ALLIED HEALTH SCIENCES

Basic Community Health

Natural History of Disease & Prevention of Disease

Dr. N Sivarajah Department of Community Medicine Faculty of Medicine, University of Jaffna August 30, 2012

Natural History of Disease is a key concept in Epidemiology

It signifies the way in which a disease evolves over time from the earliest stages of its pre-pathogenesis phase to its termination as, recovery, disability or death in the absence of treatment or prevention.

Dr. N Sivarajah

Natural History of Disease AHS CH

Disease Present
HEALTHY No Signs or symptoms Pathogenic changes present

Signs & Symptoms present

Clinical Stage Recovery Disability

Death Pre-pathogenic phase PATHOGENIC PHASE

Dr. N Sivarajah

Natural History of Disease AHS CH

Pre-pathogenesis phase
Period before onset of disease where the disease agent has not entered the man but factors which favour its interaction are already existing. The causative factors of disease are
Agent, Host & Environment and referred to as the EPIDEMIOOGICAL TRIAD

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Pathogenesis phase
Pathogenesis phase begins with the entry of the disease agent into the susceptible host In infectious diseases (Typhoid, Measles,
Influenza etc)

Agent Multiplies
(Incubation Period)

Pathogenesis

Disability
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Recovery

Death
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Natural History of Disease AHS CH

Disease is the interaction between Man Agent & Environment

AGENT

MAN

ENVIRONMENT

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Communicable Disease is related to Agent, Reservoir, host & Environment

Agent

Reservoir (VECTOR)

Man (Host)

ENVIRONMENT

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Agents of Disease
Biological agents: Bacteria, Viruses, fungi, protozoa, parasites etc Physical agents: Heat, cold, Noise, Radiation, trauma, friction, oxygen lack etc Chemical agents: allergens, dust, insecticides, calcium carbonate (Kidney stones), Serum bilirubin (Jaundice) etc Nutrient agent: Excess of deficiency in Proteins, minerals, vitamins Social agents: Poverty, smoking, drugs and alcohol abuse, social isolation, maternal deprivation etc

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Reservoir could be
Man
Diarrhoeal diseases, Respiratory diseases, Sexually transmitted diseases

Animal / Birds
Rabies, Plague, Avian flu, pigs, cattle

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Natural History of Disease AHS CH

Host Factors
Demographic Characteristics: Age, sex, ethnicity Biological Characteristics: genetic factors, blood cholesterol, immunological factors Social & Economic characteristics: Education, Occupation, Lifestyle factors: like personality traits, exercise, alcohol consumption, smoking Risky behaviour Immunity
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Environmental Factors
Physical environment: air pollution, water pollution, soil pollution, climate Biological environment: Living organisms like microbes, vectors, animals Psychosocial Environment: cultural values, customs, habits, beliefs, attitudes, morals, religion, health services

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Prominent Risk Factors

Heart Disease Cancer Stroke Motor Vehicle accidents Diabetes Cirrhosis of Liver
Dr. N Sivarajah

Smoking, High blood pressure, elevated serum cholesterol, diabetes, obesity, lack of exercise, Type A Personality Smoking, alcohol, solar radiation, ionizing radiation, environmental pollution, infections agents, dietary factors High Blood Pressure, elevated cholesterol, smoking Alcohol, speed, automobile design,

Obesity, diet Alcohol

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Iceberg of Disease
Symptomatic Disease

What is seen by the Physician

Pre-symptomatic Disease

What is in the community and not seen by the Physician

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Prevention of Disease
The Goals of Medicine are

Promotion of health Preservation of Health Restoration of Health when impaired Minimize suffering & Distress
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Levels of Prevention
Primordial Prevention Primary Prevention Secondary Prevention Tertiary Prevention

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Primordial Prevention
Usually in Chronic diseases Prevention of emergence of risk factors in countries or population groups where they have not yet appeared
Since obesity is a risk factor in adult diseases, and have their origin in early childhood, prevention of adoption of harmful life styles (smoking, eating patterns, lack of exercise) in childhood are discouraged
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Disease Present
HEALTHY No Signs or symptoms Pathogenic changes present

Signs & Symptoms present

Clinical Stage Recovery Disability

Death Pre-pathogenic phase Primary Prevention PATHOGENIC PHASE Secondary Prevention Tertiary Prevention

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Primary Prevention
Action taken prior to a disease so that the disease never occurs
Provision of safe water Proper sanitation Balanced diet Health education

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Secondary Prevention
Is action taken to halt the progress of disease. It is essentially screeing and appropriate action
Antenatal screening Case finding Growth monitoring Isolation of Patients with communicable diseases Adequate and complete treatment
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Tertiary Prevention
Is intervention at the stage of late pathogenesis to
Reduce or limit impairments and disability Minimize suffering Promote patients adjustments to intermediate conditions Rehabilitation

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THANK YOU

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