Concepts of Disease,

Prevention and Control

Ms.Hellen Amaguru
 Session objectives
• By the end of this session students should be
able to;

1. To describe the levels of disease prevention

2. To discuss the general principles of disease

prevention.

3. To describe modes of intervention.

 Prevention
 The goals of medicine are to promote health, to
preserve health, to restore health when it is
impaired & to minimize suffering and distress.

 These goals are embodied in the word "prevention"

 Disease prevention includes measures not only to prevent

the occurrence of disease, such as risk factor reduction, but
also to arrest its progress and reduce its consequences once
established.
 Prevention; Definition & Concept
• Actions aimed at eradicating, eliminating or minimizing
the impact of disease and disability, or if none of these
are feasible, retarding the progress of the disease and
disability.

• The concept of prevention is best defined in the context

of levels, traditionally called primary, secondary and
tertiary prevention. A fourth level, called primordial
prevention, was later added.
Levels of Disease Prevention and Control
 Levels of Dx prevention
Levels of Phase of Target
prevention disease
Primordial Underlying Total population and
conditions selected groups
leading to
causation
Primary Specific causal Total population,
factors selected groups and
healthy individuals

Secondary Early stage of Patients

disease

Tertiary Late stage of Patients

disease
(treatment,
rehabilitation)
 Primordial prevention
 Primordial prevention is defined as prevention of risk
factors themselves, beginning with change in social and
environmental conditions in which these factors are
observed to develop, and continuing for high risk
children, adolescents and young adults.

 Primordial prevention, a relatively new concept, is

receiving special attention in the prevention of chronic
diseases. 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.
 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 &
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).
 Primordial prevention
• 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.

• General access to energy-dense diets coupled with

typically sedentary urban lifestyles creates a trend
toward obesity and chronic disease.
 Primordial prevention
• It is important to change the the surroundings or
environment that somebody lives in that promotes
major risk factor development.

• Primordial prevention calls for changing the socio-

economic status of society. A better socio-economic
status correlates inversely with lifestyle factors like
smoking, abnormal food patterns and exercise.
 Primordial prevention
• Primordial prevention begins in childhood when health
risk behaviour begins. Parents, teachers and peer groups
are important in imparting health education to children.

• Cost-effectiveness of primordial prevention.

• The cost of prevention:

– can we afford it?
– can we afford not to do it?
 Primordial prevention
• Examples of primordial prevention actions:

• National policies and programmes on nutrition involving

the agricultural sector, the food industry, and the food
import-export sector.

• Comprehensive policies to discourage smoking.

• Programmes to promote regular physical activity.

 Responsibilities for primordial
prevention:
• Government - to legislate (e.g. anti-tobacco advertising), develop and fund
intervention programs. A high level of government commitment is required for
effective primordial prevention.

• Professional and non-governmental organizations - to develop targets in

conjunction with government, advise and provide educational resources to
government and the community, educate health-care providers.

• Industry - to support recommendations from government and professional

bodies (e.g. food processing, tobacco advertising), health promotion, funding.

• Hospitals, health clinics, health practitioners and health-care workers - for

health promotion, risk assessment.
 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”
 Primary prevention (cont.)
• 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 well-being, and
quality of life of people or by specific protective
measures.
 Primary prevention
Primary prevention
Achieved by

Health promotion Specific protection

Immunization and seroprophylaxis
Health education
chemoprophylaxis
Use of specific nutrients or
Environmental modifications
supplementations
Nutritional interventions Protection against occupational
Life style & behavioral changes hazards
Safety of drugs and foods
Control of environmental hazards,
e.g. air pollution
 Health promotion
• Health promotion is “ the process of enabling people
to increase control over the determinants of health
and thereby improve their health”.

Approaches for Primary Prevention

• The WHO has recommended the following

approaches for the primary prevention of chronic
diseases where the risk factors are established:

– a. Population (mass) strategy

– b. High -risk strategy
 Population (mass) 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.
 High -risk strategy
• 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.
 Secondary prevention
• It is defined as “action which halts the progress of a disease at its
incipient stage to prevent 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 in the community from acquiring the

infection and thus provide at once secondary prevention for the
infected ones and primary prevention for their potential contacts.
 Early diagnosis and treatment
• 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.
 Tertiary prevention
• 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.
Tertiary prevention: Disability
limitation
disease

impairment

disability

handicap
 Tertiary prevention: Disability limitation
• 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.”
 Tertiary prevention: Disability
limitation
• 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.”
 Tertiary prevention: Disability
limitation
Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
 Control
• Concept of control:
• The term disease control describes ongoing
operations aimed at reducing:

– The incidence of disease

– The duration of disease and consequently the risk of
transmission
– The effects of infection, including both the physical
and psychosocial complications
– The financial burden to the community.
 Control
• Control activities focus on primary prevention
or secondary prevention, but most programs
combine both.
control

elimination

eradication
 Disease Elimination
• Between control and eradication, an intermediate goal
has been described, called "regional elimination"

• The term "elimination" is used to describe interruption

of transmission of disease, as for example, elimination
of measles, polio and diphtheria from large geographic
regions or areas.

• Regional elimination is now seen as an important

precursor of eradication.
 Disease Eradication
• Eradication literally means to "tear out by roots".

• It is the process of “Termination of all transmission of infection by

extermination of the infectious agent through surveillance and
containment”.

• Eradication is an absolute process, an "all or none" phenomenon,

restricted to termination of an infection from the whole world. It
implies that disease will no longer occur in a population.

• To-date, only one disease has been eradicated, that is smallpox.

 Monitoring
• Monitoring is "the performance and analysis of routine
measurements aimed at detecting changes in the
environment or health status of population" (Thus we
have monitoring of air pollution, water quality, growth
and nutritional status, etc).

• It also refers to on -going measurement of performance

of a health service or a health professional, or of the
extent to which patients comply with or adhere to advice
from health professionals.
 Surveillance
• surveillance means to watch over with great attention,
authority and often with suspicion.

• According to another, surveillance is defined as "the

continuous scrutiny (inspection) of the factors that
determine the occurrence and distribution of disease
and other conditions of ill-health.
 Objectives of Surveillance
• The main objectives of surveillance are:
– (a) to provide information about new and changing trends in
the health status of a population, e.g., morbidity, mortality,
nutritional status or other indicators and environmental
hazards, health practices and other factors that may affect
health

– (b) to provide feed-back which may be expected to modify the

policy and the system itself and lead to redefinition of
objectives, and

– (c) provide timely warning of public health disasters so that

interventions can be mobilized.
Control of infectious diseases (the 4 “C”s
Control

Cases Contacts Carriers Community

Diagnosis
notification
isolation standard observation detection Epidemiological
strict Investigation &
disinfectionprotective
containment
treatment
follow up
release
 Evaluation of control
• Evaluation is the process by which results are compared with the intended
objectives, or more simply the assessment of how well a program is
performing.

• Evaluation should always be considered during the planning and

implementation stages of a program or activity.

• Evaluation may be crucial in identifying the health benefits derived (impact on

morbidity, mortality, sequelae, patient satisfaction).

• Evaluation can be useful in identifying performance difficulties.

• Evaluation studies may also be carried out to generate information for other
purposes, e.g., to attract attention to a problem, extension of control activities,
training and patient management, etc.
 To summarize
• Successful prevention depends upon a knowledge of causation,
dynamics of transmission, identification of risk factors and risk
groups, availability of prophylactic or early detection and
treatment measures, an organization for applying these measures
to appropriate persons or groups, and continuous evaluation of
and development of procedures applied.

• The objective of preventive medicine is to intercept or oppose the

"cause" and thereby the disease process.

• This epidemiological concept permits the inclusion of treatment as

one of the modes of intervention.
 Quiz
• Match the following statements with any of the levels below. Each
option may be selected once, more than once, or not at all:

(a) Performing carotid endarterectomy in a patient with transient

ischemic attack.
(b) Recommending regular physical activity to a patient with no
known medical problem.
(C) Vaccinating a health care worker against hepatitis B.
(d) Giving isoniazid for 1 yr to a 28-year-old medical student with a
positive PPD tuberculin skin test.

• 1. primary prevention 2. secondary prevention

• 3. tertiary prevention 4. health promotion
 Levels of disease prevention
• With relevant disease examples describe the
levels by which such diseases can be prevented
and controlled among populations.