Prevention and

control of
disease
Dr Jasem Mohd Kulaib

Assisstant Professor,
Dept. of Community Medicine, RAK
MHSU

Consultant (A) Family Physician

Director of PHC, RAK Medical
District
 DEFINITION OF
PREVENTION:
TheManagementOfThose
FactorsThatCouldLeadTo
DiseaseSoAsToPreventThe
OccurrenceOftheDisease.

Mosbydictionary
Prevention
Thegoalofmedicineisto
promote,topreserve,torestore
healthwhenitisimpaired&to
minimizesuffering&distress.
Thesegoalsareembodiedinthe
wordprevention.
 Successful
prevention
Successful prevention depends upon a
knowledge of causation, dynamics of
transmission, identification of risk
factors & risk groups, availability of
prophylactic or early detection &
treatment measures to appropriate
persons,groups&continuousevaluation
of&developmentofproceduresapplied.
 The objective
of preventive
medicine
is to intercept or oppose
thecause&therebythe
diseaseprocess.
What determines a persons
health behavior?
What they
were taught
Emotions
Education
Social status
Environment
Perception
of risk
What factors affect health?
Geneticscertain diseases might run in your
family
Behavior such as smoking or using drugs
Physical environment such as air or water
pollution
Access to health care; for example, lack of
transportation to the doctor
Income; for example, lack of health insurance
Education; for example, being unaware
of the risks of certain behavior
Chronic diseases:
A disease lasting three months or more, that
cannot be prevented or cured by medicine.
Very common
Most are preventable
Usually leads to a long course of illness
Usually develops slowly
Usually progresses over time
Heart disease
Diabetes
Cancer
Asthma
 Types of Disease
prevention
Primary
Secondary
Tertiary

Information for this section taken from the following source: The Centers
for Disease Control and Prevention, National Center for Infectious Diseases.
http://www.CDC.gov/ncidod/op/handwashing.htm
Leavells Levels of
Prevention
Stage of disease Level of prevention Type of response

Pre-disease Primary Prevention Health promotion and

Specific protection

Latent Disease Secondary prevention Pre-symptomatic

Diagnosis and
treatment

Symptomatic Disease Tertiary prevention Disability limitation for

early symptomatic disease
Rehabilitation for late
Symptomatic disease
Levels of prevention

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention
 Primordial prevention
Primordial prevention consists of
actionsandmeasuresthatinhibitthe
emergence of risk factors in the
form of environmental, economic,
social, and behavioral conditions
andculturalpatternsoflivingetc.
 Primordial
It is prevention
the prevention of the (cont.)
emergence or
development of risk factors in countries or
populationgroupsinwhichtheyhavenotyet
appeared

For example, many adult health problems

(e.g., obesity, hypertension) have their early
originsinchildhood,becausethisisthetime
when lifestyles are formed (for example,
smoking,eatingpatterns,physicalexercise).
Primordial prevention
(cont.)
Inprimordialprevention,effortsare
directedtowardsdiscouragingchildren
fromadoptingharmfullifestyles.

Themaininterventioninprimordial
preventionisthroughindividualand
masseducation
 Primary
prevention
Itincludestheconceptof"positivehealth", a
concept that encourages achievement and
maintenanceof"anacceptablelevelofhealth
that will enable every individual to lead a
sociallyandeconomicallyproductivelife".
Primary prevention may be accomplished by
measures designed to promote general health
and wellbeing, and quality of life of people
orbyspecificprotectivemeasures.
 Primary prevention

Achieved by

Health promotion Specific protection

Immunization and seroprophylaxis
Health education
chemoprophylaxis
Use of specific nutrients or supplementations
Environmental modifications
Protection against occupational hazards
Nutritional interventions Safety of drugs and foods
Life style and behavioral changes 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
therebyimprovetheirhealth.
Approaches for
Primary

Prevention
TheWHOhasrecommendedthe
followingapproachesfortheprimary
preventionofchronicdiseaseswhere
theriskfactorsareestablished:

a.Population(mass)strategy
b.Highriskstrategy
 POPULATION
STRTEGY
Thepopulationstrategyisdirectedat
the whole population irrespective of
individual risk levels. E.g., Even a
small reduction in the Bp or serum
cholesterol of a population would
produce a large reduction in the
incidenceofcardiovasculardisease.
HIGH RISK
STATERGY
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.
Primary
prevention :
Activities that take place before a disease
or injury is present to prevent it from
occurring. For example:

Vaccination for chicken pox

Education on the dangers of smoking
Wearing sunscreen to prevent skin cancer
Wearing a seatbelt to prevent injury
Other primary prevention
methods:
Hand washing
Stops bacteria and viruses
from spreading.
Isolating those who are ill
Stay home from school if
you are sick
Secondary
prevention
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
adequatetreatment.
Secondary
prevention
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.
 Secondary
prevention
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.
 Secondary
prevention
It thus protects others from 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.
Secondary
prevention:
Activities that take place once the disease
has already occurred to help treat, reverse,
or stop the illness. For example:
Testing for certain
diseases like scoliosis.
Treating diseases with
medicine, like diabetes
and high cholesterol.
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.

Theearlierthediseaseisdiagnosed,andtreated
the better it is for prognosis of the case and in
the prevention of the occurrence of other
secondarycases.
Tertiary
prevention
Itisusedwhenthediseaseprocesshas
advancedbeyonditsearlystages.
Itisdefinedasallthemeasuresavailableto
reduceorlimitimpairmentsanddisabilities,
andtopromotethepatientsadjustmentto
irremediableconditions.
Interventionthatshouldbeaccomplishedin
thestageoftertiarypreventionaredisability
limitation,andrehabilitation.
Tertiary
prevention
Rehabilitation activities that will help the
patient lead a normal life once the disease
has already caused illness or injury. For
example:
Physical therapy after an accident
Oxygen for those with breathing problems
Asthma treatments
 DISEASE CONTROL

Describes(ongoing)operationsaimedatreducing
:
Theincidenceofdisease
Durationofdisease(riskoftransmission)
Effects of infection (both physical and
psychosocial)
Financialburdentothecommunity
Mainly focused on primary and secondary
prevention
Disease control
Control
Elimination
Eradication
Extinctionpublicpolicyinterventionthat
restricts the circulation of an infectious
agent beyond the level that would result
from spontaneous, individual behaviors
toprotectagainstinfection
Control
Conceptofcontrol:
Thetermdiseasecontroldescribesongoing
operationsaimedatreducing:
Theincidenceofdisease
Thedurationofdiseaseandconsequentlythe
riskoftransmission
Theeffectsofinfection,includingboththe
physicalandpsychosocialcomplications
Thefinancialburdentothecommunity.
 Controlactivitiesfocusonprimary
preventionorsecondaryprevention,
butmostprogramscombineboth.

Control
Elimination
eradication
Disease
Elimination
Betweencontrolanderadication,an
intermediategoalhasbeendescribed,called
"regionalelimination"
Theterm"elimination"isusedtodescribe
interruptionoftransmissionofdisease,as
forexample,eliminationofmeasles,polio
anddiphtheriafromlargegeographic
regionsorareas
Regionaleliminationisnowseenasan
importantprecursoroferadication
Disease eradication
Diseaseeradication
Onlyonediseasehasbeeneradicated
sofar:
Smallpox
Eradicationunderwayfor:
Poliomyelitis,Dracunculiasis,
Malaria,Measels
Monitoring
Monitoringis"theperformanceandanalysisof
routinemeasurementsaimedatdetecting
changesintheenvironmentorhealthstatusof
population"(Thuswehavemonitoringofair
pollution,waterquality,growthandnutritional
status,etc).

Italsoreferstoongoingmeasurementof
performanceofahealthserviceorahealth
professional,oroftheextenttowhichpatients
complywithoradheretoadvicefromhealth
professionals.
Surveillance
surveillancemeanstowatchoverwithgreat
attention,authorityandoftenwithsuspicion

Accordingtoanother,surveillanceisdefined
as"thecontinuousscrutiny(inspection)of
thefactorsthatdeterminetheoccurrenceand
distributionofdiseaseandotherconditions
ofillhealth"
 Objectives of

Surveillance
Themainobjectivesofsurveillanceare:

(a)toprovideinformationaboutnewandchanging
trendsinthehealthstatusofapopulation,e.g.,
morbidity,mortality,nutritionalstatusorother
indicatorsandenvironmentalhazards,healthpractices
andotherfactorsthatmayaffecthealth

(b)toprovidefeedbackwhichmaybeexpectedto
modifythepolicyandthesystemitselfandleadto
redefinitionofobjectives,and

(c)providetimelywarningofpublichealthdisastersso
thatinterventionscanbemobilized.
 Control

Cases Contacts Carriers Community

Diagnosis
notification standard
strict Epidemiological
isolation observation detection
protective Investigation &
disinfection containment
treatment
follow up
release
Control of
infectious diseases
(the 4 Cs
1cases/Dx,notification,isolation
andtreatment
2contacts/observation
3carriers/detection
4community/epidimiological
investigation
 Evaluation of
control
Evaluation is the process by which results are
comparedwiththeintendedobjectives,ormore
simplytheassessmentofhowwellaprogramis
performing.

Evaluationshouldalwaysbeconsideredduring
the planning and implementation stages of a
programoractivity.

Evaluation may be crucial in identifying the

health benefits derived (impact on morbidity,
mortality,sequelae,patientsatisfaction).
 CONCLUSION
Understandingdiseasepathologyisthefirststep
towardsformulatingpreventivemeasures.
Prevention can be achieved in any stage of
disease.
Primordial or primary prevention is most
effectiveandeconomical.
Disease control is also a part of prevention
which is achieved by means of continuous
monitoringandsurveillanceofdisease