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PREVENTION AND CONTROL

OF DISEASES

DR.(BRIG) S.K. AGGARWAL


PROF
DEPT OF COMMUNITY MEDICINE

Pre-Pathogenesis phase
Disease
Process

Pathogenesis phase

Man not yet


affected
Agen
t

Death
Chronic

Host

Disability/defe
ct
illness
Tissue/physi
o change
multiplicatio
n
Entry

Environment

Mode of
intervention

Primary
preventi
on
Health
Specific
Promotio Protectio
n
n

Immunity/
resistance

Recovery

Interaction--- Host
raction
Early path Early
lesions

Level of
preventi
on

Sign/symptom
s

Secondary
prevention

ED&T

Advance
disease

Convalescence

Tertiary prevention
Disability
Limitatio
n

Rehabilitation

NATURAL HISTORY OF DISEASE


PATHOGENESIS STAGE
Entry of agent, multiplication, tissue and

physiological changes, I.P., clinical phase,


Post-clinical phase
Host reaction is unpredictable may result in
sub-clinical/in-apparent infection/ carrier state
May be modified by
immunisation/chemotherapy/chemoprophylax
is
Process insiduous in chronic diseases like
CHD

RISK FACTORS
Exact agent of disease can not be identified e.g. CHD,

peptic ulcer, cancer, mental diseases


An attribute/exposure significantly associated with
development of disease
An determinant modifiable by intervention reducing
possibility of disease or adverse outcome
e.g. smoking and lung cancer
Often suggestive but absolute proof of cause and

effect usually lacking


Presence does not denote that disease will occur and
absence of it meaning disease will not occur

RISK FACTORS
Identifiable prior to event/disease
Combination of risk factors may have additive or

synergistic effect on occurrence of disease


smoking and occupational exposure - additive
Smoking, hypertension and high cholesterol levels

synergistic for CHD

Causative - smoking & lung cancer


Contributory lack of exercise in CHD

RISK FACTORS
Modifiable smoking, hypertension, raised cholesterol

levels, obesity, physical exercise


OR
Non-modifiable age, sex, race, genetic factors
Individual

OR
Collective malaria risk areas, pollution, poor water supply
Risk factors as well as degree of risk are determined by

epidemiological studies
Importance pre-symptomatic screening for diseases

RISK GROUPS
Risk/target groups identified as per certain criteria,

who need special priority attention for health care


Risk group can be defined as a group of people or

a subsection of the population, who, by virtue of


certain characteristics, are likely to have a higher
probability of suffering from one or more diseases
or from general ill health
Also called Risk Approach
A health care management strategy
More efficient utilisation of existing resources

RISK FACTORS GUIDELINES


FOR DEFINING AT-RISK
GROUPS
Biological situation
Age e.g. infants, LBW, toddlers, elderly
Sex females in reproductive age
Physiological state Pregnancy
Genetic factors family h/o genetic disorders

Physical env

Slums/ overcrowded conditions/poor water


supply/proximity to industries

Socio-cultural situation

Social class, ethnic group, access to health services,


lifestyle and other harmful behaviour pattern

AIM & OBJECTIVES OF


PREVENTION & CONTROL
Preserve, restore and promote health
To reduce burden of disease - incidence and

prevalence
To reduce duration of disease
To reduce severity & complications
To reduce mortality
To reduce further spread and transmission
To reduce financial burden

PRE-REQUISITES FOR
PREVENTION AND
CONTROL
Knowledge of
Natural h/o disease
Aetiology/ causation
Dynamics of transmission
Availability of prophylactic/early detection tools
and treatment
Organisational infrastructure
Continuous monitoring and evaluation

SOME IMP
TERMINOLOGIES
Diseases control
Diseases

elimination
Diseases

Eradication

DISEASE CONTROL
Containment of disease to a level where it

ceases to be a Public Health problem


Disease agent persists in community at a low
level
State of equilibrium is established between
agent, host and environment

DISEASE ELIMINATION
Intermediate goal between control and

eradication
Interruption of transmission and elimination of
disease from a large geographic area/region
Regional elimination is precursor for
eradication
E.g. Measles, Diphtheria, Polio

DISEASE ERADICATION
Termination of all transmission of infection by

extermination of agent
Absolute process to uproot
Used for cessation of infection/disease from globe
SMALLPOX is only disease to have been eradicated
from world
Polio, Measles and Guineaworm
disease(Dracunculiasis)
are considered amenable for eradication

DISEASE ERADICATION
Every disease has its own epidemiological

characteristics - Natural history, dynamics of


transmission, existence of carriers/reservoirs
of infection, animal hosts , and
availability/otherwise of vaccine and effective
treatment
Every disease is , as such , not amenable to
eradication

DISEASE ERADICATION
Control measures aim to reduce morbidity from

disease
Once morbidity is reduced substantially, residual

infection still persists in community/area and state


of equilibrium is established
There many be hidden sources of infection and

unrecognised modes of transmission, changes in


organism like resistance etc and these may get
activated whenever equilibrium is disturbed

DISEASE
PREVENTION
Prevention

Promote
health

Preserve
health

Restore
health

LEVELS OF
PREVENTION
Primordial
Primary
Secondary
Tertiary

PRIMORDIAL
PREVENTION
New concept, especially applicable for chronic

Diseases
Prevention of emergence/development of risk
factors/unhealthy lifestyles in populations
where these have not yet occurred/appeared
discouraging to adopt harmful lifestyles
smoking, eating patterns, lack of physical
exercise
By individual / mass education

PRIMARY PREVENTION
Action before onset of disease ( Pre-

pathogenic phase)
Removing possibility of occurrence of disease
By Health promotion and Specific
protection , as also Health Education
Not only for prevention of occurrence of
disease but also includes concept of Positive
Health
Also for chronic Diseases - elimination/
modification of risk factors

PRIMARY PREVENTION
Approaches
1.

Population/Mass strategy

E.g.

Small reduction in BP/Cholesterol levels of


populations leads to large reduction in incidence of CHD

Directed

towards socio-economic, behavioural and


lifestyle changes in populations

PRIMARY PREVENTION
2. High-risk strategy
Detection

of people at high risk and


modifying risk factors

PRIMARY PREVENTION
Safe, low cost, high returns
E.g. Rise in std of living(Primary Prevention)

even before availability of vaccines/ other


medical interventions led to drastic
reduction /control of many comm. Diseases
Holistic approach measures of health
promotion, protection from disease agents
and protection from environmental hazards

SECONDARY
PREVENTION
To halt progress of disease at its early stage and prevent

any complications ( Early pathogenesis stage)


Early diagnosis and Treatment ( includes case finding

and screening)
Aims to search for un-recognised illness and early

treatment before irreversible changes occur


Collateral advantage prevents further transmission of

disease protects community from acquiring infection( Pr.


Prevention)
More expensive and less effective than Primary Prevention

TERTIARY PREVENTION
Late pathogenesis stage
Aim to limit/ reduce further impairment

/disability and promote/hasten adjustment to


his conditions/environment
Includes Disability limitation and
Rehabilitation
May still help to prevent sequelae of disease

MODES OF INTERVENTION
Health Promotion
Specific protection
Early diagnosis and treatment
Disability limitation
Rehabilitation

HEALTH PROMOTION
Enabling people to have increased control to

improve their health


Aim strengthen host
Health education
Environmental sanitation
Nutritional interventions
Lifestyle and behavioural changes
Exercise & physical activity/yoga/meditation
Periodic health check-ups
Healthy habits
Healthy behaviour faithful partner
Safe drinking water

HEALTH PROMOTION
1. Health Education
Most cost effective
Inform about diseases their causation and
prevention
Aimed at general public, priority groups, indls,
community leaders, decision makers
2. Environmental modifications
E.g. Safe water, sanitary latrines, control of
pests/rodents, better housing etc

HEALTH PROMOTION
3. Nutritional interventions
Nutrition education, food fortification, nutritional
supplementation, nutritional programmes
4. Lifestyle and behavioural changes
Requires individual and community responsibility
for health
Role of treatment providers as educators
Health education is imp for changing opinions,
habits and behaviour

SPECIFIC PROTECTION

Immunization
Chemoprophylaxis
Occupational hazards and accidents
Environmental control

carcinogens/ allergens/pollution
Safety and quality of food & drugs
Nutrition - Iodised salt for goiter
- Iron & folic acid
- Mid day meal
- Vit A for
Nightblindness
Genetic counselling

EARLY DIAGNOSIS AND


TREATMENT
Aim to detect disturbances in

homeostatic/compensatory mechanisms when


biochemical, structural and functional changes
are still reversible
Criteria of diagnosis generally based on detection
of these changes as they precede development of
manifest signs and symptoms of disease
Improves prognosis and prevents occurrence of
secondary cases and long term disability
Reduces morbidity and mortality e.g. Ca
cervix/breast, hypertension, Tuberculosis, Leprosy
Prevention / Control ?

EARLY DIAGNOSIS & PROMPT


TREATMENT
SCREENING
MEDICAL EXAMINATION
SURVEYS

DISABILITY LIMITATION
Late pathogenesis phase to halt progression of

disease process to impairment and handicap


1.

Impairment

Loss/abnormality of psychological, physiological or


anatomical struction or function

e.g.

loss of foot, defective vision, mental retardation

May

lead to secondary impairments

e.g.

Leprosy damage to nerves plantar ulcers or


foot drop

DISABILITY LIMITATION
2. Disability
Restriction/inability to do certain activities/functions

In the manner or range considered normal


3. Handicap
Disadvantage resulting from impairment/disability

that limits/prevents individual from fulfilling his/her


role considered normal for that individual

DISABILITY LIMITATION
Accident
medical
Loss of foot

--- Disease
--- Impairment

Inability to walk - Disability


social
Unemployed

Largely

----- Handicap

Largely

DISABILITY
LIMITATION
TREATMENT:
Medical
Surgical

REHABILITATION
Combined and coordinated use of

medical, social, educational and


vocational measures for training and
retraining individual to highest possible
level of functional ability
Aim
To reduce impact of disability/handicap and
enable his social integration ( Active
participation in mainstream of community life)

REHABILITATION
Medical - restoration of

function( must start very


early in treatment process)
Vocational - restoration of
capacity to earn
Social - restoration of
family & social
relationship
Psychological restoration of dignity &
confidence

REHABILITATION MEDICINE
New speciality
Includes disciplines of Physiotherapy,

occupational therapy, speech therapy,


audiology, psychology, social work, vocational
guidance and placement services
Rehabilitation a difficult and demanding

task, requires patience, cooperation,


dedication and perseverance on the part
of everyone involved

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