SEMINAR ON

EPIDEMIOLOGICAL
APPROACHES AND
APPLICATION OF
EPIDEMIOLOGY IN HEALTH CARE
DELIVERY, HEALTH
SURVEILLANCE AND HEALTH
INFORMATICS

SUBMITTED BY:
SUBMITTED TO:
Mr. Hanuman Bishnoi
Tessy

Sister

1st Year M.Sc. Nursing

Coordinator

Class

S.R.M.M., C.O.N.
S.R.M.M., C.O.N.
TOPIC
: Epidemiological approaches and applications of epidemiology
in health care
delivery, health surveillance and health informatics
GROUP

: M.Sc. Nursing 1st year students

AIM:
The group will be able to get thorough understanding of various concepts of
epidemiology and uses of epidemiological approach in health care delivery
and apply that in various health care settings.
SPECIFIC OBJECTRIVES:
At the end of the discussion the group will be able to:
1.
2.
3.
4.
5.
6.

Define epidemiology
Discuss aims of epidemiology
Describe various epidemiological approaches
Explain health surveillance and its uses
Know about health information and its applications
Discuss applications of epidemiology in health care delivery system

INTRODUCTION
Epidemiology began with Adam and Eve, both trying to investigate the
quality of forbidden fruit. It is derived from the Greek word: EPIDEMIC.
EPI

: UPON (AMONG)

DEMOS

: PEOPLE

LOGOS

: STUDY OR KNOWLEDGE

DEFINITIONS
Epidemiology is:

The study of distribution and determinants of disease frequency in

man.
(Mac
Mohan, 1960)
The study of various factors and conditions that determine the
occurrence and distribution of health, disease, defect, disability and
death among group of individuals
(Clark,
1965)
The study of distribution and determinants of health related states
and events in specified population and the application of this study to
control the health problems.
(John M.
Last, 1988)

Three common components of epidemiology:

Disease frequency
Distribution of disease
Determinants of disease

AIMS OF EPIDEMIOLOGY:
According to international Epidemiological Association, epidemiology has 3
main aims:
1. To describe the distribution and magnitude of health and disease
problems in human populations.
2. To identify etiological factors (Risk Factors) in the pathogenesis of
disease.
3. To provide data essential to the planning, implementation and
evaluation of services for the prevention, control and treatment of
disease and to the setting up of priorities among the services.
These aims and objectives are served by three major types of
epidemiological studies. These are:
1. Descriptive studies
2. Analytical studies
3. Experimental studies

EPIDEMIOLOGICAL APPROACH:
The epidemiological approach to problems of health and disease is based on
2 major foundations:
A. Asking questions
B. Making comparisons
A) Asking questions:
Epidemiology has been defined as A means of learning or asking
questions. And getting answers that lead to further questions.
For example, following questions could be asked:-

RELATED TO HEALTH EVENTS:

What was the event?

What was the magnitude?
Where did it happen?
When did it happen?

Who are affected?

Why did it happen?

RELATED TO HEALTH ACTION:

What can be done to reduce this problem and its consequences?

How can it be prevented?
What actions should be taken by the community? By the health
services? By other sectors? Where or for whom these activities are to
be carried out?
What resources are required? How are the activities to be arranged/
organized?
What difficulties may arise and how might they be overcome?

Answer to the above questions may provide clues to disease etiology and
help epidemiologist to guide planning and evaluation.

B) MAKING COMPARISONS:
The basic approach in epidemiology is to make comparison and draw
inferences. This may be comparison of 2 or more group- one group having
the disease or having been exposed to risk factors, and the other group not
having the disease.
By making comparisons the epidemiologist tries to find out the crucial
differences in the host and the environmental factors between affected and
non affected.
In short epidemiologist weighs, balances and contrasts.
Clues to epidemiology come from these comparisons.

ESSENTIALS OF COMPARISONS:

COMPARIBILITY:
A. Between study and control group. Both groups should be similar.
For the facts to be comparable, they must be accurate and must be
gathered in uniform way.
Study and control group should be similar with regard to their age, sex,
composition and similar other pertinent variables.
The best method of ensuring comparability is randomization or random
allocation or by matching of certain characteristics.

HEALTH SURVEILLANCE:
The dictionary meaning of word Surveillance is supervision or close watch
especially on suspected persons.
Epidemiological surveillance means close vigilance or occurrence and
distribution of health related problems, population dynamics, community
behavior and environmental processes resulting in increased risk of ill health
in community.

COMPONENTS OF PUBLIC HEALTH SURVEILLANCE:

1. Identification of missed and suspected cases, their confirmation by
laboratory investigation.
2. Identifying source of infection and channel of transmission.
(Monitoring the disease prevalence, its related risk factors and
intervention of control program for the same are the important
activities of the surveillance.)
The epidemiological surveillance can be done at various levels.
1. INDIVIDUALISTIC/ FAMILY SURVEILLANCE:
Surveillance of an infected person in a family as long as the individual is a
source of infection to others. Example: typhoid cases and carriers.
2. COMMUNITY/ LOCAL POPULATION SURVEILLANCE:
Active and passive surveillance of whole community for early detection,
prevention and control of disease. Example: malaria.
3. NATIONAL SURVEILLANCE:
Example: surveillance of small pox after its eradication.
4. INTERNATIONAL SURVEILLANCE:
It includes surveillance of some of the diseases which are listed by WHO like
malaria, polio etc.

SURVEILLANCE PROCESS:
The surveillance is a systematic process and the main steps involved are:
1. Collection of relevant information about the disease under surveillance.
2. Analysis and interpretation of these diseases

3. Reporting of this information to concerned authorities for decisions and

actions leading to prevention and control of diseases.

1. Collection of relevant information about the disease under

surveillance.
Effectiveness of the surveillance system depends upon identification of
cases, collection of relevant information about the disease and their
recording and reporting. Various methods for surveillance are as under:
a) Routine reporting of cases and deaths recorded at health centers,
dispensaries and hospitals. (Passive surveillance)
b) Active surveillance:
Actively looking for those particular types of cases who have not been
recorded under the routine system. Its done by health workers and
community people. Example: surveillance of tuberculosis and malaria
cases.
c) EPIDEMIOLOGICAL INVESTIGATIONS:
Its usually done when there is occurrence of more than usual number
of cases in a particular place during particular time period, when there
is a sudden out break of any disease and when a communicable
disease which has never occurred before but has occurred now. Thus
epidemiological investigation provides important supplementary
information which is not obtained by other surveillance methods.
d) SENTINEL CENTERS:
Sentinel centers are those hospitals, health centers, laboratories,
special disease hospitals etc which are identified for collecting
information for selected diseases. The information is collected,
compiled and forwarded to higher authorities for use: for immediate
action and for making future plans and policies etc.
Sentinel surveillance can provide reliable information about selected
diseases indicating the trend of disease prevalence in a particular area.
e) SPECIAL SAMPLE SURVEY:
Special sample survey is an effective method of surveillance of
diseases. There are different sample surveys but the survey by cluster
sampling technique is recommended by WHO. The target population,
the sample size vary from disease to disease, example the target
population for polio myelitis is 5-9 years, for diarrhea, 0-4 years.
2.

Compilation and Analysis of data:

Once surveillance data is collected for a reporting period by whatever
method, it needs to be compiled and analyzed to assess the frequency

and distribution by person, place, and time. The reporting period can
be a week, a month or a year.
This information can be presented in tables, spot maps, charts and
graphs. This kind of presentation helps in determining the pattern of
occurrence of disease and whether there is decrease or increase in the
number of cases.

3. REPORTING OF DATA AND PROVIDING FEED BACK:

Once the data is analyzed a report is to be prepared in the format
prescribed by the authority. The report is sent regularly for each
reporting period. The report should be complete. If some information is
missed or reported late, it should be included in the next reporting
period. If any further investigations are done during the period and if
any action is taken or is going to be taken, it needs to be reported.
Feedback should be given to all the members of health team as to how
the data is used which is collected by them and reported through
regular meetings and as and when desired by anyone.

HEALTH INFORMATION:
HEALTH INFORMATION SYSTEM:
A mechanism for the collection, processing, analysis and transmission of
information required for organizing and operating health services and also
for research and training.
OBJECTIVES:
The primary objective of health information system is to provide realistic,
relevant and up to date, adequate, timely and reasonably complete
information for health managers at all levels and at the sharing of technical
and scientific information by all health personnel participating in the health
services of a country and also to provide at periodic intervals data that will
show the general performance of the health sources and to assist planners in
studying their current functioning and trends in demand of work load.
COMPONENTS OF HEALTH INFORMATION SYSTEM:

Information and indicators on the following:

Demography and vital events.

Environmental health statistics.
Health statistics: mortality, morbidity, disability, and quality of life.
Health resources: facilities, beds, man power.
Utilization and non utilization of health care services: attendance,
admission and waiting lists
Indices and outcome of medical care.
Financial statistics (cost expenditure) related to the particular
objective.

USES OF HEALTH INFORMATION:

The important uses to which health information may be applied are:
1. To measure the health status of the people and to quantify their health
care needs.
2. For local, national and international comparisons of health status.
3. For planning, administration and effective management of health
services and programs.
4. For assessing whether health services are accomplishing their
objectives in terms of their effectiveness and efficiency.
5. For assessing the attitudes and degree of satisfaction of beneficiaries
with the health system.
6. For research in to particular problems of health and disease.

USES OF EPIDEMIOLOGY:
Epidemiology helps to:
1. Study the occurrence and distribution of diseases in a community
2. Identify the determinants of disease
3. Diagnose the health status of the community by identifying health
problems on the basis of morbidity and mortality pattern and by
identifying the individual and the groups who are at risk and require
special attention or care.
4. Estimate the risk i.e. statistical probability of disease, accident and
defect and the chances of avoiding them.
5. Plan effective need based care services on the basis of epidemiological
information regarding distribution and frequency of disease and
disabilities and their associated factors and causes.
6. Determine the effectiveness of health care services planned and
implemented on the basis of predetermined criteria regarding its

relevance, effectiveness, efficiency and impact on community health.

This can help to plan better services in future.
7. Determine the usefulness and effectiveness of new/ innovative
techniques, measures and programs etc. before they are used widely.
Example: evaluation of polio vaccine, new anti rabies vaccine.
8. Complete the clinical picture of chronic disease and slow growing
disease or those which remain asymptomatic for a long time and
describe their natural history. Example: degenerative disease of the
nervous system.
9. Identify syndrome by describing the distribution and association of
clinical phenomena in the population.
10.
Fore
cast the likely occurrence of certain diseases on the basis of
epidemiological principles. Example: changing trends in occurrence of
malaria due to change in climatic factors such as rain fall.

CONCLUSION:
Epidemiology deals with careful collection of data, systematic analysis, and
prompt interpretation of these compiled facts related to various aspects of
health and disease that gives an idea about who is at risk for getting a
disease, how a disease progresses and help in proper planning of health
services to control and prevent these disease.
So, the nurses must be well acquainted with the knowledge of various
approaches in epidemiology, measurement of epidemiology etc. to work
efficiently in the field of public health nursing.

BIBLIOGRAPHY
1. Basavanthappa B T. Community health nursing. 2nd edition; 2008,
Jaypee publication New Delhi, page number 619- 660
2. Gulani KK. Community health nursing: Principles and Practice. 1st
Edition; 2005, Kumar Publishing House, New Delhi, Page No. 181220
3. Park K. Parks Textbook of Preventive and Social Medicine. 19 th
Edition; 2007, Bhanot publication, Jabalpur, Page No. 49- 110.
4. Stanhope M, Lancaster J. Community and Public health Nursing.
6th Edition; 2004, Mosby Publication, Page No. 248- 280

5. Clemen-Stone, McGuire et al. Comprehensive Community Health

Nursing: Family Aggregate and Community Practice. 6th edition,
2002, Page No. 158- 181.
6. Gupta M C, Mahajan B K. Textbook of Preventive and Social
Medicine. 3rd Edition; 2005, Jaypee Publication, New Delhi, Page
No. 20- 25
7. Journal of Public health nursing
8. www.google. Com