LONG ANSWER

Q. Explain the levels of prevention and modes of intervention with suitable

examples.
Ans. The disease can be prevented by opposing its natural history at different levels
.
There are three levels of prevention—primary, secondary and tertiary.
PRIMARY PREVENTION
● This is the measure undertaken in the period of prepathogenesis (i.e. before
the development of the disease) which removes the possibility of occurrence
of the disease.
● Especially, it is all the more important in those diseases, for which no
treatment is available, e.g. AIDS, cancer, rabies, carries tooth, etc.
● Primary prevention can be adopted by two modes of intervention —namely
Health promotion and Specific protection.
Health Promotion:
This consists of ‘general measures’, which will strengthen the individual/host
and prevents the occurrence of the disease by interrupting the interaction among the
three factors of epidemiological triad.
The various measures of health promotion are:
• Health education (on personal hygiene, oral hygiene,nutrition education,
life-style, etc.).
• Sex education.
• Adequate nutrition.
• Improvement in the environmental sanitation (such ascontrol of insects,
provision of protected water supply, sanitary disposal of sewage, etc.).
• Promotion of breastfeeding and proper weaning.
• Family planning and spacing of births.
• Genetic counseling (premarital and marriage coun�seling).
• Efficient antenatal care and postnatal care.
• Recreation facilities (sports, games, cultural activities,etc.).
• Improvement in the literacy level.
• Yoga exercises and meditation.
Specific Protection:
This consists of ‘specific measures’, which prevent specific diseases.
The various measures are:
• Immunization against vaccine preventable diseases
• Silver nitrate or penicillin eye drops against ophthalmia neonatorum
• Condom against AIDS
• Use of specific nutrients (Vitamin A against nutritional blindness, IFA
against nutritional anemia, iodized salt against iodine deficiency disorders)
• Helmet against head-injury
• Masks against pneumoconiosis
• Ear plugs against noise induced deafness
 • Lead apron against radiation hazards
• Visor against welding keratitis
• Barrier cream against occupational skin cancer
• Avoidance of allergens and carcinogens
• Sterilization procedures of surgical instruments
• Pasteurization of milk
• Traffic signals against road accidents
• Quality control of foods, drugs and cosmetics, etc.
These measures need to be applied in specific situation for specific groups. They are
more concrete and effective
PRIMORDIAL PREVENTION
● It is also a primary level of prevention of the disease but it is with reference to
noncommunicable diseases, such as Obesity, hypertension, diabetes, cancer,
coronary artery disease, etc.
● This consists of elimination or modification of ‘risk factors’ of the disease. In
such chronic, non�communicable diseases, the etiological (causative) agent
is not known (or not established) and the etiology is discussed in terms of ‘risk
factors.’
● They may act as contributory factors.
There are two approaches for the primordial prevention:
• Population (mass) strategy
• High-risk strategy.
Population Strategy:
● This is directed at the whole population, irrespective of individual risk level.
For example, it is shown that a small reduction in the average blood pressure
or serum cholesterol in the population, goes a long-way in reducing the
prevalence of coronary artery disease in the community.
● This approach is directed towards changes in the life-style of the population
by health education from the childhood itself. The results of these measures
cannot be perceived immediately but are seen after several years or decades.
High-risk Strategy (Individual Strategy)
● This is directed to those individuals, who are at high risk of getting the
disease. These high-risk group can be detected by screeningprocedures
SECONDARY PREVENTION
● This is the measure undertaken in the early stage, after the
onset of the disease or even much before the development of
permanent pathology in the individual.
● The intervention is by ‘Early diagnosis and treatment.’
This can be done by various screening procedures -
Early Diagnosis and Prompt Treatment
This helps in the following ways:
• Helps in recovery from the disease (restoration)
• Reduces the duration of illness in the individual
• Minimizes the suffering
 • Prevents the development of complications
• Prevents further spread of the diseases in the community
• Prevents or postpones the death of the individual.
Thus, early diagnosis and prompt treatment is like ‘Stamping the spark rather than
calling the fire-brigade to put out the fire’.
The different screening procedures for the early diagnosis of the disease are
as follows:

Different modalities of treatment are chemotherapy, radiotherapy, immunotherapy,

hormonal therapy, psychotherapy, physiotherapy, oral rehydration therapy and
surgery.
Conditions where the treatment is for a long period as in tuberculosis or
leprosy, the physician should ensure ‘Case holding’, i.e. to see that the patient
takes the treatment correctly and completely.
TERTIARY PREVENTION
● This is the measure undertaken, when the disease process is sufficiently
advanced, (i.e. in the late pathogenesis phase).
● Tertiary prevention can be adopted by two modes of intervention—disability
limitation and rehabilitation.
Disability Limitation
● This means limiting the development of further disability in
the individual by giving intensive or aggressive treatment, when the patient comes in
the advanced stage of the disease.
● The objective is to prevent the transition from impairment to handicap.
The sequence of events in a disease process are:
Disease → Impairment → Disability → Handicap
Impairment:
This means defect in the structures and function of an organ or a part of the
body. The impairment may led to the development of secondary impairment
as in leprosy, where damage to nerves (primary impairment) may lead to
plantar ulcers (secondary impairment).
Disability:
This means inability to carry out certain routine, expected activities,
considered normal for the age, sex etc,due to impairment.
Handicap:
 This means experiencing disadvantage in thelife and not able to play the role,
expected out of her/him,resulting from the impairment or disability for
example.
Rehabilitation:
It is defined as ‘Combined and co-ordinated use of physical, social,
vocational and psychological measures for training and retraining the
individual to the highest possible level of functional ability’, so that the
individual becomes useful to himself, to the family and to the community at
large.
The different aspects of rehabilitation are:
• Physical rehabilitation Restoration of function
• Vocational rehabilitation Restoration of earning capacity
• Social rehabilitation Restoration of relationship in the
society
• Psychological rehabilitation Restoration of personal dignity
and confidence
Examples of rehabilitation are:
• Establishing the schools for the blind
• Providing aids for crippled, such as artificial limb,
crutches, wheel chair, hearing aid, etc.
• Reconstructive surgery in leprosy
• Graded exercises in paralysis
• Intraocular implantation of lens among cataract patients