By Adelyna Gatchalian

EPIDEMIOLOGY
The study of the occurrence and distribution of disease in the community, population, including determinants of factors The backbone of the prevention of the disease Studying the etiology and distribution of disease and conditions in humans should positively confirm the health of the populations. The data obtained and analyzed in EPIDEMIOLOGY is used to rank the level of health a given population in relation to another segment at an identified time.

TWO MAIN AREAS OF INVESTIGATION

1. Study of the distribution of disease 2. Search for the determinants (cause) of the disease and its distribution area of epidemiological investigation. The first area is the Distribution of health status in terms of age, gender, race, geography, time, etc. or might be an expansion of the discipline of DEMOGRAPHY to health and diseases. The second area is the explanation of patterns of disease distribution interms of causative factors.

USES OF EPIDEMIOLOGY
1. Study the history of the health population and the rise and fall of diseases and changes in their character. 2. Diagnose the health of the community and the condition of people to measure the distribution and dimension of illness in terms of incidence, prevalence, disability, mortality, needing special attention. 3. Study the work services for improvement 4. Estimate the risk of disease, accident, defects and the chances of avoiding them 5. Identify syndromes by describing the distribution and association of clinical phenomena in the population 6. Complete the clinical picture of chronic illness and distribution of their natural history 7. Search for the causes of health and disease- compare the experience of groups clearly defined by their composition, inheritance, experience, behavior and improvements

STATISTICAL MEASURES IN EPIDEMIOLOGY

1. 3. 5. 7. RATE MORBIDITY CRUDE PREVALENCE 2. 4. 6. 8. RATIO MORTALITY INCIDENCE SPECIFIC RATE

THE EPIDEMIOLOGICAL TRIANGLE

HOST
AGENT ENVIRONMENT

AGENT- Intrinsic factor of microorganism to survive in the environment to produce disease HOST- The state of the host at any given time is the result of the interaction of genetic endowment with the environment over the entire lifespan ENVIRONMENT- The sum total of all external condition and influences that affects the development of an organism which can be biological, social and physical; affects both agents and host.

PATTERN OF OCCURRENCE OF DISEASE OR FREQUENCY OR N0. OF CASES 1. SPORADIC (ISOLATED CASE) - on and off occurrence of disease, occurrence of one or several
unrelated cases(different sources) of disease in the community 2. ENDEMIC- cases of the disease are persistently/constantly present in the community 3. EPIDEMIC- an unexpected increase in the number of cases of a disease in the country. *DOH is the only one that can declare the presence of epidemic by the National Epidemiology center

4. PANDEMIC- epidemic of worldwide or continental proportion of the same disease in several countries. It is another pattern of occurrence from international perspective * PANDEMIC is declared by WHO

TIME-RELATED PATTERNS OF OCCURRENCE 1) Short time fluctuation of an epidemic 2) Cyclical variations- Recurrent fluctuations of disease that may exhibit cycles lasting for certain
period. Ex. Seasonal disease like Dengue fever- 3 cyclical patterns-2008 increase incidence of dengue expected to increase incidence by 2011 then by 2013 expect an increase in the incidence of dengue again. 3) Secular variations- change in disease frequency over a period of many years. (ex. Poliomyelitis decrease now, in frequency... In the Philippines, it has been declared polio-free in the year 2000 and expected to be eradicated by year 2005.) Epidemic is the most interesting and meaningful of the occurrence of disease as it demands immediate effective action which includes epidemiological investigation- emergency epidemiology as well as control. (NOTE: Recall knowledge on THE EPIDEMIOLOGIC TRIANGLE) BRANCHES OF EPIDEMIOLOGY 1. DESCRIPTIVE EPIDEMIOLOGY- concerned with disease frequency and distribution. Eg: a) DOH declared an epidemic in Laguna in 2008- Dengue fever b) N0. 1 cause of death is heart disease make a study on the correlation in the diet and heart disease 2. 2. ANALYTICAL EPIDEMIOLOGY- Analysis of the causes or determinants of disease (this can be used for Community Evaluation) 3. INTERVENTION/EXPERIMENTAL study of effectiveness of new methods of prevention/ treatment of disease. Eg: Effectiveness of garlic in hypertension a) Descriptive and Analytical Epidemiology are used in within Community diagnosis/community assessment b) Intervention and Evaluation Epidemiology are best approach in Evaluation of Nursing actions 4. EVALUATION EPIDEMIOLOGY measurement of the effectiveness of study of the different diseases HERD IMMUNITY, General level of immunity of a Population against a particular disease. Eg: SARS

EPIDMIOLOGICAL INVESTIGATION- is to identify the source /delineate etiology of an epidemic (this is done
if there is an epidemic)

STEPS
1. ESTABLISH THE FACT OF THE PRESENCE OF EPIDEMIC present number of cases compare to the usual no. of cases in the past at this time of the year. If less than then we can conclude. (proving that there is NO epidemic) However, if there are more cases, refer to the DOH to know if your data is valid; if data is valid then the DOH can declare hot spot- surveillance. 2. APPRAISAL OF FACTS- describing the epidemic according to: person- ex, age, sex, occupation, etc.. distribution: place-can help make conclusion and spot map should be included to be able to see geographical distribution pattern time, onset of the epidemicwas there sudden onset?

TYPES OF EPIDEMIC ACCORDING TO ONSET A. Point/common source of epidemic- common vehicle, sudden onset - ex. Food poisoning after eating
spaghetti in the party B. Propagated epidemica. Person-to-person propagated- person contact needed, slow onset. (Eg. SARS b) Vector propagate- vector population site is the single important factor in determining no. of cases. (Eg: Dengue); Strategy used here is ERADICATION OF VECTORS. (Eg. of vector: Anopheles slow moving water in mountain streams. From 9am to 3pm, breeds in shaded water strategy used here is STREAM CLEARING DOH can put an area in quarantine if the area has 0% HERD IMMUNITY. Polio

infant eradication year 2000. Last casual polio in the PHIL. 1943 Small pox 0% (worldwide) 1980 Phil. Has no more case of Small pox Somalia 1983 3. FORMULATING THE HYPOTHESIS Making an educated guess resources of epidemic Relation of cases to age, group, sex, color, occupation, school attendance, past immunization Relation of sanitary facilities, environmental health and sanitation Relation to milk and food supply and food sanitation Relation of animal or insect vectors Relation f cases and known carriers if any 4. TESTING THE HYPOTHESIS Performing diagnostic test to determine actual source. (Eg: Food poisoning- culture food sample, examine food handlers- Its a proof that it came from specific source; Drinking water- COLIFORM test. Coliform is a normal bacteria of human colon. In PHC the use of this coliform test is to know or detect the presence of Coliform in the water, this is an indicator for water potability) COLIFORM TEST 70% ethyl alcohol to be mixed in the water. This should not be exposed to sunlight. 3 days after the color of the water turns to black and this will indicate (+) result for Coliform. 5. CONCLUSSION AND RECOMMENDATION Document findings Recommendation NATIONAL EPIDEMIC SENTINEL SURVEILLANCE SYSTEM (NESSS) A Hospital-based information system to provide the DOH supplemental information on occurrence of diseases with outbreak potential. Early warning system for outbreak of: polio, measles, HIV/AIDS, diptheria, hepatitis A, B, rabies, Dengue, malaria, leptospirosis, paralysis, shellfish poisoning- red tide, forceable firecracker Injuries during new year, etc. FUNCTIONS OF THE EPIDEMIOLOGY NURSE 1. Implement public health surveillance 2. Monitor local health personnel conducting disease surveillance 3. Assist in the conduct of rapid surveillance during disasters. 4. Assist in the conduct of surveys, programs evaluations, and other epidemiologic studies 5. Conduct and assist other health personnel in outbreak investigation 6. Assist in the training course of epidemiology 7. Assist in the epidemiologist in preparing the annual report and financial plan 8. Responsible for inventory and maintenance of epidemiology and surveillance unit (ESU) equipment COMMUNITY DIAGNOSIS- It is the identification of health needs and problems of the community. Types of Data according to Source 1. Primary or First hand information data collected by the investigator himself/herself. a) Census b) Survey/sample c) Experiment CENSUS Data gathering about 100% of the population, an official and periodic enumeration; Gather information from the whole population. Conducted by middle of the year (starts in May and ends in August) Mid year population census; Usually conducted every 10 years but depending on the Presidents command. Done by the NSO (National Statistics Office) unit- Local civil Registrar WAYS OF ASSISTING PEOPLE IN THE CENSUS 1. De Jure- place of usual residence, use by the NSO 2. De Facto- actual physical location at the time of the census Survey /Sample Survey - collecting data about a sample of the population

-use of sampling techniques depending on the type of community diagnosis TYPES OF COMMUNITY DIAGNOSIS 1. Comprehensive data gathered from all source of factors that may be affected. 2. Random/ Convenience sampling 3. Problem-oriented done after the comprehensive diagnosis because we need the data from previous survey. (Eg:. Nutritional survey, we do purposeful sampling (detecting families who are susceptible) (Continuation TYPES OF DATA) 2. SECONDARY DATA- data collected by somebody else, which the investigator is using for his own purpose. a. Registry of Vital events b. Records and reports c. Publications d. informal source- this ia according to the person who gave you an information TYPES OF GRAPH 1. LINE or Curve graphs Trends over time and age. Shows peaks, valleys.and seasonal trends of birth and death rates over a period of time. 2. BAR comparison of values; each represents or expresses quantity in terms of rates or % of a particular observation like causes of illness and death. 3. AREA DIAGRAM /COMPONENT BAR GRAPH/(Pie graph) important part to the whole 4. SCATTER DIAGRAM CORRELATION OF 2 VARIABLES (X and Y)

DEMOGRAPHY- study of a population

DEMOGRAPHIC DATA 1. Population size and population growth rate depends on population census 2. Population composition 3. Population distribution MEASURING POPULATION GROWTH I. Rate of natural increase: -Crude Birth Rate Crude Death Rate II. Population Composition A. Age Composition median age- is the age that divides a population into 2 equal parts, a younger half and an older half III. Sex composition ex. Male proportion=n0.of males/total population x 100 Sex Ratio = n0. of males/n0.of females x 100 How many men are there in 100F? = (m:100f) IV. Age and sex composition- population pyramid- its a double bar graph: males at left Females at right V. POPULATION DISTRIBUTION Urban- Rural distribution Population density- no. of people living in a given area

VITAL STATISTICS
STATISTICS- refers to a systematic approach of obtaining organizing and analyzing numerical facts so that
conclusion may be drawn from them. VITAL STATISTICS- refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths. USES OF VITAL STATISTICS 1. Indices of the health and illness status of a community 2. Serves as bases for planning, implementing, monitoring and evaluating community health nursing programs and services. In statistics :

CRUDE means TOTAL N is the numerator (crude) D is the denominator- population susceptible to the event Total population average population mid year, estimated population

 PREVALENCE- percent of the population affected. 100,000- as a factor incidence rate and specific mortality rate. Natality means Birth FERTILITY RATES MWRA- married woman of reproductive age- 15-49 y.o MCRA married couple of reproductive age Rate shows the relationship between a vital event and those persons exposed to the occurrence of said event, within a given area and during a specified unit of time.. Ratio is used to describe the relationship between two (2) numerical quantities or measures of events without taking particular considerations to the time and place. Crude Rates- e or General referred to the total living population. It must be presumed that the total population was exposed to the risk of the occurrence of the event. Specific Rate the relationship is for a specific population class or group. It limits the occurrence of the events to the portion of the population definitely exposed to it. CRUDE BIRTH RATE a measure of one characteristic of the natural growth or increase of a population.

REGISTRY OF VITAL STATISTICS

NSO R.A. 3753- Civil Registry Law 3 Types a) Birth b) Marriage c) Death

PD 651 Birth Registry Law

1. Cerficate of Livebirth

Signed by the birth attendant must be final within 30 days. Can be done by midwife/mother or anyone present during delivery or knows the circumstances of the
birth. 2. DEATH CERTIFICATE (COLOR BLUE) IUFD / STILL BIRTH only the PHYSICIAN can sign the death certificate (legal authority). IN A DOCTORLESS COMMUNITY, THE MAYOR WILL SIGN IT. PD 856 SAYS THAT THE STILL BIRTH BABY WILL BE BURRIED IN THE CEMETERY. DEFINED AS UNKNOWN CAUSE OF DEATH The death will be included if the Mayor was the one who signed the death certificate. To determine if STILLBIRTH or an ABORTUS, we should see the appearance if it is like a baby, should be buried in the cemetery. Death certificate must be filled up and accomplished within 48 hours from the occurrence of death. MORTALITY RATE is the most accurate data and the best indicator /reflection of health status of a population. How to compute for the following: 1. CRUDE BIRTH RATE NATALITY RATE Total n0. of Livebirth x 1000 Total population 2. How fertile the community is? Reproductive Age = 13-49 y.o ave.menopausal 50 y.o Total n0. of livebirths x 1000 number of female of reproductive age MORBIDITY RATES 1. Prevalence rate ( pre-old and new) (Inc- new /acute) - Include everyone who are sick regardless of time of diagnosis. Total N0. of cases of a Disease x 100

Total population or population examined Total n0. of cases old an new Old cases-diagnosed before the time period. New cases cases diagnosed within the given time. ex. PTB 2010 old case diagnosed bedore 2010 but still positive in 2010 New case- diagnosed in Jan to Dec 2010 2. INCIDENCE RATE-DO NOT include here the old cases. N0. of New cases of a disease total population X100,000 Population at risk of developing the disease *Prevalance incidence, unless the disease is acute where the total no. of cases may be equal to the no. of new cases. *for Chronic Disease, the difference between prevalance and incidence may reflect the effectiveness of management. * Community Diagnosis is use for the basis of planning. ex. PTB- 15 old cases (failure) AIDS- 15 old cases (survivor) Difference PTB and AIDS-( curable or not) 3. ATTACK RATE- a more accurate measure of the risk exposure. - use during epidemic - use in epidemiologic investigation No. of persons acquiring a disease during a specific period x100 N0. expected to same disease in the period MORTALITY RATE 1. CRUDE DEATH RAT - Not to compare population - useful when considered as a series in a trend TOTAL N0.of deaths x 1000 Total population *If total death rate is decrease= good health 3. CRUDE- SPECIFIC DEATH RATE N0.of Deaths fromSpecific cause x 100,000 Total population * Basis for leading cause of death 3. AGE- SPECIFIC DEATH RATE N0. of death in an age group x 100,000 population aged 1-4 y.o * Nutritional and immunization status of the population.

-multiplication factor: ex. 1-2 per 100,000 aged 1-4 y.o died *Attack, Swaroops, Prevalence x 100 4. Proportionate Mortality rate x 100 Total n0. of deaths Ex. Teacher proportionate mortality rate Cancer proportionate mortality rate Infant proportionate mortality rate

5. SWAROOPS RATES
N0. of Deaths age > 50 y.o x 100 Total no. of Deaths *The most sensitive indicator of health status of a population ( the most accurate) -100% Swarops index ( all who died are 50 y,o and above. 6. Case fatality rate - To know if the disease is Fatal - reflects the killing power of a disease N0. of Deaths from a specific disease x 100 No. of Cases of the disease ex. SARS case is 12 death is 2 2 x 100 = 16.6 12 7. MATERNAL MORTALITY RATE -To know from those who are pregnant, how many died due to pregnancyNo. of Deaths due to pregnancy, labor or puerperium (Maternal Deaths) x 1000 Total no. of livebirths (n0. of women who got pregnant) *NOTE- no. of IUFD (still birth) may be added to the denominator

8. INFANT MORTALITY RATE ( Death in the First year) - No. 2 best indicator of health status of a population - The lesser the healthier No. of Deaths aged 0-11 mons (or 0-1 yr) x 1000 Total No. of Livebirths (n0. of infants) Note: DO NOT add stillbirth Neonatal Mortality rate - age is 0- 28 days (Death in first month) No. of Deaths aged 0-28 days x 1000 Total n0. of Liveborths

9. EARLY NEONATAL (hobdomadol) mortality rate ( death in the first week) 0-7 days old No. deaths aged 0-7 days x 1000 Total n0. of Liveboirths 10. PERINATAL MORTALITY RATE No. of Deaths aged 0-28 days + no. of IUFDs (stillbirths) x 1000 Total No. of Livebirths + No. of IUFDs (Stillbirth) Ex. Neonatal death = 5 IUFD=3 livebirth= 145 =5+3 x 1000 = 8 x 1000 = 8,000= 54.05 145+3 148 148