CPH lesson 1 reviewer

Saturday, 4 February 2023 10:55 pm

Epidemiological Approach

1. Filth interpretation of disease

Environment Sanitation
2. Statistical Approach
Analysis of Cause
3. Medical Geography Methods
Historical and Geographical Pathology
4. Field Study of Disease
Germ Theory of Disease
5. Microbiological Methods
Disease agents, Zoonoses, Arthropod role in disease transmission

Concepts of Theories of Disease Causation

1. Religious Theory
Associate disease with religion
Evil spirit and recovery to good spirit
Disease is viewed as a way of punishing those who offended the gods
Appeasing or driving evil away through offering and sacrificing animal or human
2. Filth Theory
Associate disease with physical environment
Disease variations are noted with changes of season, climate, temp, overcrowd and filth.
This theory, disease is brought abt poisonous substances and gases from earth and many
febrile cases were observed.
"bad air" was the cause of fever. By building huge fires, it can purify polluted air.
Programs to remove filth were likewise put that serve advance to community sanitation.
3. Germ or Bacteriological Theory
This theory evolved as a result of Pasteur's investigation in the latter half of 19th century.
Koch's confirm his finding as well as other scientists that disease is due to microscopic forms
of life.
Germ theory opened up new ways of controlling disease - Isolation and Quarantine.
Removing bacteriological cause such as disinfection, fumigation and general cleanliness
were employed. Bacteriology also helped to introduce the concept of origin and mode of
spread of communicable disease.
4. Concepts of multiple causation
The present concept of causation states that disease results form the interaction of multiple
ecologic factors within a dynamic system made up of an agent of disease, host and the
environment.
Environment is the sum total of all those things which we come in contact with and that
which affect us.

Why should a health worker be concerned with cause or etiology of disease?

Cause is important to us basically in guiding our approach to the tasks of prevention,
diagnosis, and treatment of disease.

Our Role
1. Determine the health status and needs of the people
2. Determine the extent to which these needs are being met by effective measures currently
 available.
3. Take steps to see that unmet needs are satisfied.
Services needs to check on:
Provision - adequate, comprehensive
Delivery - Efficient
Effective use of existing resources

Concepts of Cause
1. A cause is defined as something that brings about effect or a result
2. Pre-Koch's Era - many different bacteria caused any given disease
3. Robert Koch's Postulate states that.. " A particular disease has cause and a particular cause
results in one disease"
• The organism must be present in every case of the disease.
• The organism must be isolated and grown in pure culture
• The organism must cause a specific disease with inoculated into an animal
• The organism must then be recovered from the animal and identified
4. Web of Causation- many factors act together to cause disease,
5. A Cause is established by the effects of other determinants or risk factors like people's
behavior or their environmental characteristics.

Theory of Disease Causation

 Disease results from an imbalance between disease agent and man
 The nature of extent of the imbalance depends on the nature and characteristics of the host
and agent
 The characteristics of the two are influenced considerably by the conditions of the
environment.

PREVENTION is a principal responsibility of all health workers.

Patient often ask questions about what measures to take for maintaining health and
preventing certain diseases. Most opportunities for preventing diseases. Most opportunities
for preventing disease require an understanding of the etiology or cause of disease, so that
exposure to a causal factor in the environment can be reduced or the pathogenic chain
leading from the causal factor to the development of clinical illness can be interrupted.

Factors in Causation
1. Pre Disposing Factors - create a state of susceptibility to a disease of or state.
Example: Age, Sex, Past illness
2. Reinforcing Factors - aggravates an already established disease of or state.
Example: Unduly hard work, repeated exposure
3. Enabling Factors - factors which favor the development of disease or assist in recovery from
illness or in the maintenance of good health.
Example: poor nutrition, bad housing, low income, inadequate medical care
4. Precipitating Factors - are associated with onset of disease.
Example: exposure to a specific disease agent or a noxious agent

Risk Factors
1. Age, Sex, and Race
2. Signs and Symptoms
3. Personal and Medical History
4. Environment and Occupation

Ways by which PCP can Implement Prevention into Clinical Practice

 Identifying high risk individuals
 Screening the population at risk
 Detecting disease in its earliest stages
 Providing health educ for primary prevention
 Identifying and participating in efforts to remove harmful agents from the workplace and
the ambient environment

Reasons why Risk Factors are Difficult to Identify

1. Multiplicity of causation and outcome
2. Long latent period between exposure to risk factors and onset of disease manifestations
3. Low incidence of the particular disease

Effect of Parasites on the host

• Inflict damage on the host
• Secrete cysteine proteases that facilities tissue invasion by digesting cellular material and
degrade basement membrane.
• Invasion and destruction of the host tissue by destroying RBC's by the plasmodium malaria
• Hookworm cause massive bleed leading to Iron Deficiency Anemia IDA
• Diphyllobothrium Latum (Fish Tapeworm) compete for Vit. B nutrient producing
megaloblastic anemia.

Effect of the Host on Parasites

Genetic make-up of host influence H-P interaction: In Falciparum malaria, possession of
sickle cell trait confer protection, while presence of Duffy blood factor increases
susceptibility to Plasmodium Vivax (Malaria parasite) infection
Host nutrition
• Protein rich diet
Suitable for development of protozoans
• Low protein diet
Favor amebiasis and its complications
• High CHO
Favor tapeworm development

Effects of age and sex

If TB infection occurs at particular age and sex and the patient has low resistance, it is
possible that patient will develop TB. The plus sign (+) gives the relative importance of a
particular factor in damaging the patient's power to resist the TB bacilli. The risk factor
increase in the incident of TB in RP such as age, HIV/AIDS and the culture of poverty. In the
latter risk factor, overcrowding and malnutrition are probably the most important. Poverty
leads to bad and overcrowded housing or poor work conditions. It will also lower resistance
as well as make the infection more likely. The culture of poverty is an enabling factor for TB
to cause disease. In populations where disease is introduce for the first time people often
died in a few months from TB.

Nutrition
Starvation and malnutrition reduces resistance to disease. This is as very important risk
factor in marginalized communities, both in adult and children.