LEVELS OF PREVENTION IN

EPIDEMIOLOGY
BY
DR. UMAR LAWAL BELLO
OBJECTIVES

• At the end of the lesson, the students should be able to:

• Highlight the different levels of prevention
• Describe how to control communicable diseases
• Apply the levels of prevention of diseases to common ailment in
the community setting
INTRODUCTION
•Control is presumed to be the ultimate aim of epidemiology but now
prevention seems to be taking the lead. In a narrow common usage,
prevention means the inhibition of the development of a disease
before it occurs.
•But in the broader sense, prevention also includes all measures
which interrupt or slow the progression of disease and the resulting
disability.
•Levels of prevention are classified into primordial,
primary, secondary and tertiary stages.
 Second
ary

Primary
Preventi Tertiary
on

Primordi
al
•Prevention in epidemiology is divided into the following stages.

•Stage 1: Primordial Prevention

•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.
•It is the prevention of the emergence or development of risk factors in countries
or population groups in which they have not yet appeared
•For example, many adult health problems (e.g., obesity, hypertension) have
their early origins in childhood, because this is the time when lifestyles are
formed (for example, smoking, eating patterns, physical exercise).
•In primordial prevention, efforts are directed towards discouraging children
from adopting harmful lifestyles. The main intervention in primordial prevention
is through individual and mass education (non-specific).
•Stage 2: Primary Prevention

•Primary prevention can be defined as the action taken prior to the

onset of disease, which removes the possibility that the disease will
ever occur. It signifies intervention in the pre-pathogenesis phase of
a disease or health problem. Primary prevention may be
accomplished by measures of “Health promotion” and “specific
protection”
•It includes the concept of "positive health", a concept that
encourages achievement and maintenance of "an acceptable level of
health that will enable every individual to lead a socially and
economically productive life".
•Primary prevention may be accomplished by measures designed to
promote general health and wellbeing, and quality of life of people or by
specific protective measures.

•Health promotion is “ the process of enabling people to increase control

over the determinants of health and thereby improve their health”. It
includes health education, environmental sanitation and good housing.

•The WHO has recommended the following approaches for the primary
prevention of chronic diseases where the risk factors are established:
[Link] (mass) strategy
[Link] -risk strategy
•“Population strategy" is directed at the whole population irrespective of
individual risk levels. For example, studies have shown that even a small
reduction in the average blood pressure or serum cholesterol of a population
would produce a large reduction in the incidence of cardiovascular disease.
The population approach is directed towards socio-economic, behavioral and
lifestyle changes.
•The high - risk strategy aims to bring preventive care to individuals at
special risk. This requires detection of individuals at high risk by the
optimum use of clinical methods.

•Specific protection includes chemoprophylaxis, immunisation and good

nutrition. This is the prevention stage which reduces exposure of an
individual or alters the susceptibility of either being affected by the disease
or not.
•Stage 3: Secondary Prevention

•The second stage is the stage of early diagnosis and treatment. This is any measure that
will interfere with the progression of the disease. The measures that constitute early
detection are: screening, case finding, mass x-ray to determine lung diseases and smear
to detect cancer of cervix in a woman.

•It is defined as “ action which halts the progress of a disease at its incipient stage
and prevents complications.” The specific interventions are: early diagnosis (e.g.
screening tests, and case finding programs….) and adequate treatment.

•Secondary prevention attempts to arrest the disease process, restore health by seeking
out unrecognized disease and treating it before irreversible pathological changes take
place, and reverse communicability of infectious diseases. It thus protects others from
the community from acquiring the infection and thus provide at once secondary
prevention for the infected ones and primary prevention for their potential contacts.
•WHO Expert Committee in 1973 defined early detection of
health disorders as “the detection of disturbances of
homoeostatic and compensatory mechanism while
biochemical, morphological and functional changes are still
reversible.”

•The earlier the disease is diagnosed, and treated the better it

is for prognosis of the case and in the prevention of the
occurrence of other secondary cases.
•Stage 4: Tertiary Prevention

•The third stage of prevention is rehabilitation. This is the alleviation of

disabilities from the disease and attempt to restore effective functioning. It is
used when the disease process has advanced beyond its early stages.
•It is defined as “all the measures available to reduce or limit impairments
and disabilities, and to promote the patients’ adjustment to irremediable
conditions.” Intervention that should be accomplished in the stage of tertiary
prevention are disability limitation, and rehabilitation.

•Impairment is “any loss or abnormality of psychological, physiological or

anatomical structure or function

•Disability is “any restriction or lack of ability to perform an activity in the

manner or within the range considered normal for the human being.”
•Handicap is termed as “a disadvantage for a given individual,
resulting from an impairment or disability that limits or
prevents the fulfillment of a role in the community that is
normal (depending on age, sex, and social and cultural
factors) for that individual.”
•Rehabilitation is “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.”
 CONTROL OF COMMUNICABLE DISEASE

•Control of communicable disease is the reduction of disease

incidence, prevalence, morbidity, or mortality to a locally
acceptable level as a result of deliberate efforts; continued
intervention measures are required to maintain the reduction.
•There are three main methods of controlling communicable
diseases:
•1. Elimination of the Reservoir
•a. Man as reservoir: When man is the reservoir, eradication of an
infected host is not a viable option. Instead, the following options
are considered:
i. Detection and adequate treatment of cases: arrests the
communicability of the disease (e.g. Treatment of active
pulmonary tuberculosis).
[Link]: separation of infected persons for a period of
communicability of the disease. Isolation is indicated for
infectious disease with the following features:
 High morbidity and mortality
 High infectivity
• Quarantine: limitation of the movement of apparently well
person or animal who has been exposed to the infectious disease
for a duration of the maximum incubation period of the disease.
•b. Animals as reservoir: Action will be determined by the usefulness of
the animals, how intimately they are associated to man and the feasibility of
protecting susceptible animals.
•For example:
• Plague: The rat is regarded as a pest and the objective would be to
destroy the rat and exclude it from human habitation.
ii. Rabies: Pet dogs can be protected by vaccination but stray dogs are
destroyed.
[Link] animals used for food are examined and destroyed.

c. Reservoir in non-living things: Possible to limit man’s exposure to the

affected area e.g. Soil, water, forest, etc.
[Link] of transmission
•This involves the control of the modes of transmission from the reservoir
to the potential new host through:
i. Improvement of environmental sanitation and personal hygiene
ii. Control of vectors
iii. Disinfections and sterilization

[Link] of susceptible host: This can be achieved through:

i. Immunization: Active or Passive
ii. Chemo-prophylaxis- e.g. Malaria, meningococcal meningitis, etc.
iii. Better nutrition
iv. Personal protection. (e.g. wearing of shoes, use of mosquito bed net,
insect repellents, etc.)
 CLASS ACTIVITY
(10mins)

Utilizing the four levels

of prevention, briefly
discuss how you can
prevent malaria in your
community (8mrks)
• THANK YOU