Labs

Primordial prevention

Why is primordial prevention important?

Learning & Performance Objectives

Prevention
Disease prevention includes measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once established.

Levels of prevention (I)

Levels of prevention (II)



Definition
Primordial prevention is defined as prevention of risk factors themselves, beginning with change in social and environmental conditions in which these factors are observed to develop, and continuing for high risk children, adolescents and young adults.


Primordial prevention, a relatively new concept, is receiving special attention in the prevention of chronic diseases. 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.

General access to energy-dense diets coupled with typically sedentary urban lifestyles creates a trend toward obesity and chronic disease.

It is important to change the milieu that promotes major risk factor development. Primordial prevention calls for changing the socio-economic status of society. A better socio-economic status correlates inversely with lifestyle factors like smoking, abnormal food patterns and exercise.


Primordial prevention begins in childhood when health risk behaviour begins. Parents, teachers and peer groups are important in imparting health education to children.

Cost-effectiveness of primordial prevention

The cost of prevention: can we afford it? can we afford not to do it?


Examples of primordial prevention actions (I):National policies and programmes on nutrition involving the agricultural sector, the food industry, and the food import-export sector


Examples of primordial prevention actions (II):Comprehensive policies to discourage smoking

Examples of primordial prevention actions (III):Programmes to promote regular physical activity

Responsibilities for primordial prevention:

Government Professional and non-governmental organisations Industry Hospitals, health clinics, health practitioners and health-care workers

Making major changes in lifestyle (I)

Making major changes in lifestyle (II)

Perspectives:

The Levels of Prevention
PRIMARYPrevention
SECONDARYPrevention
TERTIARYPrevention
Definition
An intervention implemented before there is evidence of a disease or injury
An intervention implemented after a disease has begun, but before it is symptomatic.
An intervention implemented after a disease or injury is established
Intent
Reduce or eliminate causative risk factors (risk reduction)
Early identification (through screening) and treatment
Prevent sequelae (stop bad things from getting worse)
Example
Encourage exercise and healthy eating to prevent individuals from becoming overweight.
Check body mass index (BMI) at every well checkup to identify individuals who are overweight or obese.
Help obese individuals lose weight to prevent progression to more severe consequences.
Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3); 001. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm
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Cholera Prevention
10 Key factors UNICEF West and Central Africa

How is it transmitted?

It is caused by a bacterium (Vibrio cholerae) which lives naturally in brackish/freshwater amoeba, and is transmitted through -:Unsafe water (7/8 investigations in Latin America identified this as a major route)Unwashed fruit and veg (or washed in bad water), left over rice not re-heated (3 investigations +Lusaka 2004), Lack of handwashing (food preparation, hand shaking, childcare)Cooked and uncooked sea food – vibrio survives light cooking (2 investigations)

Who is most at risk?

Those living near lagoons / low lying areas with fresh/ brackish water/ fishing populations With unsafe water sources With poor faecal disposal practices With poor personal hygiene With poor food hygiene (esp. moist food of neutral acidity) Close to cholera patients in early stages (hyper-infectivity) and dealing with bodies

When does cholera become epidemic?

After heavy period of rainfall When water temperatures rise When normal diarrhoeal incidence increases Endemic cholera with good sanitation needs permanent source of vibrio, but with poor sanitation higher secondary transmission can maintain endemic status

How long does it take?

Incubation period 2hrs-5 days Infection 7-14 days, but most people do not become ill or show any symptoms Only about 10-20% of infected people show moderate or severe symptoms. Moderate symptoms difficult to differentiate from other types of acute diarrhoea Group O blood group highest risk

Endemic 1. Cholera reservoir, constant or sporadic few cases Epidemic. Triggered by factors in 4. reaches peak and then preventive measures dominate Endemic 2. Continued levels higher than endemic 1 while person to person infection continues
Typical cholera curve