Disease Prevention

Disease Prevention

The goals of medicine are:

• to promote health
• to preserve the health
• to restore health when it is impaired and
• to minimize suffering and stress.

These goals are collectively called "prevention".

For prevention, it requires:

• knowledge of causation
• dynamics of transmission
• identification of risk factors and risk group
• early detection and
• treatment measures and applying these measures to appropriate persons or group.

The levels of prevention

• Primordial prevention: behavior change methods during risk behavior development time
• Primary prevention: In the period of pre-pathogenesis
• Secondary prevention: In the period of clinical disease
• Tertiary prevention: In the period of convalescence and recovery period

Primordial Prevention

The aim of primordial prevention is to avoid the emergence and establishment of the social, economic and cultural patterns of living that are known to contribute to an elevated risk of disease e.g. obesity, hypertension have origin in childhood when lifestyle are formed (smoking, eating pattern, physical exercise). In primordial prevention, the children are discouraged from adopting harmful lifestyles. Individual and mass education are important in primordial intervention.

Examples of primordial include improving sanitation (such that exposure to infectious agents does not occur), establishing healthy communities, promoting a healthy lifestyle in childhood (for example, through prenatal nutrition programs and supporting early childhood development programmes), or developing green energy approaches. So, in preventing Catherine Richards’s diabetes, subsidized fitness programmes at the sports centre could have made make such activities more affordable for women like her, and could help to make exercise a norm for women in her community. Similarly, increasing sports programmes in schools may help reduce obesity in the subsequent generations.As these are all population-level programmes, primordial prevention is conceptually linked to population health and health promotion, but clinicians can play a role bringing problems to notice and advocating for action on determinants.

Primary Prevention

It is defined as "action taken prior to the onset of the disease that will even occur". the purpose of primary prevention is to limit the incidence of disease by controlling cause and risk factors. The intervention is done in pre-pathogenesis phase of disease. the approaches for the primary prevention include population (mass) strategy or high-risk strategy. It requires screening program to identify the high-risk group. Primary prevention includes health promotion and specific protection measures.

1. Health promotion-It is applied during pre-pathogenesis phase of the disease, and not aimed to any specific disease or disorder.

Health promotion includes:

• Health education and motivation
• Good standard of nutrition adjusted to the various developmental phases of life 0childhood, adolescence, pregnancy and old age).
• Attention to personality development by parent education for child care
• Provision of adequate housing, recreation, and suitable working conditions
• Marriage counseling and sex education
• Periodic physical examination

2. Specific protection- These measures are applied in order to prevent some specific etiologic agent by interrupting the pathogenic process whenever they reach man. Examples are:

• Immunization
• Environmental sanitation and personal hygiene
• Protection against occupational hazard
• The use of specific supplementary nutrients
• Protection from carcinogens
• Protection against allergens

Secondary Prevention

It can be defined as "action, which halts the progress of a disease at its incipient stage and prevents complication". It comprises early diagnosis and adequate treatment. Secondary prevention attempts to arrest disease process in the pathogenesis phase. It is largely the domain of clinical medicine. The drawback of secondary prevention is that the patient has already been subjected to mental anguish, physical pain, and the community to loss of productivity. It is less effective and more expensive than primary prevention.

For efficient secondary prevention, early diagnosis and prompt treatment are very important. The objectives of secondary prevention are:

• To cure or intervene disease processes
• To prevent spread of communicable diseases to others
• To prevent complications and sequelae
• To shorten period of disability

Case finding measures and individual and mass screening surveys together with theuse of confirmatory diagnostic tests are important for early diagnosis and prompt treatment.

Disability limitation-This is applied when recognition of disease had been delayed but adequate treatment can effectively interrupt the disease process. The delay in treatment distinguishes this level from the early stage of the secondary level. It requires treatment of a more or less advanced disease process, and indicates failure of prevention at an earlier level.

In this level of disease prevention, the preventive measures are primarily therapeutic, directed toward the host in order to arrest the disease process and to prevent further complications or sequelae. For disability limitation, health facilities should have provision for disability limitation and prevention of deaths.

Tertiary Prevention

Tertiary prevention aims at reducing the progress or complications of established disease and is an important aspect of therapeutic and rehabilitation medicine. It intends to reduce impairments and disabilities, minimize suffering caused by departures from good health in late pathogenesis phase of the disease.

Rehabilitation

This is the step following successfully terminating the disease process. It includes prevention and limitation of disability after anatomic and physiologic changes are more or less stabilized. Its objective is to return the affected individual to his place in the society and let them make maximum use of his remaining capacities. For example, provision of employment of handicapped persons in different institutions.

References

Gordis, L. Epidemiology. third edition. 2004.

Joshi, Banjara. Fundamentals of Epidemiology. Kathmandu: Quality Printing Press, 2007

Park, K. Park's Text Book of social and prevention Medicine. 18th edition. 2008.