Natural History of Diseases

(Communicable Disease Epidemiology)

By:
Wubareg Seifu (MPH, Asst Professor)
December, 2022

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 Session Objective
At the end this session students, will be able to;
• Describe the natural history of disease

• Identify the natural History of disease

• Describe the Iceberg of disease

• Identify spectrum of disease

• Discuss disease causation theory

• Describe the level of disease prevention

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 Individual Reflection

• What will be the fate of individuals having TB

infection in the absence of treatment?

3
 NATURAL HISTORY OF DISEASE:
• It refers to the progression of disease process, in
the absence of intervention.

• Without intervention, the process ends with

• Recovery
• Disability or
• Death

4
 Natural History of Disease Timeline
• It has four stages:
– Susceptibility
– Pre-symptomatic disease
– Clinical disease
– Disability/Recovery/Death

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1. Susceptibility Stage

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2: Pre-symptomatic Stage

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3. Clinical Stage

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4. Stage of Disability/Recovery/Death

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Iceberg of Diseases

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 Floating Tips Submerged portion
• Contribute large segment
• What clinician diagnoses
of the population
and sees in the community • Hidden mass of diseases
• Clinical cases • Epidemiologist are
concerned about it
• Clinicians are concerned
• Screening is done
• Latent
• Presymptomatic
• Carriers
• Undiagnosed

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 Disease Causation Theory

The cause of a disease:

– is an event, condition or characteristics that

comes before the disease and without which
the disease wouldn’t occur.

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 Types of causes
• Necessary cause • Component cause
– Mycobacterium
– Mycobacterium
Tuberculosis
Tuberculosis
– Co-infection
• Sufficient cause
– Mycobacterium – Under nutrition
Tuberculosis
– Advanced age
– Co-infection
– Frequent exposure

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Disease Causation Theory

How do people perceive

disease occurrence?
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 Disease Causation Theory
Old Theories Recent Theories
• Supernatural theory
• Single germ
• Theory of contagion
• Hippocratic theory • Epidemiologic triad
• The miasma theory
• Theory of spontaneous • Multifactorial causation
generation
Limitation:
• There is no scientific
evidence for this theories

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 Group Discussion (5 minutes)

• What is the impact of supernatural

disease causation theory in the
fight against COVID-19?

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 The Single Germ Theory

• Louis Pasteur demonstrated the presence of bacteria

in air (1860)
• Robert Koch discovered anthrax caused by bacteria
• Each disease will be caused by a germ
• Without that germ that disease will not be caused
• One to one relationship of the causative agent and the
disease

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 Limitation of Germ Theory

• Why only some people suffer from disease

after exposure to micro organisms?

• We can not always identify micro organism

for every human disease?

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 Epidemiologic Triad Theory

• Disease in human population occurs due to the

disturbance in the interaction of
– host,

– agent and

– environment

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 Limitation of Epidemiologic Triad Theory

• Is not applicable for chronic and non

communicable diseases since they do have
multiple factors.

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 Multifactorial causation theory
• Petten Koffer (1819-1901) contradicted the
unifactorial theory of disease causation and
emphasized that disease is multifactorial in
causation.

• Several causes or factors acting jointly,

cumulatively, by complementing or in an
unexplained manner will lead to the disease.

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Multifactorial causation theory …

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Myocardial Infraction Occurrence

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Web of Causation for the Major Cardiovascular Diseases

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 Levels of Disease Prevention
Stage of disease Level of prevention Type of response

Pre-disease Primordial • Health policy preparation

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

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Levels of Disease Prevention
Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention
 Class Exercise
• Mr Y is a 65 year - old- male farmer who has
developed lower limb paralysis due to
uncontrolled HTN. The community believes that
paralysis associated with bad sprit/evil did.
• Discus the four levels of disease prevention for
this client.
– Primordial
– Primary
– Secondary
– Tertiary
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 1. Primordial Prevention
• Consists of actions and measures that inhibit the
emergence of risk factors in the form of
environmental, economic, social, and behavioral
conditions and cultural patterns of living etc.
– Policy formulation
– International agreement
– Resource management
• The main intervention in primordial prevention is
through individual and mass education
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 2. Primary Prevention
• Intervention that takes place before the disease is
established.

• Aimed at preventing healthy people from becoming

sick.

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Components of Primary Prevention

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2.1 Health Promotion

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2.2 Prevention of Exposure
(Specific protection)

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2.3 Prevention of Disease

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 Approaches for Primary Prevention

• The WHO has recommended the following approaches

for the primary prevention of where the risk factors are
established:

a. Population (mass) strategy

b. High -risk strategy

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 Secondary Prevention:
• Methods to diagnose and treat existent cases
early and effectively.

• Concerned about reduction of disease

prevalence in a certain population.

• Target groups are pre clinical and clinical stage.

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 Objective of Secondary Prevention

• Early diagnosis (screening)

• Treat affected individuals soon

• Prevent further complication

• Prevent spread of infection to others

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 Tertiary Prevention
• It is defined as “all the measures available to reduce or
limit impairments and disabilities.

• Intervention that should be accomplished in the stage of

tertiary prevention are disability limitation, and
rehabilitation.

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Disease Process Outcomes

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 2: Rehabilitation
• The combined and coordinated use of
➢Medical
➢Physical
➢Social
➢Economical
➢Vocational
• Retraining the individual to the highest possible
level of functional ability.
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 Rehabilitation

Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
 Individual Reflection

• What is the effect of health literacy level

on disease prevention?

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