concept of control and prevention
TRANSCRIPT
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Concept of Control & Preven/on
Dr.S.Ajay Raj Assistant Professor
Department of Community Medicine VMCH & RI
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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.
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• Control ac/vi/es focus on primary preven/on or secondary preven/on, but most programs combine both.
Control
Elimina/on
Eradica/on
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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
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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.
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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.
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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"
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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.
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PREVENTION
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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"
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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.
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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
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Levels of preven+on
Primordial preven/on
Primary preven/on
Secondary preven/on
Ter/ary preven/on
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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
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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).
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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
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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”
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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".
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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
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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”.
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Health Promotion
o Health Education
o Environmental Modification
o Nutritional intervention
o Lifestyle & behavioral changes
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Health Education
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Environmental Modification
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Nutritional intervention
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Lifestyle & behavioral changes
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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.
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Specific Protection
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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
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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
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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.
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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.
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• 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.
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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.
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Early Diagnosis & Treatment
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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.
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Disability limita+on
Disease
Impairment
Disability
Handicap
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DISABILITY LIMITATION
Impairments
Disease or disorder Disabilities Handicaps
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Impairment
• Any loss or abnormality of psychological, physiological or anatomical structure or function.
Ex: loss of foot, defective vision or mental retardation
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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
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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
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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.”
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Rehabilita+on
Rehabilita/on
Medical rehabilita/on
Voca/onal rehabilita/on
Social rehabilita/on
Psychological rehabilita/on
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