PREVENTIVE HEALTH IN WOMEN INCLUDING SCREENING, IMMUNISATIONS

Definition:

Preventive health is defined as the protection, promotion , and maintainance of good health and

well-being and prevention of disease, disability, and death.

It consists of a series of steps aimed at promoting health

1) Detailed history and clinical examination by a medical practitioner

2) Advice regarding good, healthy and nutritious diet and exercise
3) Identify risk factors for disease
4) Screening for certain ailments
5) Be adequately vaccinated and immunized against illnesses

This is based on the concept that disease processes begin long before they are detected and

hence early identification can prevent complications due to the disease.

Risk factors for disease:

Common risk factors for disease include habits such as smoking whether as cigarettes, beedis,

oral tobacco or snuff. Alcohol intake in excess is another contributor to disease. Obesity due to

poor diet, inadequate exercise, sedentary lifestyle is another risk factor for disease.50% of

deaths are attributed to preventable behavior and exposure.

Screening:

Screening is a strategy used in a population to identify the possible presence of an as-yet-

undiagnosed disease in individuals without signs or symptoms. Some common diseases for

which screening tests are available include diabetes mellitus, hypertension,

hypercholesterolaemia, certain cancers such as breast cancer and cervical cancer, osteoporosis.

There are different types of screening, each with specific aims

 mass screening involves screening a large population (e.g., chest x-rays for TB)
  multiple or multiphasic screening involves the use of several screening tests on the same

occasion (e.g., an annual health check-up)

 targeted screening of groups with specific exposures is often used in environmental and

occupational health (e.g., battery workers)

 proactive or systematic screening: population registers are used to invite members of the

population at risk for screening at appropriate intervals

 case-finding (or opportunistic screening) is a form of screening restricted to patients who consult

a health practitioner for some other purpose (the GP may take your blood pressure when you

come for your 'flu shot)

The following criteria should be met before a screening programme is instituted:

The DISEASE

1. The disease should be serious - e.g., it causes death, disability, or discomfort;

2. The natural history should be understood;

3. The disease must have a latent period during which it can be detected before symptoms

appear . Examples include pre-cancerous lesions;

4. The latent period between first signs and overt disease should be long enough that

screening significantly advances the detection of disease.

DIAGNOSIS AND TREATMENT

1. Facilities need to be adequate;

2.There is an available, effective, acceptable, and safe treatment ;

3.Early treatment should be more effective than later.

The SCREENING TEST

1. Should be sensitive (and ideally also specific), and have good predictive value
2. Simple and cheap;

3. Safe and acceptable;

4. Reliable.

Immunisation and Vaccination:

Vaccination is the process by which vaccines are given to a person. Vaccine stimulates the

body’s immune system so that it can develop protective antibodies and prevent future

infection. Immunisation programmes in our country are predominantly focused on children .

However, there is a need for specific vaccines even in adult and some women specific

vaccination at appropriate ages.

Types of Preventive health-

1)Primary Prevention

2)Secondary Prevention

3)Tertiary Prevention

4)Primal Prevention

1)Primary prevention aims to prevent a disease or injury before it even occurs. It is more a

health promotion and involves adopting a healthy lifestyle.

This includes eating a healthy ,nutritious well balanced meal with adequate fruits and

vegetables that provide vitamins,minerals and roughage, drinking pure water, regular exercise

such as a daily brisk 20 minute walk.

Avoidance of smoking and consuming alcohol only in moderation.

Other prevention modalities include maintaining personal hygiene including regular hand

washing, avoidance of unsafe sexual contact.

While all these are individual activities, changes in society such as proper purification and

supply of safe drinking water, sewage treatment, proper waste disposal can also contribute to

primary prevention by reducing infectious diseases that spread via faeco- oral route.

Legislation to enforce safe activities such as seat belts, wearing helmets can reduce fatalities

due to road traffic accidents.

In general, adopting a healthy life style has been shown to increase life expectancy.

2)Secondary Prevention aims to reduce the impact of a disease or injury that has already

occurred. This is done by detecting and treating disease as soon as it has happened to halt or

slow its progress, encourage strategies to prevent recurrence and implement programs to

return people to their original health and function to prevent long term problems.

Examples include:1)Daily low dose aspirin ,statin, diet, exercise in those with heart disease or

strokes to prevent a second event

2) Mammograms and self breast exam for early diagnosis of breast cancer so it can be treated

better.

3)Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting

effects. This is done by maximizing the ability to function, improving quality of life.

Examples include-1) Stroke and spinal injury rehabilitation programs for people who have

weakness of limbs that provide physiotherapy for muscle strength, occupational therapy that

teaches rehabilitation, speech therapy etc.

2) Support groups ,eg. Alzheimer’s support groups, that have other members with similar

problems, which provide strategies for coping

3)Vocational rehabilitation programs to retrain workers for new jobs when they have recovered
as much as possible.

4) Primal prevention

New method that has come into being with advances in genetics and molecular biology. It

consists mainly in providing future parents with pertinent, unbiased information on primal

health and supporting them during their child's primal period of life (i.e., "from conception to

first birthday . It consists of prenatal care, supplementation of folic acid, correction of diseases

in would be parents that could affect unborn child, adequate care during pregnancy both

physical and psychological and care of the new born child .

Stage Susceptibilty Sub clinical Clinical Disability,recovery

Characteristics Risk factors in Exposure of Signs and Outcome of

the population individual to symptoms of disease- recovery,
risk factor and disease disability or death
disease
Level of Primary Secondary Secondary and Tertiary
prevention prevention prevention tertiary prevention
prevention
Modes of Health Screening and Treatment and rehabilitation
Intervention promotion early diagnosis rehabilition
Example Immunisation PAP smear for Angioplasty Physiotherapy
cervical cancer after myocardial after stroke
infarction and
then aspirin
 Chief causes of preventable death in women and girl children in India

These are the common causes of preventable deaths among girl children.

1)Premature births

2)Pneumonia

3)Diarrhoeal diseases

4)Sepsis

These are the common causes of preventable deaths among women

1) Heart disease
2) Infections including tuberculosis, diarrhoeal and respiratory infection
3) Maternal mortality due to pregnancy complications
4) Injury and poisoning often due to suicide
5) Cancers often breast and cervical

Immunisation in women

India’s Universal program of immunization focuses predominantly on childhood

vaccine preventable diseases. Childhood schedule of vaccination includes diphtheria-

tetanus-pertussis; measles, mumps, polio, hepatitis B, hemophilus influenza B.

Adult vaccination is a neglected entity despite the fact that nearly 25% of adult deaths

are due to infections and several of them can be prevented with appropriate

vaccines.

In addition women need access to some specific vaccines.

1. Every woman should have received rubella vaccine as rubella during pregnancy can

cause significant birth defects which can be avoided by vaccination.

2. 2 doses of tetanus toxoid are also administered during pregnancy to prevent

 neonatal tetanus.

3. Teenagers are also advised to get vaccinated with humanpapilloma virus HPV

vaccine as this is the major cause for cervical cancer.

4. Influenza is a viral disease that can cause respiratory problems and is especially

serious in pregnancy. So those who will be pregnant during influenza season

( winters) and for any woman with an increased risk for influenza-related

complications, such as cardiopulmonary disease or elderly above 65 years ,

influenza vaccine should be given. This should be administered every year

5. If hepatitis B vaccine has not been given in childhood, it should be administered as

3 doses especially in all women who are health care professionals.

Boosters may be required every 10 years.

6. Pneumococcal vaccine, protecting people against pneumococcal lung and brain

infections, are available . They are recommended for women who have chronic lung

diseases, have had splenectomy.

7. Besides, there are vaccines that are needed for people travelling abroad.

Requirements vary based on the country. For example, yellow fever vaccine is

needed for travel to certain African countries.

Hence prevention involves individual effort to maintain a healthy lifestyle, efforts by community to

maintain a safe environment, efforts by medical community with regards to screening and

immunization and together they help to maintain good health.

References-

!. Screening for disease. www. med.uottawa.ca

2.Preventive health- www. wikepedia.com

3. Adult vaccination- www.adultvaccination.org

Questions-Essay

1)What is screening?What are the types of screening? What is the criteria for screening programs?

Short Notes

1)List the types of preventive health with one example for each

2) What are the special vaccines needed only for women?

3)What are the common preventable risk factors and preventable causes of death in women?

MCQs

1.Vaccine given to women to prevent birth defects is a. measles b. mumps c. rubella d. pneumococcal

2.Doing PAP smear for early detection of cancer cervix is a type of a.primary prevention b. secondary
prevention c. tertiary prevention d. primal prevention