INTRODUCTION OF EPIDEMIOLOGY
P. Lutfi Ghazali
1
1/22/2016
DEFINITION OF EPIDEMIOLOGY “the study of how disease is distributed in populations and of the factors that influence or determine this distribution”. “the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control of health problems”. “the science of occurrence of diseases in human population”. “the study of the distribution and determinant of diseases and injuries in human populations
2
1/22/2016
DISTRIBUSI & DETERMINAN I.
II.
Epidemiologi Deskriptif Distribusi Variabel: Time (when), Place (where), Person (who) Epidemiologi Analitik Determinan Variabel: (how & why) Host – Agent – Environment Keturunan – Perilaku – Lingkungan – Pelayanan Kesehatan
4
1/22/2016
5
1/22/2016
6
1/22/2016
OBJECTIVES OF EPIDEMIOLOGY
to identify the etiology or the cause of a disease and risk factors[1] to determine the extent of disease found in the community. to study the natural history and 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 in environmental problems. [1] is factors that increase a person’s risk for disease
7
1/22/2016
Di sana terdapat 100 kasus Tuberkulosis Paru
Di sana terdapat 100 kasus Tuberkulosis Paru
1. Populasi apa yang diobservasi? 2. Kapan observasi dilakukan?
Di sana terdapat 100 kasus Tuberkulosis Paru
1. Populasi apa yang diobservasi? 2. Kapan observasi dilakukan?
Pada 1 Januari 2016 terdapat 100 kasus Tuberkulosis Paru di Kecamatan A, Kabupaten X
Pada 1 Januari 2016 terdapat 100 kasus Tuberkulosis Paru di Kecamatan A, Kabupaten X
KEBIJAKAN
Pada 1 Januari 2005 terdapat 100 kasus Tuberkulosis Paru di Kecamatan A, Kabupaten X
Tuberkulosis Paru dengan Efusi Pleura Tuberkulosis Paru Penyakit Paru
JUMLAH KASUS DI KECAMATAN A KECAMATAN B 25 0 100 1000
KEBIJAKAN
10 300
Measurement of Morbidity and Mortality Rates are defined as follows : Number of events in a specified period ----------------------------------------------------------------x k Population at risk of these events in a specified period
13
1/22/2016
Measurement of … A ratio expresses the relationship between two numbers in the form : X --- x k Y
14
1/22/2016
Measurement of … A proportion is a specific type of ratio in which the numerator is include in the denominator, and the resultant value is expressed as a percentage : X -------- x k X+Y
15
1/22/2016
Measurement of … Incidence rates measure the probability that
healthy people will develop a disease during a specified period of time or “the number of new cases of a disease in a population over a period time”
Number of new cases of a disease ----------------------------------------- over a period of time Population at risk
16
1/22/2016
Measurement of … Prevalence rate measures the number of people in a population who have the disease at a given time.
Number of existing cases of a disease ------------------------------------------------- at a point of time Total Population
17
1/22/2016
Natural History of Disease Preclinical Phase
Clinical Phase outcome
Biological onset of disease
Detectable by screening
Symptom
Diagnosis
Therapy
Lead Time
18
1/22/2016
Natural History of Disease…
19
1/22/2016
Stage of Suspectibility • Disease not yet developed • Presence of risk factors Stage of Pre-clinical Disease • No disease manifestation • Progression under clinical horizon (no detectable signs
and symptoms)
Stage of Clinical Disease • Recognizable signs and symptoms • Divided based on morphological alteration, functional limitation or objective assesment. Stage of Disability Outcome of disease : • death • disease controlled with disability • disease controlled without disability • recover
PREVENTION Definition
The goals of medicine are to promote health, to preserve health, to restore health when it is impaired, and to minimize suffering, and distress. These goals are embodied in the word “prevention”, which is easiest to define in the context of levels, customarily called primary, secondary and tertiary.
Primary Prevention
the protection of health by personal and community-wide effect. e.g. preserving good nutritional status, physical fitness, emotional wellbeing, immunizing against infectious diseases, and making environment safe. Aims : altering suspectibility and reducing
exposure
Strategy : 1. General health promotions 2. Specific protective measures
Secondary Prevention
the measures available to individuals and populations for early detection and prompt and effective intervention to correct depatures from good health Aims : cure disease, slow the progression, prevent
complication, cut off the chain of transmission Strategy : 1. Early detection of disease (screening) 2. Prompt treatment of disease
Tertiary Prevention
the measures available to reduce or eliminate long term impairments and disabilities, minimize suffering caused by existing depatures from good health, and to promote the patient’s adjusment to irremediable conditions Aims : allevation of disability and restoration of
effective functioning
Strategy : 1. Limitation of disability 2. Rehabilitation
PENYAKIT
PREVENSI / UPAYA PENCEGAHAN
TAHAP KERENTANAN (Suspectibility)
PREVENSI PRIMER Contoh : penyuluhan kesehatan, imunisasi
TAHAP PREKLINIS
PREVENSI SEKUNDER Contoh : deteksi dini kanker payudara, pengobatan TB Paru dengan DOTS
TAHAP KLINIS TAHAP KECACATAN (Disability)
PREVENSI TERSIER Contoh : fisioterapi, rehabilitasi
KEJADIAN LUAR BIASA (KLB)
27
1/22/2016
PENETAPAN KLB
Terjadinya peningkatan kasus baru 2 kali atau lebih dibandingkan dengan minggu/bulan yang sama pada periode waktu tahun sebelumnya di suatu wilayah desa, ATAU Terjadinya peningkatan jumlah kasus di suatu wilayah 2 kali lebih dari minggu sebelumnya, ATAU Munculnya kesakitan di suatu wilayah kecamatan yang selama 1 tahun terakhir tidak ada kasus.
MANAJEMEN KLB
Data epidemiologi
Keadaan masyarakat
Frekuensi penyakit (morbiditas, mortalitas) Distribusi penyakit (tempat, waktu, manusia) Determinan penyakit (faktor risiko, penyebab).
Keadaan sosial budaya (misal: kepercayaan) Keadaan ekonomi (misal: keluar masuknya manusia, hewan dan barang-barang dari dan ke daerah KLB yang dapat atau diduga dapat mengakibatkan penularan atau penyebaran penyakit) Keadaan keamanan (misal: keadaan yang berkaitan dengan faktor psikologis antara lain kekhawatiran, ketakutan, kepanikan, dan faktor-faktor lainnya.
PROGRAM PENANGGULANGAN KLB
SISTEM SURVEILANS RESPONS
Sekumpulan kegiatan yang dilakukan terus menerus secara sistematik yang meliputi:
Case detection Reporting Investigation and confirmation Analysis and interpretation Action: control/response, policy, feedback
