Concept of Prevention and Control

Dr Akila GV
Assistant professor
Department of community medicine
 INTRODUCTION
The term NATURAL HISTORY OF DISEASE signifies
the way in which a disease evolves over time from the
earliest stage of pre pathogenesis phase to its termination as
recovery, disability, or death in the absence of treatment or
prevention.
 NATURAL HISTORY OF DISEASE

The natural history of disease consists of two phases

➢ Pre pathogenesis – process in environment.

➢ Pathogenesis – process in man.

 PRE PATHOGENESIS PHASE
➢ The disease agent has not entered man but the factors which
favors its interaction with the human host are already existing in
environment.

➢Epidemiological triad – agent ,host ,environment.

➢Interaction is required to initiate disease process in man.

 PREVENTION
• To anticipate ,to precede, to make impossible by advance
provision.

• Anticipatory action based knowledge of natural history of

disease in order to make the onset or further progress of
disease unlikely.

• The objective is to intercept or oppose the cause and thereby

the disease process.
 INTERVENTION
• As any attempt to intervene or interrupt the usual sequence in
the development of disease.

• The levels of prevention and modes of intervention include

➢Primordial prevention
➢Primary prevention
✓ Health promotion
✓Specific protection
• Secondary prevention

✓ Early diagnosis and treatment

• Tertiary prevention

✓ Disability limitation

✓ Rehabilitation
 PRIMODIAL PREVENTION
• Prevention of emergence or development of risk factor in
countries or population groups in which they have not
appeared.

• Main intervention is by individual and mass education.

• For instance in IHD, if we create condition in which cigarettes

are not available or tobacco is not produced.
 PRIMARY PREVENTION
• Defined as action taken prior to onset of disease which
removes the possibility that a disease will ever occur.

• Intervention is done in pre pathogenesis level.

• Approach to primary prevention :

✓ Population strategy
✓ High risk strategy
➢Population strategy

This is directed at the whole population irrespective of

individual risk factors.

Its directed towards socio economic, behavioral and lifestyles changes.

➢ High risk strategy

To bring preventive care at individual at special risk.

To have an impact on the population three approaches
➢ Primordial prevention
➢ Population strategy
➢ High risk strategy
Health promotion

• The process of enabling people to increase control over, and

to improve health”.

• These include all steps undertaken to improve the level of

general health and well being so that conditions for initiation
of disease process are prevented.
• The intervention can be grouped under following heading :
✓Health education
✓Environmental modification
✓Nutritional intervention
✓Lifestyle and behavioural changes
✓Legislation
✓advocacy
• SPECIFIC PROTECTION

These include measures to prevent the initiation of specific

diseases or a group of diseases.

• Immunization
• Use of specific nutrients
• Chemoprophylaxis
• protection against occupational hazards
• Protection against accidents

• Protection from carcinogens

• Avoidance of allergens

• The control of specific hazards in the general

environment, eg air pollution, noise control

• Control of consumer product quality and safety of foods,

drugs, cosmetics, etc
 SECONDARY PREVENTION

• Defined as action which halts the progress of a disease at its

incipient stage and prevents complication.

• Early diagnosis and treatment

Early diagnosis is defined as the detection of disturbances of
homoeostatic and compensatory mechanism while biochemical,
morphological, and functional changes are still reversible and
prevents complication.
• It includes:

Case finding measures individual and mass

Screening surveys

Selective examination

• Objectives:

To cure and prevent disease process.

To prevent the spread of communicable disease.

To prevent complications and sequelae.

To shorten period of disability.

 TERTIARY PREVENTION

• Tertiary prevention can be defined as all measures available to

reduce or limit impairments and disabilities, minimise suffering
caused by existing departures from good health and to promote the
patient's adjustment to irremediable conditions
 DISABILITY LIMITATION
• These include all measures to prevent the occurrence of further
complications, impairments , disabilities and handicaps or even
death.
• The sequence of events are

Disease Impairment Disability Handicap

✓ Disease:

This is a pathological process and it’s manifestations which

indicate a departure from the state of perfect health
✓ 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 the
range considered normal for a human being

✓ Handicap:

A disadvantage for a given individual, resulting from an impairment or a disability, that

limits or prevents the fulfilment of a role that is normal for that individual.
 REHABILITATION

• Defined as "the combined and coordinated use of medical, social, educational and
vocational measures for training and retraining the individual to the highest
possible level of functional ability“

• Rehabilitation is undertaken at four dimensions :

• Medical rehabilitation :
This is done through medical / surgical procedures to restore the anatomy,
anatomical functions and physiological functions to as near normal as
possible.
• Vocational rehabilitation :

This includes steps involving training and education so as to enable the person to
earn a livelihood

• Social rehabilitation :

This involves steps for restoration of the family and social relationships.

• Emotional and Psychological rehabilitation :

This involves steps to restore the personal dignity and confidence.

• Examples of rehabilitation are:

• establishing schools for the blind.

• provision of aids for the crippled,

• reconstructive surgery for leprosy,

• muscle re-education and graded exercises in neurological disorders

like polio,

• change of profession for a more suitable one and modification of

life in general in the case of tuberculosis, cardiac patients and
others
 Conclusion
• The evolution of each specific disorder of man follows a more
or less constant process arising before man is involved which is
termed the natural history of disease.

• It is clear that knowledge may be lacking many of the links in

chain of causation and effects which contribute to a particular
natural history but application of preventive measures at one level
or another need not await complete knowledge of all cause and
effects
THANK YOU