Dr. Siham Gritly 1

Community medicine5 Concepts of control and prevention

Prepared by; Dr. Siham GritlyUniversity of Bahri

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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.

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Control activities focus on primary prevention or secondary prevention, but

most programs combine both; control-----elimination-----eradication

• Elimination is used to describe interruption of

transmission of disease as elimination of

measles, polio, diphtheria from geographic

regions

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• Eradication “tear out by roots” It is the

process of “Termination of all transmission of

infection by extermination (termination) of the

infectious agent through surveillance and

containment” االحتواء.

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Monitoring and Surveillance

• Monitoring is "the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population"

• monitoring of air pollution, • water quality• , growth and nutritional status, etc).

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Surveillance

• Surveillance means to watch over with great attention,

• 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”

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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

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• (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

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Evaluation of control

• Evaluation is the process by which results are

compared with the objectives

• Evaluation is the assessment of how well a

program is performing

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Concept of prevention

• The goals of medicine are to ;• Promote health• Preserve health• Restore health• Minimize suffering and distress• These goals are enclosed in the word

prevention

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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

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Levels of prevention

• Prevention defined in terms of four levels

• 1-Premordial prevention

• 2-primary prevention

• 3-secondary prevention

• 4-tertiary prevention

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• 1-Primordial prevention ;

• is the prevention of chronic diseases (obesity,

hypertension) which they have their origins in

childhood

•

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• consists of actions and measures that inhibit the emergence of risk factors in the form of

• environmental,• economic, • social, • behavioral conditions • and cultural patterns of living etc.

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• 2-Primary prevention defined

• as “action taken prior to onset of disease which

removes the possibility that the disease will ever

occur

• it means intervention in the pre-pathogenesis

phase of disease or health problems

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• Primary prevention includes the concept of

positive health that will enable every

individual to lead a socially and economically

productive life

• it is the less expensive level

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• 3-Secondary prevention defined as “action which

halts (stop) the progress of disease at its incipient

(initial) stage and prevent complication”

• Secondary prevention is an imperfect tool in control of transmission of disease

• It is more expensive and less effective than primary prevention

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• 4-Tertiary prevention defined as “all measure

available to reduce or limit impairments and

disabilities, minimize suffering caused by

existing departures from good health

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Levels of prevention

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intervention

• Intervention defined as;

• “any attempt (effort) to intervene or interrupt

the usual sequence in the development of

disease in human”

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Five mode of intervention

• Five mode of intervention have been described;• 1-health promotion

• 2-specific protection

• 3-early diagnosis and treatment

• 4-disability limitation

• 5-rehabilitation

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• 1-health promotion

• -health education

• -environmental modification

• -nutritional intervention

• -lifestyle and behavioral changes

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• 2-specific protection

• -immunization

• -use of specific nutrients

• -chemoprophylaxis

• -protection against occupational hazards

• -protection against accidents

• -protection against carcinogens etc ----

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• 3-early diagnosis and treatment are the main interventions of disease control achieved

• -through primary prevention

• 4-disability limitation • Concept of disability; the sequence of events

leading to disability and handicap stated as follows;• (disease---impairment-------disability-----handicap)

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• - impairment; In health, defined as “any loss or

abnormality of physiological, psychological, or

anatomical structure or function”

• For example mental retardation, loss of foot

•

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• - Disability is the consequence of an impairment • Defined as “ any restriction or lack of ability to

perform any activity in the manner or within the range considered normal for a human being”

• may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these.

• A disability may be present from birth, or occur during a person's lifetime

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• - handicap “as a result of disability, the person experiences certain disadvantages in life and is not able to discharge the obligations required of him and play the role expected of him in society”

• a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevent the fulfillment of a role that is normal

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• 5-rehabilitation

• -the combined and coordinated use of medical,

social, educational and vocational measures

for treating and retaining the individual to the

highest possible level of functional ability

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• Park's Textbook of Preventive and Social Medicine 21 Edition, by K. PARK