Multifactorial causation

public health

1. Multifactorial causation Presented by : Kumar Nyaupane

2. Introduction As a result of advances in public health, chemotherapy ,antibiotics and vector control the communicable diseases begin to decline – only to be replaced by new types of diseases so called modern disease of civilization eg . lung cancer, CHD, bronchitis, COPD , mental illness. These disease could not be explained on the basis of germ theory of disease nor prevented by immunization, isolation , sanitation.

3. Contd … Multiple factors leads to the disease Common in non communicable disease Alternative causal factors each acting independently Example : In lung cancer , air pollution , smoking , hereditary can produce lung cancer independently.

4. Contd … The realization began to dawn that the single cause idea was an oversimplification and there are other factors in the etiology of diseases – social, economic, cultural, genetic Example tuberculosis is not merely due tubercle bacilli, factors such as poverty , overcrowding and malnutrition contribute to its occurrence .

5. Contd … It is well known that CHD, cancer etc are due to multiple factors example, excess fat intake, smoking, alcohol , obesity, lack of exercise Behavior, lifestyle, environmental causes, ecological elements, physical factors must be taken into account while describing disease causation. The term agent is replaced by causative factors which implies the need to identify multiple causes or factors in advanced model of triangle of epidemiology.

6. Multifactorial causation in disease prevention Example : Obesity threatens to become the foremost cause of chronic disease in the world . being obese can induce multiple metabolic abnormalities that contribute to cardiovascular disease , diabetes mellitus and other chronic disorders . Unfortunately prevalence of obesity is increasing in the world.

7. Contd … Reason to rising prevalence include urbanization of worlds population , increased availability of food supplies and reduction in physical activity. Although severe obesity has received much attention in the clinical setting , most obesity in general public is moderate . Moderate obesity is undoubtedly multifactorial in origin and acquired influences probably exceed genetic factors in its causation.

8. Contd …. Therefore the prevention includes the change in any of the causal factor . Example : Lifestyle habits (Sleeping , Diet) Social factors(poverty , less healthier foods) Alcohol and smoking Medical factors (age , cushings syndrome , hypothyroidism , medications , psychological issues)