The document discusses the iceberg phenomenon, which describes a situation where a large percentage of a problem is hidden from view. Only a small "tip of the iceberg" is apparent. It provides examples of diagnosed, undiagnosed, and wrongly diagnosed diseases as well as risk factors. Several factors can determine the size of a disease iceberg, including agent, host, and environmental factors. The iceberg concept can be useful for detecting subclinical cases, controlling disease, and understanding the natural history of disease. It also discusses how the iceberg concept can be applied to primary, secondary, and tertiary prevention strategies.

1. Presenter:
ID: PG-11-43-18-007
ID: PG-11-43-18-012
ID: PG-11-43-18-013
STATE UNIVERSITY OF
BANGLADESH

2. The iceberg phenomenon describe a
situation in which a large percentage of a
problem is subclinical, unreported, or
otherwise hidden from view. Thus, only the
"tip of the iceberg" is apparent to the
epidemiologist.

4.  May include controlled
and uncontrolled
diseases.
 These are diseases
which are commonly
and easily identified
 Diseases which are
symptomatic
Diagnosed Diseases
Diagnosed
Diseases
Undiagnosed
or Wrongly
Diagnosed
Risk Factor for
Disease
Free of Risk Factor

5. Example of Diagnosed
Disease (Clinical Case)
Infection
 Infection, Arthritis,
Obesity, Cancer,
Diabetes etc.

6. Undiagnosed or Wrongly Diagnosed
Undiagnosed Diseases
 Unidentified case of
disease which are not
treated due to its
unknown nature
Wrongly Diagnosed
Diseases
 An inaccurate
assessment of a patients
condition that
sometimes lead to
wrong treatment
Diagnosed
Diseases
Undiagnosed
or Wrongly
Diagnosed
Risk Factor for
Disease
Free of Risk Factor

7. Example of Undiagnosed or Wrongly
Diagnosed Disease (Subclinical Case)
 Hormonal imbalances,
 Detoxification imbalances,
 Toxic chemical exposure,
 Digestive, absorptive and microbiological
imbalances
 Immune imbalances etc.

8. Risk Factor for Disease
 People that fall under
this category have a
high chance of acquiring
a said disease
Diagnosed
Diseases
Undiagnosed
or Wrongly
Diagnosed
Risk Factor for
Disease
Free of Risk Factor

9. People have a high chance of
acquiring a disease
Smoker Obese Person

10. Free of Risk Factor
 This people who have
low chances of acquiring
a disease
 People who are
considered completely
healthy
Diagnosed
Diseases
Undiagnosed
or Wrongly
Diagnosed
Risk Factor for
Disease
Free of Risk Factor

11. Size and shape of Iceberg of a
disease depends upon
1. Agent-Host-Environment relationship
2. Natural history of disease (Pathological
condition to complete recovery)

12. Agent Factors
Virulence,
Genetic drifts & Shifts
Adaptability
Host range
Survivability
Factors determining the size of a
disease Iceberg in a population

13. Factors determining the size of a
disease Iceberg in a population
Environmental Factor
 Indoor Environment
 Unhealthy living system
 Outdoor Environment
 Air pollution
 Sound pollution
 Water Pollution

14. Factors determining the size of a
disease Iceberg in a population
Host Factors
 Genetic makeup
 Early life events
 Immunological status
 Occupation
 Companions

15. Mistake made by epidemiologist
while making an iceberg model
 Giving importance to ill persons only.
 No clinical signs, no disease.
 Only a single agent is cause of infection.
 False interpretation of clinical intervention.
 Dependency on clinical records.

16. Uses of Iceberg Concept
 For detection of sub-clinical and in-apparent cases
 Treatment of in-apparent cases
 Control of disease with more number of sub-clinical
cases
 To have a detailed knowledge regarding natural
history of disease

17. Use of Iceberg Concept in
Disease Control
 Primary Prevention
 Secondary Prevention
 Tertiary Prevention

18. Primary Prevention
 Primary prevention defined as action taken prior to
onset of disease.
 WHO recommends two approaches
1. Population Strategy
2. High risk Strategy
Example: e.g. Tran-boundary measures, Import
prohibitions, Vaccination, Eradication

19. Secondary Prevention
 Secondary prevention is the action that taken at
incipient stage of disease
 Specific interventions are-
1. Case finding programs
2. More expensive and less effective than primary
prevention
 Draw back is patient feels pain & productivity

20. Tertiary Prevention
 When disease is advanced beyond its early stages
Specific interventions are-
 All measures available to reduce pain and diseases
 When disability stabilized then apply rehabilitation
 Consist of psychosocial, vocational and medical
components