Epi Unit IV Prevention & Control

Concepts of Prevention &
Control
Prepared BY:
Akash Samuel
BSN,RN
Copyright © 2019 By Akash Samuel

• Discuss the Concept & level of prevention
• Discuss Primary, Secondary and Tertiary level
of prevention
• Elaborate Interventions and approaches for
primary, secondary and tertiary level of
prevention.
• Define and discuss concept of disease control
and eradication.

• Health is:
– The state of being free from illness or injury.
– The overall condition of someone's body or mind
– Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity. (WHO,1948)
• Disease is:
– Any deviation from or interruption of the normal structure
or function of any part, organ, system of the body that is
manifested by a characteristic signs and symptoms and
whose etiology, pathology and prognosis may be known or
unknown.(Dorland 1981)

❖ The goals of epidemiology, community & public health are
to promote health, to preserve health, to restore health
when it is impaired, & to minimize suffering & distress.
❖ These goals are incorporated in the word "Prevention“.

Definition And
Concept of Prevention
❖ The action of stopping something from happening or
arising.
❖ Actions aimed at eradicating, eliminating or minimizing
the impact of disease/disability, or if none of these are
feasible, retarding the progress of the disease & disability.
❖ The concept of prevention is best defined in the context of
levels, traditionally called primary, secondary and tertiary
prevention. A fourth level, called primordial prevention,
was later added.

Determinants of Successful
Prevention
➢ Successful prevention depends upon:
1. A knowledge of causation,
2. Dynamics of transmission,
3. Identification of risk factors and risk groups
4. Availability of prophylactic or early detection and treatment
measures,
5. An organization for applying these measures to appropriate
persons or groups
6. Continuous evaluation of and development of procedures
applied

Preventable Causes of
Disease
BEINGS MODEL
Biological factors and Behavioral Factors
Environmental factors
Immunologic factors
Nutritional factors
Genetic factors
Services, Social factors, and Spiritual factors
[JF Jekel, Epidemiology, Biostatistics, and Preventive Medicine, 1996]

Leavell’s Levels of Prevention
Stage of Disease Level of Prevention Type of Response
Pre-disease Primary Prevention Health promotion and

Specific protection
Latent Disease Secondary prevention Pre-symptomatic

Diagnosis and
treatment
Symptomatic Disease Tertiary prevention •Disability limitation

for early symptomatic
disease
•Rehabilitation for late
Symptomatic disease

Levels of Prevention
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
QUATERNARY Prevention

Primordial Prevention
• Actions & measures that inhibit the emergence of risk factors

in the form of environmental, economic, social, & behavioral
conditions & cultural patterns of living etc.
(- John Last’s dictionary)
Prevention of risk factors themselves, beginning with change in

social & environmental conditions.

• It is the prevention of the emergence or development of risk
factors in countries or population groups 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, physical exercise).

• In primordial prevention, efforts are directed towards
discouraging children from adopting harmful lifestyles
• The Modes of intervention in primordial prevention is

through individual & mass education.
• Has to start in childhood when health risk behavior

develops more frequently.

Examples of primordial
prevention
National programmes and policies on:
❖ Food and nutrition
❖ Against smoking and drug
❖ To promote regular physical activity

Primary Prevention
• The action taken prior to the onset of disease, which
removes the possibility that the disease will ever occur.
• It is designed to prevent a disease or condition, from

occurring in the first place.
• It signifies intervention in the pre-pathogenesis phase of a

disease or health problem.

Primary Prevention
• It includes the concept of "positive health", a concept that
encourages achievement & maintenance of "an acceptable
level of health that will enable every individual to lead a
socially & economically productive life".
❖ Primary prevention may be accomplished by measures
designed to promote general health and well-being, &
quality of life of people or by specific protective measures.
❖ Modes of intervention of Primary prevention
I. Health promotion
II. specific protection”

Modes of Intervention for
Primary Prevention
Health Promotion
❖ Health promotion is “ the process of enabling people to

increase control over the determinants of health &
thereby improve their health”.
❖ Not directed against any particular disease
Specific Protection
❖Efforts directed toward protection against

specific diseases. e,g vaccines

Primary Prevention
Health Specific
Promotion Protection
Health Immunization
Education
Chemoprophylaxis
Environmental
Modifications Protection against occupational
hazards
Nutritional
Interventions Use of specific nutrients or
supplementations
Life style &
Behavioral Safety of drugs & foods
Changes
Control of environmental hazards, e.g. air
pollution

Approaches for Primary
Prevention
• The WHO has recommended the following
approaches for the primary prevention of chronic
diseases where the risk factors are established:
– a. Population (mass) strategy
– b. High -risk strategy

Population (Mass) Strategy
• “Population strategy" is directed at the whole population
irrespective of individual risk levels.
• For example, studies have shown that even a small

reduction in the average blood pressure or serum
cholesterol of a population would produce a large
reduction in the incidence of cardiovascular disease
• The population approach is directed towards socio-

economic, behavioral and lifestyle changes.

High-Risk Strategy
• The high -risk strategy aims to bring preventive care to
individuals at special risk.
• This requires detection of individuals at high risk by the

optimum use of clinical methods.

Secondary
Prevention
• Action which halts the progress of a disease at

its incipient stage and prevents complications.
• The specific interventions are: early diagnosis
(e.g. screening tests, & case finding
programs….) & adequate treatment.
Cont…

Cont..
• Secondary prevention attempts to arrest the disease
process, restore health by seeking out unrecognized
disease & treating it before irreversible pathological
changes take place, & reverse communicability of
infectious diseases.
• It thus protects others in the community from acquiring the
infection & thus provide at once secondary prevention for
the infected ones & primary prevention for their potential
contacts.
• Drawback :
❖ Patient already subjected to mental Stress & physical pain
❖ More expensive than primary prevention

Early Diagnosis
& Treatment
• WHO Expert Committee in 1973 defined early detection of
health disorders as “ the detection of disturbances of
homoeostatic & compensatory mechanism while
biochemical, morphological & functional changes are still
reversible.”
• The earlier the disease is diagnosed, & treated the better it is

for prognosis of the case & in the prevention of the
occurrence of other secondary cases.

Tertiary Prevention
• It is used when the disease process has advanced beyond
its early stages (late pathogenesis stage)
• It is defined as “all the measures available to reduce or
limit impairments and disabilities, & to promote the
patients’ adjustment to irremediable conditions.”
Modes of intervention:
I. Disability limitation
II. Rehabilitation

Disability limitation
To prevent or halt the transition of disease process from
impairment to handicap.
Disease
Impairment
Disability
Handicap

Impairment:
• Any loss or abnormality of psychological, physiological or
anatomical structure or function.
Disability:
•Any restriction or lack of ability to
perform an activity in the manner or
within range considered normal for
human being.

Handicap
• 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, & social and
cultural factors) for that individual.”

Rehabilitation
• The combined & coordinated use of
medical, social, educational, &
vocational measures for training &
retraining the individual to the
highest possible level of functional
ability.”
Examples of rehabilitation:
•Establishing schools for blind
•Provision of aids for crippled
•Exercises in neurological disorders

Rehabilitation
Medical Vocational Social Psychological

Rehabilitation Rehabilitation Rehabilitation Rehabilitation
Restoration Restoration Of Restoration Of Restoration Of

Of Function Capacity To Family And Social Personal Dignity
Earn A Relationships And Confidence
Livelihood

Principles of tertiary prevention

Quaternary Prevention
• The action taken to identify patient at risk of over-
medicalisation, to protect him from new medical
invasion, and to suggest to him interventions, which
are ethically acceptable.
• Quaternary prevention is the set of health activities to
mitigate or avoid the consequences of unnecessary or
excessive intervention of the health system.
• Quaternary prevention should take precedence over
any alternative preventive, diagnostic and therapeutic,
as is the practice version ‘primum non nocere’

Intervention types in
quaternary prevention
Healthcare professionals must be aware of the
consequences of their decisions, and include quaternary
prevention interventions in their daily clinical practice
with each patient.
• Do not mistake risk factor with disease.
• To avoid check ups or unnecessary exams.
• To avoid technical interventionism in healthcare.
• To avoid the indiscriminate use of antibiotics (very often
unnecessary, with the subsequent unjustified increase of
bacterial resistances)

Strategy for Prevention
Identify
Populations
at High
Modify Existing
Disease Risk
Intervention (based on
Programs demography /family
history, host factors..)
Evaluate Assess
Intervention Exposure
Programs
Conduct
Apply
Research on
Population- Mechanisms
(including the
Based study of genetic
Intervention susceptibility)
Programs
Epidemiology Division

Summary of levels of
Prevention

Control
The term disease control describes ongoing operations aimed
at reducing:
– The incidence of disease
– The duration of disease & consequently the risk of

transmission
– The effects of infection, including both the physical &

psychosocial complications
– The financial burden to the community.

Public Health Approaches
For Disease Control

• Control activities focus on primary
prevention or secondary prevention, but
most programs combine both.
Extinction The specific infectious agent no
longer exists in nature or in the
laboratory.
Eradication Termination of all transmission of

infection by extermination of infectious
agents
Elimination Reduction to zero of the incidence of a specified

disease in a defined geographic area as a result of
Control deliberate efforts
n Public Policy interventions that restricts the circulation of an infectious
agent beyond the level that would result from spontaneous individual
behaviors to protect against infection.

Disease Elimination
• Between control & eradication, an intermediate goal has

been described, called "regional elimination"
• The term "elimination" is used to describe interruption of

transmission of disease, as for example, elimination of
measles, polio and diphtheria from large geographic regions
or areas
• Regional elimination is now seen as an important precursor

of eradication.

Disease Eradication
• Eradication literally means to "tear out by roots".
• It is the process of “Termination of all transmission of
infection by extermination of the infectious agent
through surveillance and containment”.
• 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 no
longer occur in a population.
• To-date, only one disease has been eradicated, that is
smallpox.

Framework For Eradication

Control of Infectious Diseases
(The 4 “C”s)
Control
Cases Contacts Carriers Community

Diagnosis
Notification
Isolation Observation Detection Epidemiological
Disinfection Investigation &
Containment
Treatment
Follow up
Release

CONCLUSION
❖Understanding disease pathology is the first step
towards formulating preventive measures.
❖Prevention can be achieved in any stage of disease .
❖Primordial or primary prevention is most effective and
economical.
❖Disease control is also a part of prevention which is
achieved by means of continuous monitoring and
surveillance of disease.

REFERENCES
• Mir, A. M. (n.d.). A Synopsis of epidemiology and basic statistics. Karachi.
Retrieved 2nd
• Gordis, L. (2014). Epidemiology (Fifth edition.). Philadelphia, PA: Elsevier
Saunders. Gordis, Leon.
• Park K.(2011). Park’s Textbook Of Preventive And Social Medicine. 21st
Ed. Jabalpur: Banarsidas Bhanot.
• Miller M, Barrett S, Henderson DA. Control and Eradication. In: Jamison
DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al.,
editors. Disease Control Priorities in Developing Countries [Internet]. 2nd
ed. Washington (DC): World Bank; 2006 [cited 2015 Feb 5]. Available
from: http://www.ncbi.nlm.nih.gov/books/NBK11763/
• DCP_1163-1176.qxd - ch62.pdf [Internet]. [cited 2015 Feb 9]. Available
from: http://www.ncbi.nlm.nih.gov/books/NBK11763/pdf/ch62.pdf

REFERENCES
• Have You Heard of “Primordial Prevention”? - Improving Population
Health [Internet]. [cited 2015 Feb 9]. Available from:
http://www.improvingpopulationhealth.org/blog/2011/05/primordial_p
revention .html
• The Five Stages of Prevention: A New Paradigm for Classifying the
Prevention of Disease (Updated 2014) [Internet]. [cited 2015 Feb 5].
Available from:
http://www.academia.edu/5673406/The_Five_Stages_of_Prevention_
A_New_Par
adigm_for_Classifying_the_Prevention_of_Disease_Updated_2014_
REFERENCES
• Soben Peter. Essentials of Public Health Dentistry. 5th ed. New
Delhi: Arya Publising House; 2013.
• Molyneux DH, Hopkins DR, Zagaria N. Disease eradication,
elimination and control: the need for accurate and consistent usage.
Trends Parasitol. 2004 Aug;20(8):347–51.
• Dowdle WR. The principles of disease elimination and eradication.
Bull World Health Organ. 1998;76(Suppl 2):22–5.


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Concepts of Prevention &

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

❖ These goals are incorporated in the word "Prevention“.

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Pre-disease Primary Prevention Health promotion and

Latent Disease Secondary prevention Pre-symptomatic

Symptomatic Disease Tertiary prevention •Disability limitation

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

• Actions & measures that inhibit the emergence of risk factors

(- John Last’s dictionary)

Prevention of risk factors themselves, beginning with change in

Copyright © 2019 By Akash Samuel

• For example, many adult health problems (e.g., obesity,

Copyright © 2019 By Akash Samuel

• The Modes of intervention in primordial prevention is

• Has to start in childhood when health risk behavior

Copyright © 2019 By Akash Samuel

❖ Food and nutrition

❖ Against smoking and drug

❖ To promote regular physical activity

Copyright © 2019 By Akash Samuel

• It is designed to prevent a disease or condition, from

• It signifies intervention in the pre-pathogenesis phase of a

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

❖ Health promotion is “ the process of enabling people to

❖Efforts directed toward protection against

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

• For example, studies have shown that even a small

• The population approach is directed towards socio-

Copyright © 2019 By Akash Samuel

• This requires detection of individuals at high risk by the

Copyright © 2019 By Akash Samuel

• Action which halts the progress of a disease at

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

• The earlier the disease is diagnosed, & treated the better it is

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Medical Vocational Social Psychological

Restoration Restoration Of Restoration Of Restoration Of

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

Copyright © 2019 By Akash Samuel

– The incidence of disease

– The duration of disease & consequently the risk of

– The effects of infection, including both the physical &

– The financial burden to the community.