Concepts of Control & Prevention

Concepts of Control
Concepts of Prevention
Facilitator:
Dr. NAVPREET
Assistant Professor, Department of Community Medicine
Govt. Medical College & Hospital, Chandigarh.
Specific Learning Objectives
• At the end of session, the learner shall be able to:
 Differentiate Control, elimination and eradication.
 Apply Levels of prevention.
 Apply Modes of intervention.
 Describe International Classification of Disease
Disease control
• The disease agent is permitted to exist in the
community at a level where it ceases to be as
public health problem.
• State of equilibrium becomes established
between A, H & E.
• Aims at reducing:
i. Incidence of disease
ii. Duration of disease
iii. Risk of transmission of infection
iv. Financial burden to the community.
Disease Elimination
• Interruption of transmission of disease from
large geographic regions or areas.
• An important precursor for eradication.
• e.g. Measles, Polio.
Disease Eradication
• Termination of all transmission of infection by
extermination of the infectious agent.
• Tear out by roots.
• Cessation of infection and disease from the whole
world.
• e.g. Small pox.
• Potential candidates: Polio, Measles, Dracunculiasis.
Monitoring
• The performance and analysis of routine
measurements aimed at detecting changes in the
environment or health status of population.
• e.g. Air pollution, Performance of health services
Surveillance
• The continuous scrutiny of all aspects of occurrence
and spread of disease that are pertinent to effective
control.
• Goes beyond passive reporting of cases.
• Lab confirmation of presumptive diagnosis
• Finding out source of infection
• Routes of transmission
• Identification of all cases, susceptible contacts, those
who are at risk.
Evaluation
• The process by which results are compared with the
intended objectives.
 Formative evaluation
 Summative evaluation
• Crucial in identifying health benefits derived.
• Useful in identifying performance difficulties.
Concepts of Prevention
• The objective of preventive medicine is to intercept
or oppose the “cause” and thereby the disease
process.
• Levels of Prevention:
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention
Primordial Prevention
• Prevention of emergence or development of
risk factors in population groups in which they
have not yet appeared.
• e.g. Lifestyle diseases.
• Intervention: Health education.
Primary Prevention
• Action taken prior to the onset of disease,
which removes the possibility that a disease
will occur.
• Intervention in the pre‐pathogenesis phase.
• Elimination or modification of risk factors.
• e.g. Communicable diseases and NCDs.
• Approaches for primary prevention:
a. Population (mass) strategy
b. High‐risk strategy
Secondary Prevention
• Actions which halts the progress of a disease
at its incipient stage and prevents
complications.
• Intervention in early pathogenesis phase.
– Early diagnosis and adequate treatment.
• Largely the domain of a clinical medicine.
• Drawbacks:
– Already there is suffering of mental anguish, pain.
– Loss of productivity
– More expensive and less effective
Tertiary Prevention
• All measures available to reduce or limit
impairments and disabilities, minimize suffering
caused by existing departures from good health and
to promote the patient’s adjustment to irremediable
conditions.
• Intervention in late pathogenesis phases to prevent
sequelae and limit disability.
Modes of Intervention
• Any attempt to intervene or interrupt the
usual sequence in the development of
disease.
• Modes of intervention:
1. Health promotion
2. Specific protection
3. Early diagnosis and treatment
4. Disability limitation
5. Rehabilitation
Health Promotion
• Health education
• Environmental modifications
• Nutritional interventions
• Life style and behavioral changes
Specific Protection
• Immunization e.g. Vaccine preventable diseases.
• Specific nutrient e.g. Iron.
• Protection against injuries (helmet, seat belt)
• Chemoprophylaxis e.g. against Malaria.
• Control of consumer product quality and safety of
foods, drugs, cosmetics etc.
Early diagnosis and Treatment
• The detection of disturbances of homoeostatic and
compensatory mechanism while biochemical,
morphological and functional changes are still
reversible.
• Important in reducing high morbidity and mortality.
Disability Limitation
Disease e.g. Accident
Any loss or abnormality of psychological,
Impairment Physiological or anatomical structure or
function,
e.g. loss of foot.
Any restriction or lack of ability to perform an
Disability activity in the manner or within the range
considered normal for a human being.
e.g. unable to walk.
Disadvantage for a given individual that limits or
Handicap prevents the fulfillment of a role that is normal
for that individual.
e.g. unemployed.
Rehabilitation
• 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.
 Medical rehabilitation
 Vocational rehabilitation
 Social rehabilitation
 Psychological rehabilitation
Hospitals and Community
• Hospitals:
 “An ivory tower of disease”
 Health Promotion settings
• Functions of a doctor:
 The care of the individual
 The care of community
Community diagnosis & Community treatment
 As a teacher
Disease Classification
• To compare morbidity and mortality data at
national and international levels.
• To facilitate decision making in prevention.
• To facilitate the research on particular
disease.
• International Classification of Diseases (ICD).
– ICD‐10
– Alphanumeric coding of disease.
Take Home Message…

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