MODUL-1 DAY-3

PREVENTION
Susceptible
(at risk)
Primary prevention
Health promotion
Specific protection
Presym-
tomatic
stage
Secondary prev.
Early detection
& prompt
treatment
Clinical
stage
Stage
of
dis-
ability
Tertiary prev.
Disability
limitation
Rehabilitation
Genetic
Environment
Behavior
Health Services
Physical
Social, cultural
Biological, economical
Determinants
DETERMINANTS
OF DISEASE
NEVER SINGLE FACTOR
ALWAYS MULTI FACTORS
BUT SOME FACTORS
MORE DOMINANT AND
OTHERS LESS DOMINANT
HOST (intrinsic)
AGENT
(biologic, physic, mechanical,
chemical, nutrient)
ENVIRONMENT
(Physical, Biological, Social)
The Epidemiologic Triad/Triangle
(Model Segitiga)
Genetic
HOST
EXTERNAL (extrinsic)
INTERNAL
(intrinsic)
Physical Environment
Social
politic,
economic
culture
Biological
Environ-
ment
Model Roda (Wheel Model)
BLUM MODEL
Morbidity and
mortality in
a population
Environmental factors
(biological, physical, social, economical, politic)
Health
services
Genetic
Behavior
Socioeconomic determinants
Maternal
factors
Environmental
Contamination
Nutrient
deficiency
Injury
Healthy
Personal
Illness
control
Sick
Growth
faltering
Mortality
Prevention
Treatment
Mosley Model
MDGs (2015)
1. Reduce poverty
2. Reduce Maternal Mortality Rate
3. Reduce Infant & Child MR
4. Reduce child under nutrition
5. To combat HIV-AIDS, TBC, Malaria
6. Gender equality (role of women)
7. Environment

Death
Chronic
Carrier
Cure with
squelae
Cure without
squelae
Asymptomatic
stage
Symptomatic
stage
NATURAL HISTORY OF DISEASE
Squaelae = organ damage = disability
Prevention can be done when
determinants and natural history of
the disease are understood
LEVEL OF PREVENTIONS IN BROAD
CONCEPT
Primary prevention
Health promotion
Behavior change education
Policy/regulation
Specific protection
(specific to a certain disease)
Secondary prevention
Early detection and
prompt treatment/action
Tertiary prevention
Disability limitation
Rehabilitation
Medical
Psychological
Social
Economical
Prolonging
life/increase
quality of life
Susceptible
(at risk)
Primary prevention
Health promotion
Specific protection
Presym-
tomatic
stage
Secondary prev.
Early detection
& prompt
treatment
Clinical
stage
Stage
of
dis-
ability
Tertiary prev.
Disability
limitation
Rehabilitation
Genetic
Environment
Behavior
Health Services
Physical
Social, cultural
Biological, economical
Using Blum Model/Concept
0
500
1000
1500
2000
2500
3000
3500
2006 2007 2008 2009 2010 2011
Accidents Deaths Severe injury Minor injury
Source: Bali Dalam Angka, BPS Prov. Bali
TREND OF TRAFFIC ACCIDENTS IN BALI
(2006 2011)
600
During the last week of Ramadhan
5,161 traffic accidents
More than 1.000
1.837 severe injuries
Source: Kompas, 22 August 2012
9,289 minor injuries
THE GREATEST DANGER FOR FOREIGNERS
Acute disease versus chronic
disease
Availability of technology for
early detection
Infectious diseases versus
non infectious diseases
ICE-BERG PHENOMENA
SEVERITY OF DISEASES







ICEBERG PHENOMENON
(FENOMENA GUNUNG ES)
TWO CONSEQUENCIES OF
ICEBERG PHENOMENON
The wider the base of ice berg:
Control of the disease will be
more difficult
The statistics of the disease
will be less accurate
END OF MODUL-1
DAY-3