Natural History of Disease

& konsep pencegahan

Team teaching
IKM FK Undip
1
 Natural history of disease

• Natural history of disease refers to the progress of a

disease process in an individual over time, in the

absence of intervention.

• The natural history of a disease describes the course

of the disease in an individual starting from the moment

of exposure to the causal agents till one of the possible

outcomes occurs.

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 Definition & Stages

• Definition ; The course of a disease from

onset (inception) to resolution.
• Stages

Progress to a fatal termination

Stage of
Pre-symptomatic Clinically
pathologic Remission and relapses
stage manifest disease
onset
Regress spontaneously,
leading to recovery

Risk Factors Precursors Effect of Treatment Prognostic factor

 Risk factor
• Risk factor; An aspect of personal behavior or life
style, an environmental exposure, or an inborn or
inherited characteristic, that, in the basis of
epidemiologic evidence, is known to be associated
with health-related condition (s) considered
important to prevent.
– Risk marker; increased probability of a specified outcome; not
necessarily a causal factor
– Determinant; can be modified by intervention, thereby reducing the
probability of occurrence of disease or other specified outcomes
 The Natural history of disease
in a patient
Preclinical Phase Clinical Phase

(A) (P) (S) (M) (D) (T)

• A ; Biologic onset of disease

• P ; Pathologic evidence of disease if Sought
• S ; Signs and symptoms of disease
• M ; Medical care sought
• D ; Diagnosis
• T ; Treatment
Gordis L. Epidemiology. WB Saunders Company. 1996
(Leavell's Level of Application of Preventive Medicine)

THE NATURAL HISTORY OF A DISEASE

STIMULUS to
HOST REACTION RECOVERY
the HOST

interrelation of
Agent, Host and Latent Period (Pre- Symptoms, with or without Defects,
Environmental symptomatic) Signs(Clinical) Disability
factors

PREPATHOGE
PERIOD OF PATHOGENESIS
NESIS

Health
Promotion Disability Limitation
Specific Early Diagnosis and Prompt
Protection Treatment,
Rehabilitation

PRIMARY SECONDARY
TREATMENT TERTIARY PREVENTION
PREVENTION PREVENTION
 TIME

Death

Infection Clinical disease

Susceptible
host Recovery

No infection

Incubation period

Latent Infectious Non-infectious

Exposure Onset
• Latent period
the time interval from infection to development of
infectiousness
• Infectious period
the time during which time the host can infect another
susceptible host
• Non-infectious period
the period when the host’s ability to transmit disease to
other hosts ceases
• Incubation period
the time interval between infection to development of
clinical disease
 Natural history of disease

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 Natural History of Disease
Detectable subclinical disease

Susceptible Subclinical Clinical Outcome:

Disease
Host Disease
Stage of Recovery,
Complications,
Diagnosis Disability, or Death
Point of sought
Exposure

Onset of
symptoms

Screening
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 The problem
• The problem is that we might know about
disease onset when symptoms occur but most
likely we will only know about the disease when
a person seeks care for the symptoms.

• In some situations an investigator will only

become aware of a case after a diagnosis is
made.

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 Importance of studying
Natural history of disease
• The understanding of this progression from
disease onset to cure or death is important for
epidemiologists.
• Natural history is as important as causal
understanding for the prevention and control of
disease.
• The earlier you can become aware of the attack
the more likely you will be able to intervene and
save lives.

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 LIMA TINGKAT PENCEGAHAN
(Five level of prevention_ Leavel & Clark)
I. Peningkatan Kesehatan (Health Promotion )
II. Perlindungan umum dan khusus terhadap
penyakit penyakit tertentu ( General and
specific Protection )
III. Menegakan diagnosa secara dini dan
pengobatan yang tepat (early diaganosis &
prompt treatment )
IV. Pembatasan kecacatan ( Disability limitation)
V. Pemulihan kesehatan ( Rehabilitation )
Leavel & Clark
 ● Five levels of Prevention (Rao, 2005)

■ Primary Prevention
1. Health promotion:
good nutrition, safe water supply
2. Specific protection:
immunization, mask, glove
■ Secondary Prevention
3. Early detection & prompt treatment:
screening, oral dehydration therapy,
physiotherapy
■ Tertiary Prevention
4. Disability limitation:
bed rest, chemotherapy
5. Rehabilitation: wearing spectacles, leg prosthesis,
 Health Promotion
 Tujuannya adalah untuk meningkatkan, memajukan
dan membina kondisi sehat yang sudah ada hingga
dapat dipertahankan dan dijauhkan dari ancaman
penyebab penyakit.
Antara lain :
- pemberian makanan bergizi
- penyediaan sanitasi lingkungan yang baik
- Kebersihan perorangan
- Penyuluhan kesehatan yang bersifat umum
- Nasehat perkawinan
- Olahraga
 Perlindungan khusus
(specific Protection)
 biasanya ditujukan pada kelompok yang beresiko
tinggi, yaitu kelompok masyarakat yang punya resiko
besar untuk terkena penyakit yang bersangkutan bila
mereka tidak diberi perlindungan khusus.
Contoh:
- Imunisasi spesifik
- Specific nutrients
- Perlindungan terhadap ancaman Penyakit Akibat Kerja
- Menghindari zat-zat alergen
- Pemakaian kondom
 Pencegahan Sekunder

• Tindakan yang berupaya untuk menghentikan proses

penyakit pada tingkat permulaan sehingga tidak
akan menjadi lebih parah.
• Berbentuk upaya ‘diagnosa dini dan pengobatan
segera’ (early diagnostic and prompt treatment)

Contoh:
• - Case Finding
• - Survey kesehatan
• - Monitoring dan surveilans epidemiologi
 Pencegahan tersier
• Dilakukan pada stadium penderita sudah dalam kondisi sakit yang
jelas nyata secara klinis, dan bahkan mungkin sudah lanjut.
Ada dua tingkat:
• Disability Limitation
Mencegah agar penyakit tidak parah lagi/ supaya penderita tidak
mati
• Rehabilitation
- Memulihkan dan menempatkan kembali penderita, kedudukan
atau fungsinya semula atau setidaknya mencarikan alternatif lainnya
sesuai dengan kemampuannya setelah ia sembuh dari penyakitnya.
contoh :
Tempat pendidikan untuk tuna netra dan tuna rungu
Tempat pendidikan untuk anak2 cacat dan terbelakang
Fisioterapi dan pelatihan/perawatan neurologis untuk penderita
polio
 Reference books

• Principles of Epidemiology in Public Health Practice. Third

Edition. An Introduction to Applied Epidemiology and
Biostatistics. Centers for Disease Control and Prevention
(CDC)
• Gordis L. Epidemiology. 2009

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