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
Achieved
by
Health
promo/on
Specific
protec/on
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
Disease
or
Impairments
Disabilities disorder 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