Chapter 5 Health care and prevention measures

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CHAPTER FIVE: HEALTH CARE AND PREVENTION MEASURES:

CHAPTER FIVE: HEALTH CARE AND PREVENTION MEASURES 10/26/2012 1 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Health care:

Health care Health care (or healthcare ) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care , secondary care and tertiary care , as well as in public health . Health care services are either provided by the Private or public health care givers. 10/26/2012 2 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Health care:

Health care Access to health care varies across countries, groups and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies. Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies from country to country. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others planning is made more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism ; a well-trained and adequately-paid workforce ; reliable information on which to base decisions and policies ; and well maintained facilities and logistics to deliver quality medicines and technologies. 10/26/2012 3 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Levels of Care :

Levels of Care Primary health care Secondary health care Tertiary health care Quaternary care Home and community care 10/26/2012 4 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primary health care:

Primary health care The “first” level of contact between the individual and the health system. Essential health care (PHC) is provided. A majority of prevailing health problems can be satisfactorily managed. The closest to the people. Provided by the primary health centers. (health centers, dispensaries, general medical clinics) general practitioner or family physician, or a non-physician primary care provider, such as a physician assistant or nurse practitioner. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse, a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia) Depending on the nature of the problem, health care worker may refer the sick for a secondary health care service 10/26/2012 5 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Secondary health care:

Secondary health care >Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists. >serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services More complex problems are dealt with. Comprises curative services Provided by the district hospitals The 1 st referral level 10/26/2012 6 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Tertiary health care:

Tertiary health care Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital. Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions. Offers super-specialist care Provided by regional/central level institution. Provide training programs 10/26/2012 7 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Quaternary care :

Quaternary care The term quaternary care is also used sometimes as an extension of tertiary care in reference to medicine of advanced levels which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centres. 10/26/2012 8 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Home and community care :

Home and community care Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programmes for the prevention of transmissible diseases. They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders and other types of health and social care services. Community rehabilitation services can assist with mobility and independence after loss of limbs or loss of function. This can include prosthesis, orthotics or wheelchairs. Many developed countries help seniors live full, independent lives in the comfort of their own homes. There is an entire section of health care geared to providing seniors with help in day to day activities at home, transporting them to doctor’s appointments, and many other activities that are so essential for their health and well-being. With obesity cases increasing, - good eating habits; making physical education compulsory in school; and teaching young adolescents to have positive self-image. 10/26/2012 9 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

PowerPoint Presentation:

Primary health care Primary health care (PHC) became a core policy for the World Health Organization with the Alma-Ata Declaration in 1978 and the ‘Health-for-All by the Year 2000’ Program. The commitment to global improvements in health, especially for the most disadvantaged populations, was renewed in 1998 by the World Health Assembly. This led to the ‘Health-for-All for the twenty-first Century’ policy and program, within which the commitment to PHC development is restated. 10/26/2012 10 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

What is Primary Health Care?:

What is Primary Health Care? PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes the following: health promotion illness prevention care of the sick advocacy community development 10/26/2012 11 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

PowerPoint Presentation:

Primary Health Care (PHC) PHC is: Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that community and the country can afford … (Alma-Ata, 1978) 10/26/2012 12 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

PowerPoint Presentation:

Principles for PHC PHC based on the following principles : Social equity Nation-wide coverage Self-reliance Inter-sectoral coordination People’s involvement in the planning and implementation of health programs 10/26/2012 13 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Principles of PHC:

Principles of PHC The 1978 Declaration of Alma-Ata proposed a set of PRINCIPLES for primary health care. PHC should: “Reflect and evolve from the economic conditions and socio-cultural and political characteristics of the country and its communities, and be based on the application of the relevant results of social, biomedical and health services research and public health experience” 2. “Address the main health problems in the community, providing promotive, preventive, curative and rehabilitative services accordingly” 10/26/2012 14 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Principles continued:

Principles continued 3. “Involve, in addition to the health sector, all related sectors and aspects of national and community development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, 4. “Promote maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develop through appropriate education the ability of communities to participate” 10/26/2012 15 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Principles continued:

Principles continued 5. “Be sustained by integrated, functional and mutually-supportive referral systems, leading to the progressive improvement of comprehensive health care for all, and giving priority to those most in need” 6. “Rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community.” 10/26/2012 16 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Core Activities for PHC:

Core Activities for PHC There is a set of CORE ACTIVITIES, which were normally defined nationally or locally. According to the 1978 Declaration of Alma-Ata proposed that these activities should include: 10/26/2012 17 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Core Activities for PHC:

Core Activities for PHC Education concerning prevailing health problems and the methods of preventing and controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation Maternal and child health care, including family planning Immunization against the major infectious diseases 10/26/2012 18 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Core Activities for PHC:

Core Activities for PHC 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Basic laboratory services and provision of essential drugs. 9. Training of health guides, health workers and health assistants. 10. Referral services. 10/26/2012 19 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

WHO Strategies of PHC:

WHO Strategies of PHC 1 . Reducing excess mortality of poor marginalized populations: PHC must ensure access to health services for the most disadvantaged populations, and focus on interventions which will directly impact on the major causes of mortality, morbidity and disability for those populations. 2. Reducing the leading risk factors to human health: PHC, through its preventative and health promotion roles, must address those known risk factors, which are the major determinants of health outcomes for local populations. 10/26/2012 20 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

WHO Strategies of PHC:

WHO Strategies of PHC 3. Developing Sustainable Health Systems: PHC as a component of health systems must develop in ways, which are financially sustainable, supported by political leaders, and supported by the populations served. 4, Developing an enabling policy and institutional environment: PHC policy must be integrated with other policy domains, and play its part in the pursuit of wider social, economic, environmental and development policy. 10/26/2012 21 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s):

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) Appropriateness Availability Adequacy Accessibility Acceptability Affordability Assessability Accountability Completeness Comprehensiveness Continuity 10/26/2012 22 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Appropriateness :

Appropriateness Whether the service is needed at all in relation to essential human needs, priorities and policies. The service has to be properly selected and carried out by trained personnel in the proper way. 10/26/2012 23 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Adequacy :

Adequacy The service proportionate to requirement. Sufficient volume of care to meet the need and demand of a community 10/26/2012 24 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Affordability :

Affordability The cost should be within the means and resources of the individual and the country. 10/26/2012 25 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Accessibility :

Accessibility Reachable, convenient services Geographic, economic, cultural accessibility 10/26/2012 26 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Acceptability :

Acceptability Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers. 10/26/2012 27 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Availability :

Availability Availability of medical care means that care can be obtained whenever people need it. 10/26/2012 28 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Assessebility :

Assessebility Assessebility means that medical care can be readily evaluated. 10/26/2012 29 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Accountability :

Accountability Accountability implies the feasibility of regular review of financial records by certified public accountants. 10/26/2012 30 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Completeness :

Completeness Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation. 10/26/2012 31 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Comprehensiveness :

Comprehensiveness Comprehensiveness of care means that care is provided for all types of health problems. 10/26/2012 32 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Continuity :

Continuity Continuity of care requires that the management of a patient’s care over time be coordinated among providers. 10/26/2012 33 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

To Summarize :

To Summarize Primary care is an approach that: Focuses on the person not the disease, considers all determinants of health Integrates care when there is more than one problem Uses resources to narrow differences 10/26/2012 34 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Continuation of summary:

Continuation of summary Forms the basis for other levels of health systems Addresses most important problems in the community by providing preventive, curative, and rehabilitative services Organizes deployment of resources aiming at promoting and maintaining health. 10/26/2012 35 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Health prevention measures:

Health prevention measures In health care prevention, we shall deal with two main issues involved in this process: Prevention Control 10/26/2012 36 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

(I) Prevention:

(I) Prevention 10/26/2012 37 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Goal of medicine:

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 "prevention" 10/26/2012 38 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Prevention; Definition and Concept:

Prevention; Definition and Concept Actions aimed at eradicating, eliminating or minimizing the impact of disease and disability, or if none of these are feasible, retarding the progress of the disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary and tertiary prevention. A fourth level, called primordial prevention, was later added. 10/26/2012 39 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Determinants of Prevention:

Determinants of Prevention 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 10/26/2012 40 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Preventable Causes of Disease :

Preventable Causes of Disease “BEINGS “- mnemonic B iological factors and B ehavioral Factors E nvironmental factors I mmunologic factors N utritional factors G enetic factors S ervices, S ocial factors, and S piritual factors [JF Jekel , Epidemiology, Biostatistics, and Preventive Medicine, 1996] 10/26/2012 41 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Leavell’s Levels of Prevention:

Leavell’s Levels of Prevention Stage of disease Level of prevention Type of response Pre-disease Primary Prevention Health promotion and Specific protection Latent Disease Secondary prevention Pre-symptomatic Diagnosis and treatment Symptomatic Disease Tertiary prevention Disability limitation for early symptomatic disease Rehabilitation for late Symptomatic disease 10/26/2012 42 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Levels of prevention:

Levels of prevention Primordial prevention Primary prevention Secondary prevention Tertiary prevention 10/26/2012 43 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primordial prevention:

Primordial prevention Primordial prevention consists of actions and measures that inhibit the emergence of risk factors in the form of environmental, economic, social, and behavioral conditions and cultural patterns of living etc. 10/26/2012 44 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primordial prevention (cont.):

Primordial prevention (cont.) It is the prevention of the emergence or development of risk factors in countries or population 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 time when lifestyles are formed (for example, smoking, eating patterns, physical exercise). 10/26/2012 45 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primordial prevention (cont.):

Primordial prevention (cont.) In primordial prevention, efforts are directed towards discouraging children from adopting harmful lifestyles The main intervention in primordial prevention is through individual and mass education 10/26/2012 46 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primary prevention:

Primary prevention Primary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur. It signifies intervention in the pre-pathogenesis phase of a disease or health problem. Primary prevention may be accomplished by measures of “ Health promotion ” and “ specific protection ” 10/26/2012 47 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primary prevention (cont.):

Primary prevention (cont.) It includes the concept of " positive 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 productive life". Primary prevention may be accomplished by measures designed to promote general health and well-being, and quality of life of people or by specific protective measures. 10/26/2012 48 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Primary health care prevention:

Primary health care prevention PHC P Primary prevention Specific protection Health promotion Achieved by Health education Environmental modifications Nutritional interventions Life style and behavioral changes Immunization and seroprophylaxis chemoprophylaxis Use of specific nutrients or supplementations Protection against occupational hazards Safety of drugs and foods Control of environmental hazards, e.g. air pollution 10/26/2012 49 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Health promotion:

Health promotion Health promotion is “ the process of enabling people to increase control over the determinants of health and thereby improve their health”. 10/26/2012 50 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Approaches for Primary Prevention:

Approaches for Primary Prevention The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are established: a. Population (mass) strategy b. High -risk strategy 10/26/2012 51 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Population (mass) strategy:

Population (mass) strategy “Population strategy" is directed at the whole population irrespective of individual risk levels. For example, studies have shown that even a small reduction in the average blood pressure or serum cholesterol of a population would produce a large reduction in the incidence of cardiovascular disease The population approach is directed towards socio-economic, behavioral and lifestyle changes 10/26/2012 52 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

High -risk strategy :

High -risk strategy The high -risk strategy aims to bring preventive care to individuals at special risk. This requires detection of individuals at high risk by the optimum use of clinical methods. 10/26/2012 53 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Secondary prevention:

Secondary prevention It is defined as “ action which halts the progress of a disease at its incipient stage and prevents complications.” The specific interventions are: early diagnosis (e.g. screening tests, and case finding programs….) and adequate treatment. Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases. It thus protects others from in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts. 10/26/2012 54 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Secondary prevention (cont.):

Secondary prevention (cont.) Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place, and reverse communicability of infectious diseases. It thus protects others from in the community from acquiring the infection and thus provide at once secondary prevention for the infected ones and primary prevention for their potential contacts. 10/26/2012 55 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Early diagnosis and treatment:

Early diagnosis and treatment WHO Expert Committee in 1973 defined early detection of health disorders as “ the detection of disturbances of homoeostatic and compensatory mechanism while biochemical, morphological and functional changes are still reversible.” The earlier the disease is diagnosed, and treated the better it is for prognosis of the case and in the prevention of the occurrence of other secondary cases. 10/26/2012 56 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Tertiary prevention:

Tertiary prevention 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 disabilities, and to promote the patients’ adjustment to irremediable conditions.” Intervention that should be accomplished in the stage of tertiary prevention are disability limitation , and rehabilitation . 10/26/2012 57 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Disability limitation:

Disability limitation disease impairment disability handicap 10/26/2012 58 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Impairment:

Impairment Impairment is “any loss or abnormality of psychological, physiological or anatomical structure or function.” 10/26/2012 59 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Disability:

Disability Disability is “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for the human being.” 10/26/2012 60 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Handicap:

Handicap Handicap is termed as “a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfillment of a role in the community that is normal (depending on age, sex, and social and cultural factors) for that individual.” 10/26/2012 61 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Rehabilitation :

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.” 10/26/2012 62 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Rehabilitation:

Rehabilitation Rehabilitation Medical rehabilitation Vocational rehabilitation Social rehabilitation Psychological rehabilitation 10/26/2012 63 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

S:

S Strategy for Prevention Assess Exposure Identify Populations at High Disease Risk (based on demography / family history, host factors..) Conduct Research on Mechanisms (including the study of genetic susceptibility) Apply Population-Based Intervention Programs Evaluate Intervention Programs Modify Existing Intervention Programs I n t e r v e n t i o n A s s e s s m e n t 10/26/2012 64 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

(II) Control:

(II) Control 10/26/2012 65 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Control:

Control 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. 10/26/2012 66 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Control continued:

Control continued Control activities focus on primary prevention or secondary prevention, but most programs combine both. control elimination eradication 10/26/2012 67 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Disease Elimination :

Disease Elimination Between control and eradication, an intermediate goal has been described, called "regional elimination" The term "elimination" is used to describe interruption of transmission of disease, as for example, elimination of measles, polio and diphtheria from large geographic regions or areas Regional elimination is now seen as an important precursor of eradication 10/26/2012 68 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Disease Eradication:

Disease Eradication Eradication literally means to "tear out by roots". It is the process of “Termination of all transmission of infection by extermination of the infectious agent through surveillance and containment”. Eradication is an absolute process, an "all or none" phenomenon, restricted to termination of an infection from the whole world. It implies that disease will no longer occur in a population. To-date, only one disease has been eradicated, that is smallpox. 10/26/2012 69 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Monitoring:

Monitoring Monitoring is "the performance and analysis of routine measurements aimed at detecting changes in the environment or health status of population" (Thus we have monitoring of air pollution, water quality, growth and nutritional status, etc). It also refers to on -going measurement of performance of a health service or a health professional, or of the extent to which patients comply with or adhere to advice from health professionals. 10/26/2012 70 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Surveillance :

Surveillance surveillance means to watch over with great attention, authority and often with suspicion According to another, 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" 10/26/2012 71 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Objectives of Surveillance:

Objectives of Surveillance 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 (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. 10/26/2012 72 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Control of infectious diseases (the 4 “C”s:

Control of infectious diseases (the 4 “C”s Control Cases Contacts Carriers Community Diagnosis notification isolation disinfection treatment follow up release observation detection Epidemiological Investigation & containment 10/26/2012 73 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

Evaluation of control:

Evaluation of control Evaluation is the process by which results are compared with the intended objectives, or more simply the assessment of how well a program is performing. Evaluation should always be considered during the planning and implementation stages of a program or activity. Evaluation may be crucial in identifying the health benefits derived (impact on morbidity, mortality, sequelae, patient satisfaction). Evaluation can be useful in identifying performance difficulties. Evaluation studies may also be carried out to generate information for other purposes, e.g., to attract attention to a problem, extension of control activities, training and patient management, etc. 10/26/2012 74 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

To summarize:

To summarize 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 "prevention" 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 The objective of preventive medicine is to intercept or oppose the "cause" and thereby the disease process. This epidemiological concept permits the inclusion of treatment as one of the modes of intervention 10/26/2012 75 Dr. Mavole Johnson Nzau, SAUT 2012/2013 Adv. Studies in Med Soc.

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