Concept  of  Control  &  Preven/on  

Dr.S.Ajay  Raj  Assistant  Professor  

Department  of  Community  Medicine  VMCH  &  RI  

Concept  of  Control  

The  term  disease  control  describes  ongoing  opera/ons  

aimed  at  reducing:  

–  The  incidence  of  disease  

–  The  dura/on  of  disease  and  consequently  the  risk  of  transmission    

–  The  effects  of  infec/on,  including  both  the  physical  and  psychosocial  complica/ons  

–  The  financial  burden  to  the  community.  

•  Control  ac/vi/es  focus  on  primary  preven/on  or  secondary  preven/on,  but  most  programs  combine  both.  

   

Control  

Elimina/on  

Eradica/on  

Disease  Elimina+on    

•  Between  control  and  eradica/on,  an  intermediate  goal  has  been  described,  called  "regional  elimina/on"    

•  The  term  "elimina/on"  is  used  to  describe  interrup/on  of  transmission  of  disease  

•  Regional  elimina/on  is  now  seen  as  an  important  precursor  of  eradica/on  

Disease  Eradica+on  •  Eradica/on  literally  means  to  "tear  out  by  roots".    

•  It  is  the  process  of  “Termina/on  of  all  transmission  of  infec/on  by  extermina/on  of  the  infec/ous  agent  through  surveillance  and  containment”.  

•  Eradica/on  is  an  absolute  process,  an  "all  or  none"  phenomenon,  restricted  to  termina/on  of  an  infec/on  from  the  whole  world.  It  implies  that  disease  will  no  longer  occur  in  a  popula/on.  

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

Monitoring  

•  Monitoring  is  "the  performance  and  analysis  of  rou/ne  measurements  aimed  at  detec/ng  changes  in  the  environment  or  health  status  of  popula/on  

 •  It  also  refers  to  on  -­‐going  measurement  of  performance  of  a  health  service  or  a  health  professional,  or  of  the  extent  to  which  pa/ents  comply  with  or  adhere  to  advice  from  health  professionals.  

Surveillance    

•  Surveillance  means  to  watch  over  with  great  aSen/on,  authority  and  oTen  with  suspicion  

   •  According  to  another,  surveillance  is  defined  as  "the  con/nuous  scru/ny  (inspec/on)  of  the  factors  that  determine  the  occurrence  and  distribu/on  of  disease  and  other  condi/ons  of  ill-­‐health"    

Objec+ves  of  Surveillance  –  To  provide  informa/on  about  new  and  changing  trends  in  the  health  status  of  a  popula/on  

–  To  provide  feed-­‐back  which  may  be  expected  to  modify  the  policy  and  the  system  itself  and  lead  to  redefini/on  of  objec/ves,  and    

 –  Provide  /mely  warning  of  public  health  disasters  so  that  interven/ons  can  be  mobilized.  

PREVENTION  

Goal  of  medicine  

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

   •  These  goals  are  embodied  in  the  word  "preven/on"    

Preven+on;  Defini+on  and  Concept  

•  Ac/ons  aimed  at  eradica/ng,  elimina/ng  or  minimizing  the  impact  of  disease  and  disability,  or  if  none  of  these  are  feasible,  retarding  the  progress  of  the  disease  and  disability.  

 

Determinants  of  Preven+on  •  Successful  preven/on  depends  upon:    –  a  knowledge  of  causa/on,    –  dynamics  of  transmission,    –  iden/fica/on  of  risk  factors  and  risk  groups,    –  availability  of  prophylac/c  or  early  detec/on  and  treatment  measures,    

–  an  organiza/on  for  applying  these  measures  to  appropriate  persons  or  groups,  and    

–  con/nuous  evalua/on  of  and  development  of  procedures  applied    

Levels  of  preven+on  

Primordial  preven/on  

Primary  preven/on  

Secondary  preven/on  

Ter/ary  preven/on  

LEVELS OF PREVENTION  Primordial prevention

Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared.

Primary prevention Action taken prior to the onset of disease, which removes the possibility that a

disease will ever occur. Secondary prevention

Action which halts the progress of a disease at its incipient stage and prevents complication.

Tertiary prevention All measures available to reduce or limit impairments and disabilities,

minimize suffering caused by patients adjustment to irremediable conditions

Primordial  preven+on  •  It  is  the  preven/on  of  the  emergence  or  development  of  risk  factors  in  countries  or  popula/on  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  /me  when  lifestyles  are  formed  (for  example,  smoking,  ea/ng  paSerns,  physical  exercise).    

 

Primordial  preven+on  (cont.)  

•  In  primordial  preven/on,  efforts  are  directed  towards  discouraging  children  from  adop/ng  harmful  lifestyles    

 •  The  main  interven/on  in  primordial  preven/on  is  through  individual  and  mass  educa/on    

Primary  preven+on  

•  Primary  preven/on  can  be  defined  as  the  ac/on  taken  prior  to  the  onset  of  disease,  which  removes  the  possibility  that  the  disease  will  ever  occur.  

•  It  signifies  interven/on  in  the  pre-­‐pathogenesis  phase  of  a  disease  or  health  problem.  

•  Primary  preven/on  may  be  accomplished  by  measures  of  “Health  promo/on”  and  “specific  protec/on”  

Primary  preven+on  (cont.)  

•  It  includes  the  concept  of  "posi/ve  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  produc/ve  life".    

Primary  preven/on  

Specific  protec/on  Health  promo/on  

Achieved  by  

Health  educa+on  

Environmental  modifica+ons  

Nutri+onal  interven+ons  

Life  style  and  behavioral  changes  

Immuniza+on  and  seroprophylaxis  

chemoprophylaxis  

Use  of  specific  nutrients  or  supplementa+ons  

Protec+on  against  occupa+onal  hazards  

Safety  of  drugs  and  foods  

Control  of  environmental  hazards,    e.g.  air  pollu+on  

Health  promo+on  

•  Health  promo/on  is  “  the  process  of  enabling  people  to  increase  control  over  the  determinants  of  health  and  thereby  improve  their  health”.  

Health Promotion

   o Health Education

o  Environmental Modification

o  Nutritional intervention

o  Lifestyle & behavioral changes

Health Education

Environmental Modification

Nutritional intervention

Lifestyle & behavioral changes

Specific  protec+on  

•  Use  of  Specific  immuniza/on  (BCG,  DPT,MMR  vaccines)    

•  Chemoprophylaxis  (tetracycline  for  Cholera,  dapsone  for  Leprosy,  Chloroquine  for  malaria,etc.,)    

•  Use  of  specific  nutrients  (vitamin  A  for  Children,  IFA  tablets  for  Pregnant  mothers)  

•  Protec/on  against  accidents  (Use  of  helmet,  seat  belt,etc.,)    

•  Protec/on  against  occupa/onal  hazards.  •  Avoidance  of  allergens.  •  Protec/on  from  air  pollu/on.  

Specific Protection

Approaches  for  Primary  Preven+on  

•  The  WHO  has  recommended  the  following  approaches  for  the  primary  preven/on  of  chronic  diseases  where  the  risk  factors  are  established:  

 – a.  Popula/on  (mass)  strategy    – b.  High  -­‐risk  strategy  

Popula+on  (mass)  strategy  •  “Popula/on  strategy"  is  directed  at  the  whole  popula/on  

irrespec/ve  of  individual  risk  levels.      •  For  example,  studies  have  shown  that  even  a  small  reduc/on  

in  the  average  blood  pressure  or  serum  cholesterol  of  a  popula/on  would  produce  a  large  reduc/on  in  the  incidence  of  cardiovascular  disease    

 •  The  popula/on  approach  is  directed  towards  socio-­‐economic,  

behavioral  and  lifestyle  changes    

High  -­‐risk  strategy    

•  The  high  -­‐risk  strategy  aims  to  bring  preven/ve  care  to  individuals  at  special  risk.    

•  This  requires  detec/on  of  individuals  at  high  risk  by  the  op/mum  use  of  clinical  methods.  

Secondary  preven+on  

•  It  is  defined  as  “  ac/on  which  halts  the  progress  of  a  disease  at  its  incipient  stage  and  prevents  complica/ons.”  

 •  The  specific  interven/ons  are:  early  diagnosis  (e.g.  screening  tests,  and  case  finding  programs….)  and  adequate  treatment.  

 

•  Secondary  preven/on  aSempts  to  arrest  the  disease  process,  restore  health  by  seeking  out  unrecognized  disease  and  trea/ng  it  before  irreversible  pathological  changes  take  place,  and  reverse  communicability  of  infec/ous  diseases.  

 •  It  thus  protects  others  from  in  the  community  from  acquiring  the  infec/on  and  thus  provide  at  once  secondary  preven/on  for  the  infected  ones  and  primary  preven/on  for  their  poten/al  contacts.  

Objec/ves  of  secondary  preven/on  

•  Complete  cure  and  prevent  the  progression  of  disease  process.  

•  To  prevent  the  spreads  of  disease  by  curing  all  the  known  cases.    

•  To  prevent  the  complica/ons  and  sequel  of  disease.    

•  To  shorten  the  period  of  disability.  

Early Diagnosis & Treatment

Ter+ary  preven+on  

•  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  disabili/es,  and  to  promote  the  pa/ents’  adjustment  to  irremediable  condi/ons.”  

•  Interven/on  that  should  be  accomplished  in  the  stage  of  ter/ary  preven/on  are  disability  limita/on,  and  rehabilita/on.  

Disability  limita+on  

Disease  

Impairment  

Disability  

Handicap  

DISABILITY LIMITATION

Impairments

Disease or disorder Disabilities Handicaps

Impairment  

•  Any loss or abnormality of psychological, physiological or anatomical structure or function.

Ex: loss of foot, defective vision or mental retardation

 

Disability

o  Any restriction or lack of ability to perform an activity in the manner or within the range of considered normal for a human being

o  Ex: can not walk due to accident

Handicap

o  A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex and social and cultural factors) for that individual.

o  Reduction in a person’s capacity to fulfill a social role

o  E.g., unemployed due injury or not being able to walk

Rehabilita+on    

•  Rehabilita/on  is  “  the  combined  and  coordinated  use  of  medical,  social,  educa/onal,  and  voca/onal  measures  for  training  and  retraining  the  individual  to  the  highest  possible  level  of  func/onal  ability.”  

Rehabilita+on  

Rehabilita/on  

Medical  rehabilita/on  

Voca/onal  rehabilita/on  

Social  rehabilita/on  

Psychological  rehabilita/on  

THANK  U