• Sickness- is a state of social dysfunction that is a role

that the individual assumes when ill

• Disease- is a physiological/psychological dysfunction

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 Introduction #3
Community Health

also termed as
• community medicine, public health, social health and
preventive medicine
is the science and art of
• promoting health,
• preventing disease and
• restoring and maintaining health through organized
community effort 7
 Introduction #4

Knowledge about human health and disease is the sum

of the contributions of a large number of disciplines
mainly

•Biomedical Sciences
•Clinical Science
•Public Health

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 Introduction #5
Community medicine-

 is a system of delivery of comprehensive health

care to the people by a health team to improve the
health of a community

 It embraces the preventive and social medicine

along with curative and promotive health services

• Community- refers to a group of people who share some thing in

common.
E.g neighborhood, work place, race, religion or social activity.
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 Introduction #6

Social medicine – is a study of man as social being in

relation to his environment.
othe study of community health with respect of social aspects
(social, economical, cultural, psychological, environmental and
genetic factors) in the community as a whole.

 Preventive medicine- deals with the measures to protect the

individuals from the diseases, and to keep them in a state of
positive health.
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Introduction #7

Clinical medicine-
 medical care of individuals.
 Typically these are sick people who have
presented for help.

 In community medicine- the community replaces

the individual patients as the primary focus of
concern

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Introduction #8

Clinical Medicine Community medicine

Focus Individuals Populations

Main Patient diagnosis Community diagnosis

questions

Methods Taking history, Epidemiologic studies

physical examination,
investigations

Interventions Treatment Prevention and

Control
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 Introduction #9

Community diagnosis-
is the process of identification and detailed description of the
most important problems of a given community.

It may be broad or narrow in scope, and may deal with only a
single topic or a single sub group.

The task of community diagnosis requires statistical knowledge

in addition to medical skills

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 Introduction #10

• Some of the ways a health worker could make

community diagnosis are:

1. Discussion with community leaders and health

workers-community felt health problems

2. Attending community gatherings-community felt

health problems

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Introduction #11

3. Survey of available health records

4. Field survey

5 Analysis of collected data and compilation of

report in order to reach at community diagnosis

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 Introduction #12

• Community diagnosis provides basis for decision on:

• The need for intervention
• Type of intervention needed
• Target group at whom intervention should be directed
• Provide baseline for later intervention

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 Introduction ##

Reading Assignment

$$ Core functions of public health

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II. EPIDEMIOLOGY

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The History of Epidemiology #1

• Environment affects health status

• Hippocrates – 2000 years ago
• Formal beginning of epidemiology – 19th century
• Study designs
• J. Lind/Scurvy,
• J. Snow/Cholera(1850s)

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The History of Epidemiology #

• The Emergence of modern epidemiology – 20th

century
• B. Hill – causation
• Framingham heart study
• Field polio vaccine trial

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 Definition of Epidemiology#1

Is a science which studies the

• Frequency

•Distribution

•Determinants
oof health and health related events in populations,
and

•The application of this knowledge for the promotion of

health, prevention and control of diseases.
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 Definition of Epidemiology#12
 Key words in the definition are:
1. Distribution
• who? Where? And when? Of occurrence of health and
health related events
2. Frequency
• Epidemiology is a quantitative science;
• morbidity rates measure the frequency of disease ,
• mortality rates quantify the occurrence of death.

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Definition of Epidemiology#3

3. Determinants
• Factor which may be event, characteristic or any
definable entity that brings about change in health
and health related conditions.
• It refers to “why diseases occur in certain places?
In a certain period? Or in a certain population
groups?”

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 Definition of Epidemiology#4
4. Health and health related events =>
 It is easier to define and measure disease, disability and death
than to produce operational definition of health.

 include (Scope of epidemiology):

• Acute and chronic diseases
• Events such as injuries
• Conditions such as disabilities
• Behaviors
• Genetic characteristics
• Etc.
 Epidemiology is concerned not only with disease but events like
birth, death, migration e.t.c.
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Definition of Epidemiology#5

5. Human population =>

• Epidemiology studies the health of groups,
communities, and whole population.
6. Application-
• Epidemiology is an applied science.
• The ultimate purpose of all epidemiological studies
is the prevention and control of health problems.

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Epidemiologic Approaches#1

• activities/steps/branches Descriptive
1. Observe and count cases Epidemiology
2. Describe cases by
• Time, place, person
3. Compare rates and develop hypothesis
• Regarding causal factors

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Epidemiologic Approaches#2

4. Test hypothesis regarding causal factors – Analytic

epidemiology
5. Assess performance of interventions –
Experimental epidemiology
6. Implement actions (control, prevention) –
Applications
7. Evaluate interventions/programs – Evaluative
Epidemiology

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 Uses of Epidemiology#1
• Determining the frequency and distribution
• For planning of health care, allocation of
resources
E.g. - plotting malaria cases by month

Figure: monthly number of malaria cases

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 Uses of Epidemiology#2
• Identifying the causal factors including agents, risk
factors and modes of transmission
• For designing and selecting appropriate
interventions

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 Uses of Epidemiology #3
• Assess performance of interventions
• For adopting best interventions

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 Uses of Epidemiology#4
• Evaluate prevention and control programs
• For adopting best programs

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Assumptions in Epidemiology#1

•Diseases (or other health events) do not occur at

random

•Diseases (or other health events) have causal and

preventive factors that can be identified

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 FIELDS OF EPIDEMIOLOGY#1
• Infectious diseases epidemiology
• Non infectious diseases like nutritional deficiency, mental
disorders( e.g. addiction, crime, suicide),
hypertension ,cancer, accidents, congenital anomalies and
degenerative diseases
• Occupational epidemiology
• Environmental epidemiology
• Reproductive epidemiology

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FIELDS OF EPIDEMIOLOGY#2

- Microbial epidemiology

- Descriptive epidemiology

- Risk factor epidemiology

- Clinical epidemiology- natural history of diseases, diagnostic

& screening, therapy

- Molecular, genetic, etc.

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## ??

Reading Assignment
#1 Core functions of Epidemiology
#2 How Epidemiology related with pharmacy speciality

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Thank you!!!

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