DISEASE PREVENTION

and CONTROL
By Dr. Nadya Elarusy
CONCEPT OF DISEASE
CAUSATION
CAUSAL CONCEPTS
 Natural History of Disease
 Simple Model
 Level of Prevention
 Spectrum of disease and “the iceberg”
 Causal concept of disease
 Agent, Host, and Environment
 Causal Web
EPIDEMIOLOGICAL TRIAD
 The causes of disease are often considered in
terms of a triad of factors:
 The host
 The agent
 The environment
 For infectious disease, it is useful to add a fourth
factor, the vector.
 EPIDEMIOLOGY TRIAD

•Personal hygiene
•Social behaviour
•Occupation
•Genetic
HOST •Previous Disease
•Immune status

•Biologic agents •Sanitation

Vector
•Chemical agents •Water supply
•Physical agents •Food hygiene
AGENT ENVIRONMENT
•Social and •Housing
psychological
stressors

Figure 1: The epidemiologic triad of disease

EPIDEMIOLOGICAL TRIAD
This triad represents the relationship / interaction
between the environment, infectious agent and
hosts.
The interaction among these three categories
dictate the impact of any infection.
 AGENT FACTORS
The classification of agents:
i. Biological agents
• Bacteria, virus, protozoa, helminthes, fungi
ii. Chemical agents
• Drugs, insecticide
iii. Physical agents
• Humidity, intense sound, vibration, heat, cold, light, pressure,
electromagnetic radiation
iv. Mechanical agents
• Bullets, knives, and other agents which may cause death and
disability.
v. Nutrient agents
• High fat diet, high cholesterol diet, vitamin deficiencies, protein-
calorie malnutrition.
vi. Social agents
• Tobacco use, drug abuse, physical inactivity
HOST FACTORS
Host factors are intrinsic factors that influences an individual
exposure, susceptibility, or response to a causative agent. These
factors include:
i. Age
ii. Sex
iii. Ethnicity
iv. Marital status
v. Religion
vi. Occupation
vii. Resistance
viii. Immunity
ix. Behavior
x. Genetic composition
xi. Psychological makeup
xii. Anatomic structure
xiii. Presence of disease or medication
xiv. Nutritional status
ENVIRONMENT FACTORS
Environment factors is the sum total of all external
conditions /extrinsic factors and influences that
affect the life and development of an organism.
It thus influences both the agent and the host.
ENVIRONMENT FACTORS
Environmental factors include:
oPhysical factor such as:
• Climate, physical surrounding (e.g., nursing home, hospital)
oEcologic factors such as:
• Vectors that transmit the agent
oSocio-economic factors such as:
• Overcrowding, sanitation, water supply, housing, ventilation, and the
availability of health services.
Multifactorial causation
 The epidemiologic triad of disease is not applicable
for non infectious and chronic diseases like coronary
artery diseases. Because it has multiple factors
 This theory helps to understand the various
associated causative factors, priorities, and plan
preventive measures to control the disease.
Web of Causation
Web of causation considers all predisposing factors and
their interaction
CONCEPTS OF PREVENTION
Successful prevention depends up on:
 A knowledge of causation
Dynamics of transmission
 Identification of risk factors and risk groups
Availability of prophylactic or
Early detection and treatment measures
LEVEL OF PREVENTION
 Levels of prevention:
o Primordial prevention: Prevention of the emerge or
development the risk factors
o Primary prevention: Prevention of the disease
occurrence.
o Secondary prevention: Prevention of the
development of disease complications
o Tertiary prevention: the preventive measures aimed
to reduce or eliminate long-term impairments and
disabilities
Primordial prevention
 It is Prevention of the emerge or development the risk
factors (environmental, economic, social, behavioral)
known to increase the future risk of disease in population
groups.
 Childhood is usually the target group for this type of
prevention
 Examples of primordial prevention:
 Improving sanitation
 Promoting a healthy lifestyle in childhood
 The main intervention in primordial prevention is through
individual and mass education
PRIMARY PREVENTION
An action taken to prevent the development of
a disease in order to reduce its incidence.
Avoid exposure to the agent of disease
Is directed towards the pre-pathogenesis
phase/susceptibility stage
 PRIMARY PREVENTION
 2 components:
i. Health promotion
ii. Specific protection
Health promotion
 Consist of non-medical changes in life-style,
nutrition and the environment
 It intended to strengthen the host through
variety of interventions:
a. Health education
b. Environmental modifications
c. nutritional interventions
d. life-style and behavioral changes
PRIMARY PREVENTION
Specific protection:
 If health promotion changes are not fully
effective, it may be necessary to employ
specific protection
Examples:
 Immunization/vaccination
 Use of specific nutrients
 Chemoprophylaxis
 Protection against occupational hazards
 Protection against accidents
 Protection from carcinogens
 Avoidance of allergens
SECONDARY PREVENTION
Directed towards the subclinical stage in people
who carry the agent but are not yet symptomatic.
The identification of people who have already
developed a disease, at an early stage.
Activities targeted at detecting disease at earliest
possible time to:
 Begin treatment
 Stop progression
 Protect others in the community
SECONDARY PREVENTION
 It is largely the domain of clinical medicine
 It is often more expensive and less effective
than primary intervention
 Component: early detection (screening or
case finding) and prompt treatment.
SECONDARY PREVENTION
 Screening:
 Active detection of a disease in asymptomatic,
apparently healthy individual (eg: PAP Smear for
cervical cancer, tuberculin skin test for TB).
 Purpose:
To detect a disease in asymptomatic individuals. So
reducing the morbidity and mortality in certain
disease as, essential hypertension, cervix and
breast cancers
To detect earliest symptoms of a disease.
Shortening of the period of communicability and
reducing the mortality from communicable
diseases. E.g: TB, STD
SECONDARY PREVENTION
 Prompt treatment
 Treating asymptomatic patients may prevent the
progression to symptomatic disease
 e.g. treating asymptomatic HIV-infected patients
with antiretroviral therapy to delay the onset of
AIDS.
TERTIARY PREVENTION
 Directed toward the clinical stage of disease.
 Disease has become symptomatic.
 The aim is to prevent or minimize the progression of
the disease or its complication.
 The key goal of tertiary prevention is to improve
quality of life
 2 components:
i. Disability limitation – for patients with early
symptomatic disease.
ii. Rehabilitation – for patient with late symptomatic
disease.
TERTIARY PREVENTION
 Disability limitation:
 Medical or surgical measures aimed at
correcting the anatomic and physiologic
component of disease in symptomatic
patient.
 limit the progression of disease.
TERTIARY PREVENTION
 Rehabilitation:
 Seeks to soften the impact of the disease and
thus preventing it from causing complete social
and functional disability
 e.g: Stroke patient may be taught how to care for
himself or herself in the activities of daily living.
This may enable him or her to avoid the negative
effects associated with prolonged inactivity (e.g:
increasing muscle weakness)
TERTIARY PREVENTION
 Disability limitation:
 Medical or surgical measures aimed at correcting the
anatomic and physiologic component of disease in
symptomatic patient.
 limit the progression of disease.
 Goal is to halt the disease process and thereby prevent
or limit the impairment.
DISEASE CONTROL
Disease Control:
I. Communicable disease control (CDC).
II. Non-communicable disease control (NCDC).
The term “disease control” describes ongoing operations aims:
1. To reduce the incidence of disease.
2. To reduce the duration of illness, and subsequently the
risk of transmission.
3. To reduce the subclinical case.
4. To remove carriers of disease.
5. To reduce the effects of infection, including both the
physical and psychosocial complications; and
6. To reduce the financial burden to the community.
DISEASE CONTROL
 In disease control, the disease ‘’agent’’ is
permitted to persist in the community at a level where it
ceases to be a public health problem according to the
tolerance of the local population.
 Disease control involves all measures designated
to reduce disease incidence, prevelance,
morbidity or mortality to a locally acceptable level.
 Control activities may focus on:
 Primary and secondary prevention
 The concept of tertiary prevention is
comparatively less relevant to control efforts.
 These can be judged by morbidity and mortality
figures
 DISEASE CONTROL
 The success of control program depend on:
i. The knowledge of the cause of disease
ii. Its transmission
iii. Identifying risk factors in individuals, groups and
community,
iv. Availability of prophylactic measures
v. Active immunizations
vi. Active case detection
vii. Treatment, and
viii. Public health measure.
 DISEASE ELIMINATION
The term elimination is used to described interruption of
transmission of disease.
Disease elimination: Reduction of the incidence of infection
caused by a specific agent to zero in a defined geographic
area; continued measures to prevent reestablishment of
transmission (eg: polio, measles).
 It is placed between control and eradication and can
be taken a step for eradication of disease.
 It is a disease free zone in a definite geographical
area. But it is still present in other countries
DISEASE ERADICATION
 Eradication of disease:
 It is complete removal of disease from
the world.
 Permanent reduction to zero of the
worldwide incidence of infection caused by
specific agent; intervention measures are
no longer needed (eg; small pox).