Dr. Irwin Aras - Prevention & Control

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Irwin ArasIrwin ArasCommunity Medicine Dept.Community Medicine Dept.

FMUHFMUH

Concepts of DiseasePrevention and Control

(I) Prevention



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The goals of medicine;o to promote health,

o to preserve health,

o to restore health when it is impaired, and

o to minimize suffering and distress.

These goals are embodied in the word

"prevention"

Prevention; Definition and ConceptPrevention; Definition and Concept

Actions aimed at eradicating, eliminating orminimizing the impact of disease and disability,or if none of these are feasible, retarding theprogress of the disease and disability.

The concept of prevention is best defined in thecontext of levels, traditionally calledprimary,

secondary and tertiary prevention. A fourthlevel, calledprimordialprevention, was lateradded.



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Determinants of PreventionDeterminants of Prevention

Successfulprevention depends upon:

◦ a knowledge of causation,

◦ dynamics of transmission,

◦ identification of risk factors and risk groups,

◦ availability of prophylactic or early detection andtreatment measures,

◦ an organization for applying these measures toappropriate persons or groups, and

◦ continuous evaluation of and development ofprocedures applied

Preventable Causes of Disease

BEINGS

Biological factors andBehavioral Factors

Environmental factors

Immunologic factors

Nutritional factors

Genetic factors

Services,Social factors, andSpiritual factors

[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]



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Natural History of DiseaseNatural History of Disease((GertsmanGertsman, 2003)), 2003))

Leavell’sLeavell’sLevels of PreventionLevels of Prevention

Stage of disease Level of prevention Type of response

Pre-disease Primary Prevention Health promotion andSpecific protection

Latent Disease Secondary prevention Early diagnosisandprompt treatment

Symptomatic Disease Tertiary prevention •Disability limitation for

early symptomaticdisease•Rehabilitation for lateSymptomatic disease



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Levels of preventionLevels of prevention

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention

PrimordialPrimordial PreventionPreventionconsists of actions and measuresthatinhibit the emergenceof risk factors inthe form of environmental, economic, social,and behavioral conditions and culturalpatterns of living etc.



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PrimordialPrimordial PreventionPrevention

It is the prevention of the emergence ordevelopment of risk factors in populationgroups in which they have not yet appeared

For example;

◦ many adult health problems (e.g., obesity,hypertension) have their early origins in childhood,because this is the time when lifestyles are formed(for example, smoking, eating patterns, physicalexercise).

PrimordialPrimordial PreventionPrevention In primordial prevention, efforts are

directed towardsdiscouragingchildrenfrom adopting harmful lifestyles

The main intervention in primordialprevention is throughindividual and

mass education



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PrimaryPrimary PreventionPrevention

Primary prevention can be defined as;◦ theaction taken prior to the onset of disease,

◦ whichremoves the possibility that the disease willever occur.

Itsignifies intervention in the pre-pathogenesis phase of a disease or healthproblem.

Primary prevention may be accomplished by

measures of “Health promotion” and“Specific protection”

PrimaryPrimary PreventionPrevention It includes the concept of "positive health“;

a concept that encourages achievement andmaintenance of "an acceptable level of health thatwill enable every individual to lead a socially and

economically productive life ".

Primary prevention may be accomplished;

◦ bypromote general health and well-being, andquality of life of people or

◦ byspecific protective measures.



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HealthPromotion

•Health education•Good standard of nutrition•Attention to personality development•Provision of adequate housing, recreation and

agreeable working conditions•Marriage counseling and sex education•Genetics•Periodic selective examinations

SpecificProtection

•Use of specific immunizations•Attention to personal hygiene•Use of Environmental sanitation•Protection against occupational hazards•Protection from accidents

•Use of spesificnutrients•Protection from carcinogens•Avoidance of allergens

Health promotionHealth promotion Health promotion is;

“ the process of enabling people to increasecontrol over the determinants of health andthereby improve their health”.



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Approaches for Primary PreventionApproaches for Primary Prevention

The WHO has recommended the followingapproaches for the primary prevention of chronicdiseases where the risk factors are established:

a. Population (mass) strategy

b. High -risk strategy

Population (mass) strategyPopulation (mass) strategy

“Population strategy" is directed at the wholepopulation irrespective of individual risk levels.

For example;

studies have shown that even a small reduction inthe average blood pressure or serum cholesterol ofa population would produce a large reduction in the

incidence of cardiovascular disease

The population approach is directed towardssocio-economic, behavioral and lifestylechanges



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HighHigh--Risk StrategyRisk Strategy

The high -risk strategy aims to bringpreventive care to individualsat specialrisk.

This requires detection of individuals athigh riskby the optimum use of clinicalmethods.

SecondarySecondary PreventionPrevention It is defined as;

“action which hal t s t he progress of a disease at itsincipient stage and prevents complications.”

The specific interventions are:◦ early diagnosis (e.g. screening tests, and case finding

programs….) and◦ adequatetreatment.

Attempts to;◦ arrestthe disease process,◦ restorehealth by seeking out unrecognized disease and

treating it before irreversible pathological changes takeplace, and

◦ reversecommunicability of infectious diseases.



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EarlyEarly DiagnosisDiagnosis andand Prompt TreatmentPrompt Treatment

WHO Expert Committee in 1973 definedearly detection of health disorders as;

“the detection of disturbances of homoeostatic andcompensatory mechanism while biochemical,morphological and functional changes are stillreversible.”

The earlier the disease is diagnosed andtreated, the better it is for prognosis of the

case and in the prevention of the occurrence ofother secondary cases.

Tertiary Tertiary PreventionPrevention It is used when the diseaseprocess has

advanced beyond its early stages.

It is defined as;

“all the measures available to reduce or limit

impairments and disabilities, and to promote the

patients’ adjustment to irremediable conditions.”

Intervention that should be accomplished in thestage of tertiary prevention aredisabilitylimitation, and rehabilitation.



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DisabilityDisability LimitationLimitation

disease

impairment

disability

handicap

ImpairmentImpairment Impairment is;

“any loss or abnormality of psychological,

physiological or anatomical structure or

function.”



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DisabilityDisability

Disability is;

“any restriction or lack of ability to perform

an activity in the manner or within the range

considered normal for the human being.”

HandicapHandicap Handicap is;

“a disadvantage for a given individual,

resulting from an impairment or disability,

that limits or prevents the fulfillment of a role

in the community that is normal (depending

on age, sex, and social and cultural factors)

for that individual.”



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Rehabilitation is ;

“ the combined and coordinated use of

medical, social, educational, and vocational

measures for training and retraining the

individual to the highest possible level of

functional ability.”

RehabilitationRehabilitation

◦(II) Control



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ControlControl

The termdisease control describes ongoingoperations aimed at reducing:

◦ The incidenceof disease

◦ Thedurationof disease and consequently the risk oftransmission

◦ Theeffectsof infection, including both the physicaland psychosocial complications

◦ Thefinancialburden to the community.

Control ActivitiesControl Activities

Focus on primary prevention or secondaryprevention, but most programs combineboth.

Control Elimination Eradication



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DiseaseDisease EliminationElimination

Between control and eradication, anintermediate goal has been described, called"regional elimination“

The term "elimination" is used to describeinterruption of transmission of disease;

as for example, elimination of measles, polio anddiphtheria from large geographic regions or areas

Regional elimination is now seen as animportant precursor of eradication

Disease EradicationDisease Eradication

Eradication literally means to "tear out by roots".

It is the process of “Terminat ion of all t ransmissionof inf ection by ext ermination of t he infectiousagent t hrough surveillance and conta inment ”.

Eradication is an absolute process, an "all or none"phenomenon, restricted to termination of an infection

from the whole world. It implies that disease will nolonger occur in a population.

To-date, only one disease has been eradicated, that issmallpox.



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MonitoringMonitoring

Defined as;"the performance and analysis of routinemeasurements aimed to detecting changes in theenvironment or health status of population" (Thuswe have monitoring of air pollution, water quality,growth and nutritional status, etc).

SurveillanceSurveillance surveillance means to watch over with great

attention, authority and often withsuspicion.

Defined as;

"the continuous scrutiny (inspection) of the factors

that determine the occurrence and distribution of

disease and other conditions of ill-health"



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ReferencesReferences

Salama, R. Concept of prevention & control. LecturePresiding.PhD. Community Medicine Suez Canal UniversityEgypt.

Gerstman, BB (2003). Epidemiology kept simple.

Yarnell, J (2007). Epidemiology and prevention.

Gordis, L (2009). Epidemiology.

Bustan, MN (1997). Epidemiologi penyakit tidak

menular.Noor, NN (1997). Epidemiologi penyakit menular.

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Terima KasihTerima Kasih

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Dyanavad

SpaciboMerci, Danke

Naishitz

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Dr. Irwin Aras - Prevention & Control

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