Levels of Prevention and Modes of

Intervention
 Introduction
• Signifies the way in which disease evolves over
time
• Key concept in epidemiology
• Each disease – unique natural history
• Not the same for all individuals
• Best established through cohort studies
 Onset of Usual time of
symptoms diagnosis
Exposure
Pathologic
changes

Stage of Stage of Stage of Stage of

susceptibility subclinical clinical recovery,
disease disease disability or
death

PRIMARY
SECONDARY TERTIARY
PREVENTION
PREVENTION PREVENTION
 Natural history of disease
STAGE 1: Susceptibility

DESCRIPTION: Risk factors which assist

the development of
disease exist, but disease
has not developed

EXAMPLE: Smoking
 Natural history of disease
STAGE 2: Presymptomatic disease

DESCRIPTION: Changes have occurred

to lead toward illness but
disease is not yet
clinically detectable

EXAMPLE: Alveoli deteriorate

 Natural history of disease

STAGE 3: Clinical Disease

DESCRIPTION: Detectable signs and/or

symptoms of disease exist

EXAMPLE: Emphysema detected by

pulmonary function test
 Natural history of disease
STAGE 4: Disability

DESCRIPTION: Disease has progressed to

the point of causing a
residual effect

EXAMPLE: Person has difficulty

breathing
• What are the factors leading to the disease
occurrence?
– Agent factors
– Host factors
– Environment factors (physical, biological,
psychological)
 Levels of prevention
LEVEL: Primary
DESCRIPTION: Promote general health
and avoid risk factors for
disease --- Utilize protective
measures to prevent
susceptibility and
pre-symptomatic disease
EXAMPLE: Stop smoking or choose
not to start; avoid areas
where people are smoking
 Levels of prevention
LEVEL: Secondary
DESCRIPTION: Early detection and
timely treatment
EXAMPLE: Routine pulmonary
function tests for those at
risk; medicine to help
patients breath more
easily; smoking cessation
programs if patient smokes
 Levels of prevention

LEVEL: Tertiary

DESCRIPTION: Rehabilitation and

prevention of further
disease or disability

EXAMPLE: Oxygen therapy;

facilitating ambulation
with technical devices
 What is intervention?
• Intervention is an attempt to intervene or
interrupt the usual sequence in the
development of disease in man.
• This may be by the provision of treatment,
education, help or social support.
 Modes of intervention
5 methods of intervention:
i. Health promotion
ii. Specific protection
iii. Early diagnosis and prompt treatment
iv. Disability limitation
v. Rehabilitation
 Health promotion
• The process of enabling people to increase
control over, and to improve health.
• It is not directed against any particular
disease, but is intended to strengthen the host
through a variety of approaches
(intervention).
• The approaches include:
– Health education, environmental changes,
nutritional modification, lifestyle modification, etc.
 Specific protection
• Idea is to avoid disease altogether. Currently
available interventions includes:
Immunization, use of specific nutrients,
chemoprophylaxis, protection against occupational
hazards, protection against accidents, protection
from carcinogens, avoidance of allergens, better
environmental conditions e.g. control of air and
noise pollution, control of consumer product quality
and safety of foods, drugs, cosmetics
Early diagnosis and prompt treatment
WHO expect committee defined it as “The
detection of disturbances of homeostatic and
compensatory mechanism while biochemical,
morphological and functional changes are still
reversible”.
 Early diagnosis and prompt
treatment
Interventions:
• Early diagnosis: better prognosis, better prevention of
further occurrence of a disease / long term disability.
Screening
Contact Tracing
Individual exam (History, GPE, lab investigation)
• Prompt treatment
Individual T/M
Mass T/M
 Disability limitation

• When a patient report late in the pathogenesis

phase, the mode of intervention is disability
limitation.

• Objective:
To halt the transition of the disease process from
impairment to handicap.
 Rehabilitation
• Definition: It 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”.

• It includes all measures aimed at reducing the

impact of disabling and handicapping conditions
and at enabling the disabled and handicapped to
achieve social integration(active participation of
the disabled and handicapped people in the
mainstream of community life.)
 Prevention approaches
Population-Based Approach:
• Preventive measure widely applied to an entire
population (public health approach)

• Strive for small absolute change among many

persons

• Must be relatively inexpensive and non-

invasive
 Prevention approaches
High-Risk Approach:
• Target group of individuals who are at high risk

• Strive for strong risk factor control

• Often times requires clinical action to identify the

high risk group and to motivate risk factor
control.