Levels of prevention 

Levels of prevention 

Definitions

"Activities designed to protect patients and other members of the public from actual or potential health threats and their harmful consequences."

                                                                                                                                                [According to Mosby's Medical Dictionary 8th edition 2009]

"Prevention is the action aimed at eradicating, eliminating or minimizing the impact of disease and disability (According to A Dictionary of Epidemiology)

Goals-

  • Promotion of health
  • Prevention of illness
  • Preserve health
  • Restoration of health

Levels of Prevention -

  • Primordial Prevention
  • Primary Prevention
  • Secondary Prevention
  • Tertiary Prevention

1. Primordial Prevention

Definition-

"It is the prevention of development of risk factors in population groups in which they have not yet appeared."

  • Special Attention is Given in preventing Chronic Disease.
  • Main Intervention is Health Education.
  • In this efforts are dedicated towards Discouraging people from adopting Harmful Life styles/Habits through Individual & Mass Education.
  •  Primordial prevention, a relatively new concept, is receiving special attention in the prevention of chronic diseases. Ex., many adult health problems (e.g. obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed(Ex., smoking, eating patterns, physical exercise).
  • Primordial prevention begins in childhood when health risk behavior begins. Parents, teachers and peer groups are important in imparting health education to children.

Intervention-

Individual and mass education.

Examples-

  • Adult health problem eg.- Obesity, hypertension
  • Lifestyle changes eg. - Smoking, Physical exercise
  • Food and nutrition 

2.  Primary Prevention -The purpose of primary prevention is to prevent a disease from occurring. It includes intervention in the prepathogenesis phase of a disease. In simple terms, primary prevention is defined as "action taken prior to the onset of disease, which reduces the possibility of disease occurrence". This concept is now used in the prevention of noncommunicable diseases like coronary health disease, hypertension, cancer, etc. by eliminating or modifying the risk factors of disease.

Definition-

Primary Prevention can be defined as "action taken prior to the onset of disease, which removes the possibility that the disease will ever occur."

  •  In this Action are taken before the onset of Disease.
  • It signifies intervention in the pre- pathogenesis phase of a disease or health problem.

Approaches of Primary Prevention -

The WHO has recommended the following approaches for primary prevention-

  • Population (Mass) Strategy
  • High risk strategy

1. Population (Mass) strategy- It is directed at the whole population irrespective of individual risk levels.

  • The population approach is directed towards socio-economic, behavioral and lifestyle changes.

2. High Risk Strategy - It is aim to bring preventive care to individuals at special risk. Examples-Immunization and taking regular exercise.

Intervention-

  • Health promotion
  • Specific protection

 

A. Health promotion

Definition-"A process of enabling people to increase control the determinants of health and thereby improve their health”.

  • “ Health Promotion is directed towards Strengthening the Host.”
  •  Process of enabling people to increase control over and to improve health

Intervention-There aim can be achieved  by following  intervention-

  • Environmental modification
  • Health Education
  • Life style change
  • Behavioral changes
  • Nutritional intervention

B.  Specific Protection

Definition-Efforts directed toward protection against specific diseases."

  •  “ The provision of Conditions for normal Mental & Physical Functioning of the Human beings & in Group.it includes the Promotion of Health , Prevention of Sickness , & Care of Individuals .”

Intervention-

  • Immunization (BCG, DPT, MMR Vaccines) and seroprophylaxis
  • Chemoprophylaxis(tetracycline for Cholera, dapsone for Leprosy, Chloroquine for malaria,etc.,) 
  • Protection against accidents
  • Use of specific nutrients or supplementations (vitamin A for Children, iron folic acid tablets for Pregnant mothers)
  • Safety of drugs and foods
  • Protection against occupational hazards e.g. - Use of helmet, Seat belt etc.
  • Control of environmental hazards e.g. - Air pollution
  •  Avoidance of allergens.

3. Secondary Prevention-Secondary level of prevention is early diagnosis and treatment which includes surgical procedures. It basically halts the progress of the disease at its beginning stage and will avoid further complications. In India mostly National Health Programs were operated by government at secondary level of prevention.

Definition- "The action which halts the progress of a disease at its incipient stage and prevents complications."

Intervention-

  • Early diagnosis(e.g. screening tests, breast self examination, pap smear test, radiographic examinations etc.)
  • Adequate treatment

Objectives-

  • To prevent the spreads of disease.
  • To prevent the complications.
  • Complete cure of disease.
  • To shorten the period of disability.

Examples- Include screening for high blood pressure and breast self examination.

4. Tertiary Prevention-Tertiary level of prevention is applied when diseases has progress beyond its early stages. The main aim of this level is to reduce or limit impairment and disabilities or minimizing suffering caused by existing disease or health problems. Tertiary level of prevention will signifies intervention in late pathogenesis phase.

Definition-

"It is defined as "all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions"

  • It is used when the disease process has advanced beyond its early stages.

Modes of Intervention-

  • Disability limitation
  • Rehabilitation

a.  Disability limitation-

  • To prevent or halt the transition of disease process from Impairment & Handicap.
  • Impairment- any loss or abnormality of psychological, physiological or anatomic structure or function.
  • Disability- any restriction or lack of ability to perform an activity in the manner considered normal for a human being.
  • Handicap- disadvantage for a given individual, resulting from impairment or disability, that limits or prevents the fulfillment of a role that is normal for that individual.

b. Rehabilitation-

  • Rehabilitation is “ the combined and coordinated use of medical, social, educational, and vocational measures for training and retraining the individual to the highest possible level of functional ability.”
  • Requires cooperation from different sections of society.
  • Rehabilitation Medical rehabilitation Vocational rehabilitation Social rehabilitation Psychological rehabilitation

Types of Rehabilitation

  • Medical Rehabilitation - Restoration of body function.
  • Vocational Rehabilitation - Restoration of the capacity to earn a livelihood.
  •  Social Rehabilitation - Restoration of family and social relationship.
  • Psychological Rehabilitation - Restoration of personal dignity and confidence.

Note-Quaternary Prevention (4th Level / New Addition)

5. 4th Level Prevention

  • Goal-Prevent overmedicalization and protect patients from unnecessary or harmful medical interventions.
  • Target- Individuals who are at risk of medical overuse or excessive treatment.
  • Focus- Ethical and patient-centered care.

Examples-

  • Avoiding unnecessary antibiotics for viral infections.
  • Preventing over-diagnosis through appropriate use of screening.
  • Limiting excessive diagnostic testing or treatments in terminally ill patients.
  • Providing palliative care instead of aggressive interventions when appropriate. 

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