PENGANTAR EPIDEMIOLOGI

Sri Setiyarini

Epidemiology: Ditinjau dari asal kata (Yunani)

"Epi" - upon, "demos" - the people, "logos" - study of.

epi pada atau tentang demos penduduk Logos ilmu

the logical, systematic approach to understanding the complexities of disease (Torrence, 1997). Ilmu yang mempelajari tentang frekwensi dan penyebaran masalah kesehatan pada sekelompok manusia serta faktor faktor yang mempengaruhinya

Definisi
"The study of the distribution and determinants of health-related states or events in specified human populations and the application of this study to the control of health problems

(Last 1988: CDC)

Epidemiology
Includes 1) the methods for measuring the health of groups and for determining the attributes and exposures that influence health; 2) the study of the occurrence of disease in its natural habitat rather than the controlled environment of the laboratory; and 3) the methods for the quantitative study of the distribution, variation, and determinants of health-related outcomes in specific groups (populations) of individuals, and the application of this study to the diagnosis, treatment, and prevention of these states or events. (Last, 1995)

The Scope of Epidemiology

The study of distribution and determinants of diseases and injuries in human populations

can be applied to: diseases conditions health related events

concern in : epidemics interepidemic period sporadic endemic occurrence

The aims:
elucidate causal mechanism explain local disease occurrence describe the natural history of disease provide guidance in the adm. of health services

Specific Objects of Epidemiology

To identify the etiology or the cause of a disease and the risk factors To determine the extent of disease found in the community To study the natural history and the prognosis of disease To evaluate new preventive and therapeutic measures and new modes of health care delivery To provide the foundation for developing public policy and regulatory decisions relating to environmental problems

(education, Intervention)

Disease Control & Prevention

Health Policy

Epidemiology
Clinical
(Prognosis, Treatment)

Uses of epidemiology
PREVENTION Causation especially primary prevention natural history (secondary and tertiary prevention) Description of health status of populations service planning e.g.Tallaght Evaluation of interventions

Epidemiology and Prevention

Primary
to prevent the development of a disease in a person who is well and does not have the disease in question. Secondary to identify people who have already developed a disease, at an early stage in the diseases natural history, through screening and early intervention.

Tertiar
to reduce the damage and limit the disability to individuals with the disease.

Epidemiologic Strategy
1. Defining the disease, trait, or phenotype 2. Assembling and analyzing data on the occurrence of disease in populations 3. Testing for associations between diseases and suspected risk factors 4. Searching for mechanisms of disease and natural history

Key Concepts in Epidemiology

Natural History and Spectrum of Disease Chain of Infection

Epidemic Disease Occurrence

Natural History & Spectrum of Disease

The progress of disease process without intervention

Four Stages Exposure Pathologic Changes Onset Time of Diagnosis Infectivity Pathogenicity Virulence

>< Carriers
( In controlling disease) ( In disease statistics)

Natural History of Disease

Preclinical stage: molecular alternations

Subclinical stage: pathologic alternations

Cnical stage: clinical manifestations

Complications
Death

Usual time of diagnosis Exposure

Pathologic changes

Onset of symptoms

Suscep tibility

Subclinical
(Incubation/latency)

Clinical

Recovery disability death

Chain of Infection
Reservoir (Agent)
portal of exit

transmit (Mode of transmission)

portal of entry

determine appropriate control measures

Susceptible host (Infection)

Epidemics Occurrence
What are the patterns of expected disease occurrence?

Endemic Hyperendemic Sporadic Epidemic Pandemic

Epidemics Occurrence
Why do epidemics occur?
A recent increase in amount or virulence of the agent The recent introduction of the agent An enhanced mode of transmission Changes in the host susceptibility The new portals of entry increase host exposure

Epidemics Occurrence
What are the patterns of expected disease occurrence?

Endemic Hyperendemic Sporadic Epidemic Pandemic

Epidemics Occurrence
Epidemic Pattern Common source: point intermittent continuous Propagated Mixed Other

Manfaat Epidemiologi
Membantu pekerjaan administrasi kesehatan Menerangkan penyebab suatu masalah kesehatan Menerangkan perkembangan alamiah suatu penyakit Menerangkan keadaan suatu masalah kesehatan
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Pekerjaan Administrasi kesehatan

Planning Monitoring Penilaian (evaluation)

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PENYEBAB suatu masalah kesehatan

dimanfaatkan data tentang frekwensi dan penyebaran masalah kesehatan
Bukan memeriksa hasil pemeriksaan medis Menganalisa data tentang frekwensi dan penyebarannya di masyarakat
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PERKEMBANGAN alamiah suatu penyakit

Natural History of Disease Dapat dilakukan upaya untuk menghentikan perjalanan penyakit Dengan melalui pemanfaatan keterangan frekwensi daaan penyebaran penyakit, terutama penyebaran penyakit menurut waktu. Dengan diket waktu berakhirnya suatu penyakit dan perkembangannya

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KEADAAN suatu masalah kesehatan

Epidemi
Masalah kesehatan yg ditemukan pada daerah ttt dlm waktu singkat frk. Meningkat.

Pandemi
Masalah kesehatan , dalam waktu singkat frek meningkat, penyebaran luas

Endemi
suatu penyakit, frekwensi tetap dalam waktu yg lama

Sporadik
Masalah kesehatan yg ada di wilayah, frek beerubah ubah setiap waktu
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Jenis Epidemiologi
Epidemiologi Deskriptif Epidemiologi analitik Epidemiologi eksperimental

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Descriptive (Observational) Epidemiology

The most basic form of epidemiology, which is the description of the patterns of occurrence of health-related states or events in groups; answering the questions of "Who?", "What?" "Where?", and "When?". Descriptive epidemiology is usually one of the first things done at the scene of any disease outbreak.

Epid. Deskriptif
WHO WHERE WHAT

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Analytical Epidemiology
The design, execution and analysis of studies in groups to evaluate potential associations between risk factors and health outcomes to answer the question "Why?".
Contoh: Pengaruh rokok terhadap timbulnya penyakit kanker paru
Dilakukan perbandingan antara kelompok perokok dan tidak perokok Dilihat jumlah penderita kanker paru untuk masing masing kelompok Dari perbedaan yg ada dpt disimpulkan ada/tidaknya pengaruh rokok thd peny kanker paru
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Epidemiologi Eksperimental
Dilakukan pembuktian bahwa faktor X sbg penyebab terjadinya penyakit eksperimen atau percobaan Rokok dianggap sbg penyebab kanker paru maka dilakukan eksperimen bahwa jika rokok dikurangi kanker paru akan menurun

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Epidemiologi
Ilmu yg mempelajari tentang masalah kesehatan pada sekelompokmanusia

FREKWENSI

PENYEBARAN

FAKTOR YG MEMPENGARUHI
Disusun sebagai langkah pokok : Merumuskan hipotesa Uji hipotesa Tarik kesimpilan sebab akibat

2 hal pokok: Menemukan masalah kesehatan Mengukur masalah kesehatan

Dikelompokkan menurut Ciri manusia Tempat Waktu

Epidemiologi deskriptif

Epidemiologi analitik
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Applied epidemiology
Cancer epidemiology Psychiatric epidemiology Cardiovascular & metabolic epidemiology Nutritional epidemiology Infectious epidemiology Environmental & occupational epidemiology Molecular epidemiology Genetic epidemiology Geriatric epidemiology Injury epidemiology Social epidemiology

Basic epidemiology Methodological epidemiology

Aplikasi SETTING Epidemiologi KLINIK - MASYARAKAT

Memeriksa pasien secara individu

Memeriksa pada suatu populasi masyarakat Permasalahan kesehatan

Mengidentifikasi gejala potologi

Mengidentifikasi gejala klinik Indikator kesehatan yg dpt menjelaskan permasalahan

Diagnosis dan perawatan Menentukan langkah tindak lanjut
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Clinical Epidemiology
The application of the logical and quantitative concepts and methods of epidemiology to problems (diagnostic, prognostic, therapeutic, and preventive) encountered in the clinical delivery of care to individual patients. The population aspect of epidemiology is present because these individual patients are members of conceptual populations. "A basic science for clinical medicine" (Sackett et al.).

Tujuan

Memeriksa penyakit pada pasien Informasi yg Clinical history dibutuhkan Pemeriksaan kesehatan Diagnosis Diagnosis banding Kemungkinan diagnosis Tindakan Perawatan dan rehabilitasi Evaluasi Control, follow up
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Kesehatan Masyarakat
Tujuan Meningkatkan ststus kesehatan masyarakat Informasi yang dibutuhkan Data populasi, Problem kesehatan, pola penyakit, pelayanan kesehatan yg ada, pemeriksaan laboratorium Diagnosis Tindakan Evaluasi Diagnosis komunitas dan prioritas penanganan Program kesehatan masyarakat Perubahan status kesehatan

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Models of Disease
Explain the occurrence of disease
Ecological Approach

Ecology is the study of the relationship of organism to each other as well as to all other aspects of the environment. .

Development of an Epidemic
Organism
Man

Disease

Environment: Biologic Social Physical

Host

Biological Environment
Includes:

Agent Reservoir Vector Plants & Animals

Social Environment
Overall economic and political organization of society and of the institutions by which individuals are integrated into the society at various stages in their lives.
Particular social customs: - types of food eaten - practice of wearing shoes - permissiveness - helmet, seat belt, breast feeding - integration >< alienation - urbanization

Receptivity to new ideas: Social integration: Geographic mobility:

Physical environment
Old ones: New ones:

Heat Light Water Radiation Gravity Atmospheric pressure Chemical agent

Rapid growth of population. Increase of industrial wastes. Increase of motor vehicles.

Host Factor
Genetic: ABO >< Ulcer Sickle cell trait >< Malaria Specific Immunity: Measles, Chickenpox. Personality: Type A Personality>< CHD Social Class : Ca cervix >< High Level of Social Class

Interrelations of Factors
Those 3 factors are closely interrelated with each other and with host factor.

Three Ecological Models

The Epidemiological Triangle The Web of Causation The Wheel

KONSEP DASAR TIMBULNYA PENYAKIT

MENURUT Gordon dan Le Richt (1950), timbul tidaknya penyakit pada manusia dipengaruhi : Pejamu (host) Agent (penyakit) Environment (lingkungan)

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The Epidemiological Triangle

Host

Agent

Environmental

PEJAMU LINGKUNGAN

PENY

sehat

PEJAMU

Menderita penyakit krn daya tahan penjamu kurang

PENY
LINGKUNGAN

PENY
PEJAMU LINGKUNGAN

Menderita penyakit krn kemampuan bbt penyakit meningkat

PENY PEJAMU LINGKUNGAN

Menderita sakit karena lingkungan berubah

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 Dalam mempengaruhi timbulnya penyakit ketiga faktor saling mempengaruhi Multiple Causation of Disease Dalam menimbulkan penyakit, peranan unsur unsur tersebut tidaklah sendiri sendiri melainkan saling mempengaruhi satu sama lain jala penyebab penyakit (web of causation)

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The Web of Causation

Effect never depend isolated causes. Effect develop as the chains of causation. on single of

result

It is possible to interrupt the production of disease by cutting the chains at different points.

The Wheel
Social Environment Biologic Environment
Host

Genetic Core Physical Environment

Figure provides a schematic diagram of sufficient causes in a hypothetical individual. Each constellation of component causes represented in Figure is minimally sufficient to produce the disease;

Semoga Bermanfaat wassalam