COMMUNITY
HEALTH
NURSING
Community
- a group of people with common characteristics
or interest living together within a territory or
geographical boundary.
Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
- combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas
4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health
- is the state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. (World Health Organization)
Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender
New concept in determinants of health
- OLOF (Optimum Level Of Functioning)
Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
5. Socio-Economic – education, employment, housing
6. Health Care Delivery System – availability, accessibility
and affordability of services and facilities
Nursing
- an art and science of rendering care to
individual, families and community.
- assisting an individual, sick or well, in the
performance of those activities contributing to
health or its recovery in such a way as to help gain
independence. (OLOF)
Community Health Nursing
- a direct goal oriented and adaptable to the needs
of the individual, the family and community during health
and illness.
- (ANA, 1973)
- an area of human services directed toward
developing and enhancing the health capabilities of
people – either singly, as an individual or collectively as
groups and communities.
- (John Henrich, 1981)
- the utilization of the nursing process in different
level of clientele concerned with the promotion of health,
prevention of disease and disability and rehabilitation.
- (Aracelli Maglaya)
*** a service rendered by a professional nurse
with the community, groups, families and individuals
at home, in health centers, in clinics, in schools, in
places of work for the promotion of health,
prevention of illness, care of the sick at home and
rehabilitation.
PRIMARY GOAL OF CHN:
- Enhance people’s capability.
ULTIMATE GOAL OF CHN:
- “ To raise the level of health of the citizenry.”
PHILOSOPHY OF CHN:
- CHN is based on the worth and dignity of man.
- (Margaret Shetland)
EMPHASIS/FOCUS:
- Health promotion and Disease prevention.
Important Concepts of CHN:
1. The primary focus of CHN is on health promotion.
2. Recognized needs
of individuals, families and
communities provide the basis for CHN.
3. The family is the unit of service.
4. Contact with the client may continue over a long period
of time which include all ages and all types of health care.
5. CH nurses are generalists in terms of their practice
throughout life’s continuum –its full range of health
problems and needs.
6. CHN practice is extended to benefit not only the
individual but the whole family and community
Roles and Functions of CH Nurse:
1. Advocate
- defends the rights of the client for self-determination
- intercedes, supports, pleads or acts as guardian of the
client’s rights to autonomy and free choice for self-care
2. Supervisor
- provides administrative support
- oversees, monitors and evaluates the function of the
subordinates
3. Counselor
- encourages client to verbalize and express feelings and
concerns
- key task is active listening
4. Educator
- teaches the client to provide skills, knowledge and
attitude
- primary task is to assess readiness to learn
5. Trainer
- provides technical support
- identifies training needs, formulates training program
designs
- arranges and conducts training to provide learning
experiences to subordinates and clients
Levels of Clientele:
1. Individual
- “point entry”
2. Family
- center of delivery of care.
3. Group
- point of specific care.
4. Community
- point of entire care
PLACES IN CHN:
A. Public Health Nursing
- is a special field of nursing that combines the skills of
nursing, public health and some phases of social assistance
and functions as part of the total health program.
Public Health
- the science and art of preventing disease, prolonging
life and promoting life and efficiency. (C. E. Winslow)
- is the art of applying science in the context of politics to
reduce inequalities while ensuring the best health for the
greatest number. (WHO)
B. School Health Nursing
> Home Visitation – effective implementation of total school
program
> RA 124 – it mandates the school to provide clinics for the
minor treatment and attendance to emergency cases
> Assessment:
1. Arms
5. Ears
2. Eyes and Visual Acuity
6. Neck and Chest
3. Nose
7. Hair
4. Mouth and Teeth
8. Lower extremities
> Feeding Program
- Should run for 120 days
- Deworming with consent
C. Occupational Health Nursing
> RA 1054
– Occupational Health Act
> Business Firm must employ an occupational health nurse
when it has at least _____________?
101 employees
FAMILY – NURSE CONTACT:
I. HOME VISIT
- professional face to face contact done by a nurse to
the family.
Purposes:
1. Give nursing to the sick, post partum mother & newborn.
2. Assess living condition of client and their health
practices.
3. Give health teachings.
4. Establish relationship with health agency and public.
5. Make use of inter-referral system and promote utilization
of community services.
Principles:
1. Must have a purpose and objective.
2. Make use available information about the patient and his
family.
3. Consider and prioritize essential needs of the individual
and family.
4. Should involve the individual and family in planning and
delivery of care.
5. Plan should be flexible.
Important Steps of Home Visit:
1. Greet client and family then introduce yourself.
2. Explain the purpose of the visit.
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place then perform bag
technique
5. Perform nursing care and give health teachings.
6. Record all important data, observation and care
rendered.
7. Make appointment for a return visit.
Phases:
1. Preparatory Phase
a. review existing records of referral data of the
family
b. notifies the family of the intention to make a
home visit
2. Home Visit Phase
a. actual visits of the family
b. makes plans, interventions, evaluation with the
family and set schedule for the next visit
3. Post Visit Phase
a. records data and plans for the next visit and
referrals
Priorities During Home Visit:
1. Newborn
2. Post partum
3. Pregnant women
4. Morbid individuals
Factors affecting Frequency of Home Visit:
1. Physical, psychological and educational
2. Acceptance of family
3. Policies given by the agency
Bag Technique:
- a tool making use of a public health bag and which
the public health nurse can perform procedures during
home visits.
Rationale :
- Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.
Special Consideration:
B
- bag and its contents must be free from any
contamination.
A
- always perform handwashing.
G
- gather necessary equipments to render effective
nursing care.
Steps in Performing The Bag Technique Actions:
1. Upon arrival, place the bag on the table lined with a clean
paper. (the clean side must be out and folded part, touching
the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific
care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used
and perform handwashing.
10. Open the bag and return all things that were used in their
proper place
11. Remove apron, folding it away fro the person, the soiled
side in and the clean side out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.
II. CLINIC VISIT
Advantage:
- it is inexpensive in time and usually in cost both for the
service and for the family.
Standard Procedure in Conducting Clinic Visit:
I. Registration/Admission
1. Greet the client and establish rapport
2. Prepare records
3. Elicit client’s chief complaint and clinical history
4. Perform PE
II. Waiting Time
* Implement the “first come”, “first served” except for
emergency and urgent cases
III. Triaging
* Manage program-based cases
* Refer all non-program based cases
IV. Clinical Evaluation
* Validate clinical history and PE
* Inform client of the nature of the illness, treatment,
prevention and control measures
V. Laboratory and other diagnostic examinations
* Identify a designated referral laboratory when needed
VI. Referral System
1. Refer if needs further management (BHS to RHU, RHU
to RHU, RHU to Hospital)
2. Accompany patient if it is an emergency referral
VII. Prescription/ Dispensing
* Give proper instructions on drug intake
VIII. Health Education
1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit
Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
b. follow-up care
c. referral (if possible)
PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR
Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.
Vision :
Health for All Filipinos
Goal :
Health for All Filipinos and Health in the Hands of the
people by the Year 2020
Mission :
In partnership with the people, provide equity, access
and quality health care especially to the marginalized
Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5. Partnership between the community and the health
agencies in provision of quality life
6. Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization
RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
- Devolution Code (Mandate of Devolution)
Local Government Code
Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
- BHW
- PHW
4 Pillars/Cornerstones:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available
Levels of PHC Workers:
1. Village or Brgy. Health Workers
- health auxiliary or volunteers
2. Intermediate Level Health Workers
- Physician
- Sanitary Inspector
- Nurse
- Midwife
Ratios to catchment population:
Public Health Worker
Public Health Physician
Public Health Nurse
Public Health Midwife
Dentist
=
=
=
=
=
1:50,000
1:20,000
1:20,000
1: 5,000
1:20,000
LEVELS OF PREVENTION
1.Primary Prevention
- health promotion
- specific protection
Behaviors:
1. Quit smoking
2. Avoid/limit alcohol intake
3. Exercise regularly
4. Eat well-balance diet
5. Reduce fat and increase fiber in the diet
6. Complete immunization program
7. Wear hazard devices in work site
2. Secondary Prevention
- early diagnosis/detection/screening
- prompt treatment
Behaviors:
1. Have annual physical examination
2. Regular Pap smear for women
3. Monthly BSE for women who are 20 yrs old and
above
4. Sputum examination for Tuberculosis
5. Annual stool Guaiac test and rectal exam for clients
over age 50 yrs old
3. Tertiary Prevention
- prevention of complication
- optimal health status after a disease or
disability
Behaviors:
1. Self-monitoring of blood glucose among diabetics
2. Physical therapy after CVA
3. Attending self-management education for diabetes
4. Undergoing speech therapy after laryngectomy
Levels of Health Care and Referral System
1. Primary Level of Care
1. Rural Health Units
2. Community Hospitals and Health Center
3. Private Practitioners (Puericulture Centers)
4. Brgy. Health Stations
- is usually the first contact between the community
members and the others levels of health facility.
- provided by center physicians, public health nurses,
rural health midwives, barangay health workers,
traditional healers
2. Secondary Level of Facilities
1. Provincial/City Health Services and Hospitals
2. Emergency and District Hospitals
- serves as a referral center for the primary health
facilities
- are capable of performing minor surgeries and perform
some simple laboratory examinations
3. Tertiary Level of Facilities
1. National and Regional Health Services
2. Teaching and Training Hospitals
- serves complicated cases and intensive care
ALTERNATIVE HEALTH CARE
Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act
* created the Philippine Institute of Traditional and
Alternative Health Care
** S A N T A L U B B Y **
S - Sambong
* anti-edema, diuretic, anti-urolithiasis
A - Ampalaya
* DM
N - Niyog-niyogan
* anti-helmintic
T- Tsaang Gubat
* diarrhea, stomachache, mouth wash
A - Akapulko (Bayabas-bayabasan)
* anti-fungal
L - Lagundi
* asthma, cough, fever, dysentery, skin diseases
U - Ulasimang Bato (Pansit-pansitan)
* lowers uric acid
B - Bawang
* lowers cholesterol levels, hypertension, toothache
B - Bayabas
* washing of wounds, diarrhea, gargle for toothache
Y - Yerba Buena
* pain, rheumatism, arthritis, headache, cough and
colds, swollen gums, toothache, menstrual and gas
pain, nausea, fainting, insects bites and pruritus
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
7. If signs and symptoms are not relieved after 2 or 3
doses, consult a doctor.
DOH
(Department of Health)
Vision:
- A leader, staunch advocate and model in promoting
health for all in the Philippines.
Mission:
- Guarantee equitable, sustainable and quality health for
all Filipinos, especially the poor and shall lead the quest for
excellence in health.
3 Roles and Functions of DOH:
- Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health
policies, plans and programs to address national and sectoral
concerns.
2. Administrator of Specific Service
- administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.
Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA)
Framework for its Implementation:
- FOURmula One for Health --- *Arroyo
- Universal HealthCare (Kalusugan Pangkalahatan)
---*Aquino ( Executive Order 36)
---Phil. Health Agenda (Pres. Duterte)
ALL FOR HEALTH TOWARDS HEALTH FOR ALL
Goals:
1. Financial Protection
2. Better Health Outcomes
3. Responsiveness
Values:
1. Equitable and inclusive to all
2. Transparent and accountable
3. Uses resources efficiently
4. Provides high quality services
Strategies:
1. Advance quality, health promotion and primary care.
2. Cover all Filipinos against health-related financial risk.
3. Harness the power of strategic HRH development.
4. Invest in eHealth and data for decision-making.
5. Enforce standards, accountability and transparency.
6. Value all clients and patients, especially the poor, marginalized
and vulnerable.
7. Elicit multi-sectoral and multi-stakeholder support for health.
8 MILLENIUM DEVELOPMENT GOALS
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
- based on the fundamental values of freedom, equality,
solidarity, tolerance, health, respect for nature and shared
responsibility.
PHILIPPINE REPRODUCTIVE HEALTH
Goal:
- To achieve “Better Quality Life among Filipinos”
*Responsible Parenthood and Reproductive Health Act of 2012
- RA 10354
Local Framework Focuses on:
- Health needs of women, men, adolescents, children
and underserved groups.
Main objectives:
1. Reducing maternal mortality rate.
2. Reducing child mortality.
3. Halting and reversing spread of HIV/AIDS.
4. Increasing access to reproductive health information and
services.
10 Elements:
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention and Management of Reproductive Tract Infections
including STIs and HIV/AIDS
5. Prevention and Management of Abortion and its Complication
6. Education and Counseling on Sexuality and Sexual Health
7. Prevention and Management of Breast and Reproductive Tract
Cancers and other Gynecological Conditions.
8. Men’s Reproductive Health
9. Violence Against Women and Children
10. Prevention and Management of Infertility and Sexual
Dysfunctions
t
PHILIPPINE FAMILY PLANNING PROGRAM
*** Principal recipients of information, education, communication
and motivation in family planning:
- married couples of reproductive age
*** It requires all couples who want to receive a marriage license
to first undergo a seminar in family planning and responsible
parenthood
- PD 965
Advantages:
1. FP helps families improve their standard of living
2. FP reduces/eliminates fears of unwanted pregnancy
3. FP affords family members time to study or pursue occupational
interest
t
Major target (High Risk Women):
1. Women under 20 years old
2. Women over 35 years old
3. Women suffering from certain medical conditions that
contradict pregnancy
4. Women who have had at least 4 deliveries
*** The Family Code of the Philippines?
- Executive Order No. 209
t
The Family Planning Methods:
1. Female Sterilization
- safe and simple surgical procedure which provides
permanent contraception for women who do not want more
children. Also known as BTL that involves cutting or blocking the
two fallopian tubes.
- performed during first 2 weeks of her menstrual cycle or
within the first 3 days after delivery.
2. Male Sterilization
- permanent method wherein the vas deferens (passage of
sperm) is tied and cut or block through a small opening on the
scrotal skin. It is also known as Vasectomy.
t
3. Pill
- contains hormones estrogen and progesteron taken daily to
prevent contraceptions. Advised for women who are anemic
because of the reduced menstrual flow.
- taken some time everyday preferably at night.
Common side effects:
- dizziness, headache, nausea, spotting, weight gain, breast
fullness.
Adverse effects:
Contraindications:
1. Abdominal pain
1. pregnancy or suspected
2. Chest pain
2. history of diabetes
3. Headache
3. high blood pressure
4. Eyes blurred
4. weak heart
5. Severe leg pain
5. CA of the breast
6. over 50 years old
Important facts to remember about a Pill
1. Pill are advised for women who are anemic because of the
reduced menstrual flow
2. Take pill same time everyday
3. A packet of pills contain 28 tablets; 21 pills are “active pills”, 7
contain no hormones, only iron
4. Follow the direction of the arrows of the pill. When empty, start a
new pack on the next day without missing a day
5. For 1 missed pill: take the pill as soon as possible; take regular pill
at night
6. For 2 missed pill: take 2 pills next day, then take 2 pills the next
day again
7. For 3 missed pill: discard and substitute method, start on next
pack on next menstrual period.
t
4. Male Condom
- thin sheath of latex rubber made to fit on a man’s erect
penis to prevent the passage of sperm cell and sexually
transmitted disease organism into the vagina.
- the shelf life is 3 years in the Phils., if stored in a cool dry
place.
5. Injectables
- contain synthetic hormones, progestin which suppresses
ovulation, thickens cervical mucus, making it difficult for sperm to
pass through and changes uterine lining.
6. Basal Body Temperature
- used to measure changes of temperature during ovulation.
Temp. slightly decreases before ovulation and increases during
ovulation day. It must be measured on the same time of the day,
before rising, with the same thermometer.
t
7. Lactating Amenorhea Method or LAM
- temporary introductory postpartum method of postponing
pregnancy based on physiological infertility experienced by Breast
Feeding women.
Criteria:
1. Amenorrhea
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 months
8. Mucus/Billings/Ovulation
- abstaining from sexual intercourse during fertile (wet) days
prevent s pregnancy.
9. Abstinence
- best way to prevent pregnancy and STI’s
t
10. Sympto-Thermal Method
- method in identifying the fertile and infertile days of the
menstrual cycle as determined through a combination of
observations made on the cervical mucus, basal body temp
recording and other sign of ovulation.
11. IUD
- changes the nature of internal secretions of woman’s body.,
disturbs transport and decreases number of viable sperms
Contraindications:
1. PID
2. Septic Abortion
3. Endometritis
4. Anemia
5. Suspected pregnancy
t
Adverse effects:
1. Period that is late
2. Abdominal pain
3. Increase in temperature
4. Noticeable discharge – foul smelling
5. Severe bleeding
> an outpatient procedure; examined 1 month after insertion,
then after 6 months then after 1 year.
12. Standard Days Method
- A new method of natural family planning in which all users
with menstrual cycles between 26 and 32 days are counseled to
abstain from sexual intercourse on days 8-19 to avoid pregnancy.
-The couples use color coded cycle beads to mark the fertile
and infertile days of the menstrual cycle.
NUTRITION PROGRAMS
Goal:
- To improve the quality life of Filipinos through better
nutrition, increased productivity and improved health.
3 Most Common Deficiencies:
1. Iron
2. Vitamin A
3. Iodine
Programs and Projects:
1. Micronutrient Supplementation
- is one of the interventions to address the health and nutritional
needs of infants and children and improve their growth and
survival.
* Araw ng Sangkap Pinoy (ASAP), Garantisadong Pambata
- addresses health and nutritional needs of 6-71 months old
2. Food Fortification
- to improve the nutritional status of the populace including
children.
- legal basis: RA 8976
4 Food Staples that require Mandatory Fortification:
1. Rice with Iron
3. Oil with Vitamin A
2. Sugar with Vitamin A
4. Flour with Iron and Vitamin A
3. Essential Maternal and Child Health Services
- this ensures the right of the child to survival, development,
protection and participation.
4. Nutrition, information, communication and education
- promotion of 10 Nutritional Guidelines for Filipinos.
1. Eat variety of foods everyday.
2. Promoting exclusive breastfeeding from birth up to 4-6 months.
3. Giving proper advice on proper feeding of children.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calcium-rich foods.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe foods to prevent food-borne diseases.
10. Promoting healthy lifestyles.
5. Home, School and Community Food Production
- establishment of kitchens, gardens in home, schools and in
communities in urban and rural areas.
6. Food Assistance
- it involves complementary feeding for wasted/stunted children
and pregnant women with delivering low birthweight.
7. Livelihood Assistance
- provision of credit and livelihood opportunities to poor
households especially those with malnourished children through
linkage with lending and financial institutions.
Control of Acute Respiratory Infection (CARI)
Objective:
Reduce mortality through early detection.
Contributing Factors to Pneumonia:
1. Mothers failure to recognize signs and symptoms of
Pneumonia.
2. Indiscriminate use of antibiotics.
3. Not standardized management to Pneumonia
Sign of Severe Pneumonia:
- Chest Indrawing
Important Responsibility of the Nurse in preventing unnecessary
death from Pneumonia:
- Provision of careful assessment
National Cancer Control Program
9 Warning Signs:
C
– change in blood, bowel/bladder habits
A
– a sore that does not heal
U
– unusual bleeding/discharge
T
– thickening or lump in breast
I
– indigestion or difficulty in swallowing
O
– obvious change in wart or mole
N
– nagging cough or hoarseness
U
S
– unexplained anemia
– sudden unexplained weight loss
Specific Guidelines for Early Detection of Common Cancers
1. Breast Cancer
A. BSE - cheapest and most affordable
- done 1 week after menstrual period while
taking a shower
B. Mammography
- if a mass detected and confirmed
2. Cervical Cancer
A. Pap Smear
- primary screening tool for women over age
18
3. Colon Rectal Cancer
A. Annual digital rectal exam starting at age 40
B. Annual stool blood test starting at age 50
C. Annual inspection of colon
4. Prostate Cancer
A. Digital rectal exam
B. PSA (prostate Specific Antigen) – confirms
diagnosis
5. Lung Cancer
A. Chest X-ray
B. Sputum Cytology
LEVELS OF PREVENTION:
Primary Prevention:
- elimination of conditions causing cancer
Secondary Prevention:
- Definitive Treatment and Management
(a.) Chemotherapy, (b.) Radiation, (c. )Surgery
Tertiary Prevention:
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
National Voluntary Blood Services Program
- promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood
banks.
Legal basis:
RA 7719 “Blood Services Act of 1994”
Criteria for Eligible donor:
B = BP 90/60 – 160/100mmHg
A = 16 – 65 years old
W = 45 – 50 kgs minimum
A = At least 12.5 hemoglobin
S = Status in good condition
Main Objectives:
1. to promote and encourage voluntary blood donation
by the citizenry and to instill public consciousness of the
principle that blood donation is a humanitarian act
2. to provide adequate, safe, affordable and equitable
distribution of supply of blood and blood products
3. to mobilize all sectors of the community to participate
in mechanisms for voluntary and non-profit collection of
blood
Steps to donate:
1. Go to the nearest center
2. Register a s a donor
3. History taking
4. Vital signs, PE taking
5. Blood test with blood type
Must do after donated blood:
1. Eye on dressing at least 8 hours but not more than 12
hours
2. No lifting heavy objects
3. No smoke for 2 hours, no alcohol for 12 hours
4. Eat regular meals and increase fluids
National TB Control Program
Vision:
- A country where TB is no longer a public health problems.
Mission:
- Ensure that TB DOTS services are available, accessible and
affordable to the communities.
Treatment:
- Quality of SDF (Single Dose Formulation) & FDC (Fixed
Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1st specimen – SPOT specimen collected on the day of
consultation
2nd specimen – early morning specimen on the next day
3rd specimen – SPOT specimen collected on the 2nd day
after submission of early morning specimen
2. Chest X-ray
- to identify the extent of the disease
3. Tuberculin Testing/Mantoux Test/PPD Testing
TB Treatment:
SDF
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomycin
TB Abbreviation
OLD
NEW
R
R
INH
H
PZA
Z
E
E
S
S
# of Tablets of FDC of Patient per Body Weight
Body Weight (kg)
30-37
38-54
55-70
>70
# of Tablets
2
3
4
5
Category I: Newly Diagnosed TB Patient
- - - ( + ) DSSM, ( + ) CXR
Intensive Phase
2 months
HRZE
Maintenance Phase
4 months
HR
Category II: Previously treated patient
with relapses or failure
Intensive Phase
2 months
HRZES
Intensive Phase
1 month
HRZE
Maintenance Phase
5 months
HRE
Category III: Newly TB patient
- - - ( - ) DSSM, ( + ) CXR
Intensive Phase
Maintenance Phase
2 months
4 months
HRZ
HR
Category IV: - CHRONIC
Still ( + ) smear after supervised re-treatment
- refer to specialized facility
- Provincial NTP Coordinator
DOTS
- Direct Observed Treatment Short course
- Main strategy which primary health services around the
world are using to detect and cure TB patients.
Treatment partner:
-watching the TB patient take medicines everyday
during the whole course of treatment.
a. Staff of the Health Care facilities
b. LGU officials
c. Family members of the patient
5 ELEMENTS OF DOTS:
1. Political will
2. Sputum microscopy service
3. Regular drug supply
4. Record of patient’s progress
5. Supervision of drug intake
Leprosy Control Program
Leprosy
- known as Hansen’s Disease
- cause: Mycobacterium leprae
- MOT: prolonged intimate skin to skin contact;
droplet infection
Diagnostic procedure:
= Slit Skin Smear
Preventive Measures:
- BCG immunization
- Health education on the MOT
DOMICILLARY TREATMENT:
(Republic Act 4073)
PAUCIBACILLARY
:
6-9 months
A. Intermediate type
- flat, with not well defined patches, with slight to no
sensory loss and pale in color.
B. Tuberculoid type
- flat, with some raised patches, definite sensory loss
and rough to touch.
Treatment:
Day 1: Rifampicin and Dapsone
Succeeding days (2-28 days): Dapsone
MULTIBACILLARY:
:
24-30 months
A. Borderline type
- many raised patches at different sizes and shapes,
usually enlarged nerves and occasionally with
deformities.
B. Lepromatous type
- thickened skin and earlobes and with hair loss in
eyebrows.
Treatment:
Day 1: Rifampicin, Dapsone, Clofaximine or Lamprene
Day 2-28: Dapsone, Clofaximine or Lamprene
THE MATERNAL and CHILD HEALTH PROGRAM
Overall Goal:
- To improve the survival, health and well being of
mothers and unborn through a package of services for the
pre pregnancy, prenatal, natal and post natal stages.
Essential Health Service Packages:
A. Prenatal Registration
1St visit – as early in pregnancy as possible before four months
or during the first trimester
2nd visit – during the 2nd trimester
3rd visit – during the 3rd visit
Every 2 weeks – after 8th month of pregnancy until delivery
B. Deliver Tetanus Toxoid Immunization
OLD TT Immunization Schedule:
TT1
= given anytime during pregnancy
TT2
= 1 month after the first dose
TT3
= 1st booster dose; 6 months interval from TT2
TT4
= 1 year interval from TT3
TT5
= booster dose 1 year interval from TT4
NEW TT Immunization Schedule:
TT1
= 5th or 6th month of pregnancy
TT2
= after 1 month of TT1
TT3
= succeeding pregnancy (5th or 6th month pregnant)
TT4
= succeeding pregnancy (5th or 6th month pregnant)
TT5
= succeeding pregnancy (5th or 6th month pregnant)
Lifespan of TT Vaccines:
TT1
= 0;
0
= 80% protection;
3 yrs protection
= 95% protection;
5 yrs protection
= 99% protection;
10 yrs protection
= 99% protection;
lifetime protection
TT2
TT3
TT4
TT5
C. Micronutrient Supplementation
1. Vitamin A
10,000 IU
2X a week starting on
the 4th month of pregnancy
10,000 IU
once a day for 4
weeks if with Xeropthalmia
200,000 IU
post-partum; one
dose within 4 weeks
2. Iron
60 mg/day
1st trimester
120 mg/day
2nd/3rd trimester
60 mg/day X 3 mos. Post-partum
D. Treatment of Diseases and Other Conditions
- Unconscious
- Difficulty of breathing
- Post partum bleeding
- Parasitism
E. Clean and Safe Delivery
- ensure hygiene during labor and delivery
Qualifications for Home Care Delivery:
1. Full Term
7. No history of previous infection
2. G1-G4
8. No PROM
3. Cephalic Presentation
9. Adequate pelvis
4. No history of previous CS 10. No history of prolonged labor
5. No history of previous Complications
6. Enlargement of abdomen is equal to AOG
3 Priorities for a Safe Home Care Delivery:
1. Clean Hands
2. Clean Surface
3. Clean Cord
Post Partum Visits:
1st visit
– within a week (3-5 days)
2nd visit
– 6th week post delivery
3 Cardinal Signs of Post Partum Infection:
1. Board-like abdomen
2. Fever
3. Foul-smelling vaginal discharges
F. Support Breastfeeding
Breastfeeding and Rooming –in ACT : RA 7600
Benefits of BF to Infants:
1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ points
Benefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
New Breastfeeding Act….
REPUBLIC ACT 10028
Storage
Full-term
Room Temperature
8-10 hours
Refrigerator
48 hours
Freezer
3 months
G. Family Planning Counseling
- right choice of FP methods
- birth spacing is …..
3-5 years
Pre-term
4 hours
24 hours
3 months
Expanded Program on Immunization (EPI)
Legal Basis: PD No. 996
– providing for compulsory basic immunization for
infants and children below 8 yrs old. ( September 16, 1976)
> launched in July 1976
> free vaccines: BCG, DPT, OPV, Measles
Mandatory Infants and Children Health Immunization of 2011
--- RA 10152
Objective:
To reduce morbidity and mortality among infants and
children caused by the 6 childhood immunizable diseases
Target for Immunization Program
a. Infant
: 12 months old
b. School Entrants
: 6-7 years old
c. Pregnant Mother
Infants:
- 1 BCG
- EO 663
- 3 Hepa B
- RA 7846
- 3 DPT
- 1 Measles
- Proc. 4
- 3 OPV
School entrants:
- 1 booster dose of BCG
Pregnant mothers:
- 5 Tetanus Toxoid
- RA 1066 (tetanus elimination)
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health service
Elements of EPI:
Target setting:
calculation of eligible population
Formula: EP = total population x constant percentage
Constant percentage:
Infants
= 3% or .03
School Entrants
= 3% or .03
Pregnant Mothers
= 3.5% or .035
Cold Chain System
- to maintain potency of the vaccine
Refrigerator:
Freezer:
(-15° to -25 °C) – OPV, Measles
Body:
(2° to 8°C) - DPT, Hepa B, BCG, TT
2 most sensitive to heat vaccine:
OPV & MEASLES
2 least sensitive to heat vaccine:
BCG & TT
HOW LONG CAN VACCINE BE STORED?
DOH
REGIONAL HEALTH OFFICE
DISTRICT/ PROVINCIAL HEALTH OFFICE
HEALTH CENTER
* Health centers using cold box or transport boxes
- 5 days
* Check temperature 2x a day: first and last hour of the
clinic
Vaccine
Age
Doses
At birth
1
Interval
ROUTE
Dosage
ID(RIGHT deltoid )
0.05 ml
ID(LEFT deltoid )
0.5 ml
BCG
School
Entrants
DPT
(Triple)
6 wks.
3
4 wks.
IM (VASTUS
LATERALIS)
0.5 ml
OPV
(Sabin)
6 wks.
3
4 wks.
ORAL
2-3 gtts
HEPA B
At birth
3
4 wks.
IM (VASTUS
LATERALIS)
0.5 ml
MEASLES
9 mos.
1
SUBCUTANEOUS
0.5 ml
Pentavalent – Hib
(Penta – hib)
1. Diptheria
2. Pertussis or whooping cough
3. Tetanus
4. Hepatitis – B
5. Hemaphilus influenza type B
- to prevent pneumonia and meningitis to
babies
- injected intramuscularly
- given at age 6 weeks up to 11 months
CONTENT OF VACCINES:
BCG:
- live attenuated bacteria
OPV and MEASLES:
- live attenuated virus
DIPTHERIA & TT:
- weakened bacterial toxins
PERTUSSIS:
- killed bacteria
HEPA B:
- derived from plasma (plasma derivatives)
RNA recombinants
PRINCIPLES OF VACCINATION…
1. No BCG to a child born positive with HIV or AIDS
2. DPT is not given to a child who has recurrent
convulsions or active neurologic disease
3. DPT2 or DPT3 is not given to a child who has had
convulsions or shock w/in 3 days the previous dose but
you can give DT.
4. Don’t immunize children before referral
5. Moderate fever, malnutrition, mild resp. infection,
cough, diarrhea & mild vomiting aren’t contraindication
to vaccination.
6. Safe to administer all EPI vaccines on the same day at
different sites of the body.
7. No food 30 minutes after giving OPV.
8. Assess the child for allergy to egg before giving measles
vaccine.
9. Measles vaccine should be given as soon as the child is
9 months old regardless of whether other vaccines will
be given on that day.
10. Vaccination schedule should not be restarted from
the beginning even if the interval between doses
exceeded.
11. It is safe and effective with mild side effects after
vaccination.
12. Do not repeat BCG vaccination if the child does not
develop a scar after the first injection.
13. Strictly follow the principle of never, ever reconstitute
the freeze dried vaccines to any diluents.
14. Use one syringe, one needle per child during
vaccination.
15. During vaccination, clean the skin with cotton ball,
moistened with water only (boiled H20).
Opened vaccines should be discarded after:
> BCG & Measles
: 4-6 hours
> DPT, OPV, Hepa B & TT
: 8 hours
Open OPV vials can be used for the next immunization if:
a. Expiry date has not passed
b. Vaccines stored at 0°C to 8°C
c. Not taken out at the health center for outreach
activities
ENVIRONMENTAL HEALTH AND SANITATION
- the study of all factors in man’s physical environment, which
may exercise a deleterious effect on his well-being and survival.
FACTORS:
1. water sanitation
7. steam pollution
2. food sanitation
8. air pollution
3. refuse and garbage disposal
9. noise
4. excreta disposal
10. radiological protection
5. housing
11. institutional sanitation
6. insect vector and rodent control
Legal basis:
PD 856, 1978
Different Laws relating to Environmental Sanitation:
1. Garbage Disposal Law
- PD 825
2. Ecological Solid Waste Management Act
- RA 9003
3. Clean Air Act
- RA 8749
4. Clean Water Act
- RA 9275
5. Toxic Substances and Hazardous and Nuclear Waste Control Act
- RA 6969
WATER SUPPLY SANITATION PROGRAM
Approved type of water supply facilities:
LEVEL I
(Point Source)
- a protected well or a developed spring with an outlet but
without a distribution system.
- serves 15 to 25 households
- outreach must not be more than 250 meters from the
farthest user
LEVEL II
(Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped
distribution network and communal faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest
house
LEVEL III
(Waterworks System or Individual House Connections)
- a system with a source, a reservoir, a piped distributor
network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
Approved types of toilet facilities:
LEVEL I
Non-water carriage toilet facility – no water is necessary to
wash the waste into the receiving space.
Ex. Pit latrines, Reed odorless earth closet
Toilet facility requiring small amount of water to wash the waste
into the receiving space.
Ex. Pour flush toilet, Aqua privies
LEVEL II
on site toilet facilities of the carriage type with water-sealed and
flushed type with septic tank/vault disposal facilities
LEVEL III
- water carriage types of toilet facilities connected to septic
and/or to sewerage system to treatment plant
FOOD SANITATION PROGRAM
FOUR RIGHTS IN FOOD SAFETY:
1. Right source
- always buy fresh meat, fish, fruits and vegetables
- check for expiry dates of processed foods
- avoid buying canned foods with dents, bulges, deformation,
broken seals and improper seams
- use clean and safe water
- if doubt of water source – boil water for at least 2 minutes
2. Right preparation
- avoid contact between raw and cooked foods
- always buy pasteurized milk and fruit juices
- wash vegetables well if eaten raw
- wash hands and kitchen utensils before and after preparing food
- sweep kitchen floors to remove food droppings
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts
of the food should reach 70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT more
than 2 hours
- store foods carefully: 4 -5 hours
hot conditions : at least or above 60 degrees centigrade
cold conditions: below or equal to 10 degrees centigrade
- do not overburden the refrigerator
- reheat stored food before eating
--at least 70 degrees centigrade
Rule in Food Safety:
“WHEN IN DOUBT, THROW IT OUT”
HEALTH EMERGENCY PREPARENESS AND RESPONSE PROGRAM
Legal Mandate:
1. PD 1566 (1978)
- creation of the National Disaster Coordinating Council
- creation of the Multi-level Organization
- funding for a 2% reserve for calamities
2. RA 7160
- transfer of responsibilities from the national to local
government units giving more power, authority and
resources
- allocation of 5% calamity fund for emergency operations
Terms:
1. Disaster
- is a serious disruption of the functioning of a society,
causing wide spread human, material or environmental
losses
2. Emergency
- as any occurrence, which requires an immediate response
3. Hazards
- any phenomenon, which has the potential to cause
disruption or damage to humans and their environment
4. Risk
- the level of loss or damage that can be predicted from a
particular hazard affecting particular place at a particular
time from the point of view of the community.
2 components:
A. Susceptibility
- the factors which allows a hazard to cause an emergency
B. Vulnerability
- the factors which allows a hazard to cause a disaster
Classification of disaster
A. According to its Cause
1. Natural disaster – force of nature
2. Human generated/Manmade –
transportation/technological disasters
B. According to Onset
1. Acute or sudden impact events
2. Slow or chronic genesis (Creeping disaster)
Contributing factors to Disaster:
1. human vulnerability resulting from poverty and social
inequality
2. environmental degradation resulting from poor land use
3. rapid population growth especially among the poor
General Principles of Disaster Management:
1. The first priority is the protection of people who are at risk.
2. The second priority is the protection of critical resources and
systems on which communities depend.
3. Disasters management must be an integral function of national
development plans and objectives.
4. Disaster management relies upon an understanding of hazard
risks.
5. Capabilities must be developed prior to the impact on a hazard.
6. Disaster management must be based upon interdisciplinary
collaboration.
7. Disaster management will only be as effective as the extent to
which commitment, knowledge and capabilities ca be applied.
The Disaster Spectrum Cycle
1. Disaster Impact
2. Relief
3. Rehabilitation
4. Prevention
5. Mitigation
6. Readiness
More Specific within Preparedness includes:
1. vulnerability assessment and dissemination of information
related to particular hazards and emergencies.
2. emergency planning
3. training and education
4. warning system
5. specialized communication system
6. resources and information databases and management
systems and resource stocks
7. emergency exercises/drills
Principles of Emergency Preparedness:
1. It is the responsibility of all.
2. Should be woven into the community and administrative levels of
both government and government organizations.
3. It is an important aspect of emergency management.
4. It is connected to other aspects of emergency management.
5. Should concentrate on process and people rather than
documentation.
6. Should not be done in isolation.
7. Should not concentrate only on disasters but integrate prevention
and response strategies for any scale of emergency.
8. Hospital plays a very vital role in the management of disaster.
9. The main objective is to decrease mortality, morbidity and to
prevent disaster.
10. Every hospital should have a regular updated disaster plan.
PURPOSE OF THE DISASTER PLAN:
1. To provide policy for effective response to both internal and
external disaster situations that can create impact to the
operation of the hospital and may affect hospital staff, patients,
visitors and the community.
2. Identify hospital capability to handle mass casualty.
3. Identify responsibilities of individuals and departments in the
event of a disaster situation.
4. Identify standard operating guidelines for emergency activities
and responses.
VITAL STATISTICS
- refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
Use of Vital Statistics:
1. indices of the health and illness status of a community.
2. serves as bases for planning, implementing, monitoring and
evaluating community health nursing programs and services.
Sources of Data:
1. population census
2. registration of vital data
3. health survey
4. studies and researches
* statistic on population and the characteristics such as age, sex
- Philippine Statistic Authority
* Birth Certificate form
- Form 102; Signatory: Birth Attendant
1. Physician
2. Nurse
3. Midwife
* requires registration of birth within 30 days
- PD 651
* requires registration of births and deaths to the Office of the
Civil Registrar
- RA 3753
A. Cities – City Health officer
B. Municipalities – Municipal Treasurer
* Death Certificate form
- Form 103; Signatory: Either of the following:
1. Health Officer (Physician)
2. Local Chief Executive (City or Municipal Mayor)
3. Licensed Embalmer and Undertaker (LEU)
* reporting should be done within 2 days
COMMON VITAL STATISTICAL INDICATORS
1. Crude Birth Rate (CBR)
- a measure of one characteristic of the natural growth or
increase of a population.
total number of live births registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year
2. Crude Death Rate (CDR)
- a measure of one mortality from all causes which may
result in a decrease of population.
total number of deaths registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year
3. Infant Mortality Rate (IMR)
- measures the risk of dying during the 1st year of life. It is a
good index of the general health of a community.
total number of death under 1 year of age registered
in a given calendar
_____________________________________________ X 1000
total number of registered live births of same calendar year
4. Maternal Mortality Rate (MMR)
- measures the risk of dying from causes related to
pregnancy, childbirth and puerperium.
total number of deaths from maternal causes registered
for a given year
_____________________________________________ X 1000
total number of live births registered of same year
5. Fetal Death Rate (FDR)
- measures pregnancy wastage. Death of the product of
conception occurs prior to its complete expulsion.
total number of fetal deaths registered in a given calendar
_____________________________________________ X 1000
total number of live births registered on same year
6. Neonatal Death Rate (NDR)
- measures the risk of dying the 1st month of life. It serves as
an index of the effects of prenatal care and OB management.
number of deaths under 28 days of age registered
in a given calendar year
_____________________________________________ X 1000
number of live births registered of same year
7. Incidence Rate (IR)
- measures the frequency of occurrence of the phenomenon
during a given period of time.
number of new cases of a particular disease registered
during a specified period of time
_____________________________________________ X 1000
estimated population as of July of same year
8. Prevalence Rate (PR)
- measures the proportion of the population which exhibits
a particular disease at a particular time.
number of new and old of a certain disease
registered at a given time
_____________________________________________ X 1000
total number of persons examined at same given time
9. Attack Rate (AR)
- a more accurate measure of the risk of exposure.
number of persons acquiring a disease registered
in a given year
_____________________________________________ X 100
number of exposed to same disease in the same year
10. Case Fatality Ratio (CFR)
- index of a killing power of a disease and is influenced by
incomplete reporting and poor morbidity data.
number of registered deaths from a specific disease
for a given year
_____________________________________________ X 100
number of registered cases from same specific disease
in same year
C O P A R
COMMUNITY ORGANIZING PARTICIPATORY ACTION
RESEARCH
DEFINITIONS:
- A social development approach that aims to
TRANSFORM the APATHETIC, INDIVIDUALISTIC, and
VOICELESS POOR into DYNAMIC, PARTICIPATORY
and POLITICALLY responsive community.
- A process, by which a community identifies its
needs and objectives, develops confidence to take action
in respect to them and in doing so, extends and develops
cooperative and collaborative attitude and practices in
the community.
IMPORTANCE OF COPAR:
> COPAR is an important tool for community
development and people empowerment as this:
 helps the community workers generate community
participation in development activities.
 maximizes community participation and involvement.
 prepares people/clients to eventually take over the
management of development programs in the future
PRINCIPLES OF COPAR:
1. People, especially he most OPPRESSED,
EXPLOITED, AND DEPRIVED ( women sectors,
children, handicapped, elderly, youth ) open to
change, have the capacity to change, and are able
to bring about change.
2. COPAR should be based on the interest of the
POOREST SECTORS of society.
3. COPAR should LEAD TO SELF-RELIANT
COMMUNITY AND SOCIETY.
PROCESS USED:
A
PROGRESSIVE
CYCLE
OF
ACTIONREFLECTION-ACTION which begins with small, local
and concrete issues identified by the people and the
evaluation and reflection of and on the action taken by
them.
 CONSCIOUSNESS-RAISING
through experiential
learning is central to the COPAR process because it
places emphasis on learning that emerges from
concrete action and which enriches succeeding action.
 COPAR is PARTICIPATORY AND MASS-BASED
because it is primarily directed towards and biased in
favour of the poor, the powerless and the oppressed.
 COPAR is GROUP-CENTERED AND NOT LEADER
ORIENTED. Leaders are identified, emerged and tested
through action rather than appointed or selected by some
external force or entity.
COMMUNITY ORGANIZING
- the process whereby the community members
develop the capability to assess their health needs and
problems, plan and implement actions to solve these
problems.
- carried out by the nurse with the goal of motivating,
enhancing and seeking wider community participation in
decision-making in activities that have the potential to
impact positively on community health.
STAG E S
Stage 1. Community Analysis
- the process of assessing and defining needs,
opportunities and resources involved in initiating
community health action program.
5 Components:
1. demographic, social and economic profile
2. health risk profile
3. health/wellness outcome profile
4. survey of current health promotion programs
5. studies conducted in certain target groups
Steps:
1. Define the community.
2. Collect data.
3. Assess community capacity.
4. Assess community barriers.
5. Assess readiness for change.
6. Synthesis data and set priorities
Stage 2. Design and Initiation
1. Establish a core planning group and select a local
organizer.
2. Choose an organizational structure.
a. Leadership board or council – existing local leaders
working for a common cause
b. Coalition – linking organization and groups to work on
community issues
c. Lead or official agency – a single agency takes the
primary responsibility of a liaison for health promotion
activities in the community.
d. Grass-roots – informal structure in the community like
the neighborhood residents
e. Citizen panels – a group of citizens (5-10) emerge to
form a partnership with a government agency.
f. Networks and consortia – network develop because
of certain concerns.
3. Identify, select and recruit organizational members.
4. Define the organization mission and goals.
5. Clarify roles and responsibilities of people involved in the
organization.
6. Provide training and recognition.
Stage 3. Implementation
– put design into action.
1. Generate broad citizen participation.
2. Develop a sequential work plan.
3. Use comprehensive, integrated strategies.
4. Integrate community values into the programs, materials
and messages.
Stage 4. Program Maintenance
– at this point the program has experienced some
degree of success and has weathered through
implementation programs.
To maintain and consolidate gains of the program, the
following are essential:
1. Integrate intervention activities into community networks.
2. Establish a positive organizational culture.
3. Establish an ongoing recruitment plan.
4. Disseminate results.
Stage 5. Dissemination - Reassessment
* continuous assessment is a part of the monitoring
aspect in the management of the program. Formative
evaluation is done to provide timely modification of
strategies and activities.
1. Update the community analysis. Is there a change in
leadership, resources and participation?
2. Assess effectiveness of interventions/programs.
3. Chart future directories and modifications.
4. Summarize and disseminate results.
PHASES OF COPAR
A. Pre-Entry Phase
> Community consultation/dialogues
> Setting of issues/considerations related to site location
> Development of criteria for site selection
1. high percentage of the family income is below the
national poverty threshold
2. high malnutrition rate
3. lack of primary or secondary hospital within a 30minute ride from the area
4. area must not have relative peace and order problem
5. acceptance of the community
> Site selection
> Preliminary social investigation
>Networking with LGU’s, NGO’s and other departments
B. Entry Phase
> Integration with the community
> Sensitization of the community; information campaign
> Continuing/Deepening social investigation
> Core group formation
1. belongs to the poor sector of the society
2. responsible and committed
3. able to communicate
> Coordination with other community organization
> Self-Awareness and Leadership Training (SALT)/
Action Planning
Best technique to identify potential leaders:
- observe people who are active in small
mobilization activities that motivate residents to start
working.
C. Community Study/Diagnosis Phase
> Selection of the research team
> Training on data collection methods and techniques
> Planning for the actual gathering of data
> Data gathering
> Training on data validation
> Community validation
> Presentation of the community study/ diagnosis and
recommendations.
> Prioritization of community needs/problems for action
TYPES OF COMMUNITY DIAGNOSIS
1. Comprehensive Community Diagnosis
> aims to obtain a general information about the
community.
Elements:
A. Demographic variables
B. Socio-economic and cultural variables
C. Health and illness patterns
D. Health resources
E. Political/Leadership patterns
2. Problem-Oriented Community Diagnosis
> type of assessment that responds to a particular
need.
D. Community Organization and Capability Building
Phase
> Community meetings to draw up guidelines for the
organization
> Election of officers
> Delineation of the roles, functions and task of officers
and members
> Action-Reflection-Action session
- tool used to develop team-building and to promote an
avenue to verbalize feelings, opinions and suggestions and
enable them to participate in decision-making
> Team building exercises
> Working out legal requirements for the establishment of
the CHO
> Training of the CHO officers/ community leaders
E. Community Action Phase
> Organization and training of CHW’s
> Setting-up of linkages/network referral system
> Project Implementation Monitoring Evaluation (PIME)
of health services
> Initial identification and implementation of resource
mobilization schemes
F. Sustenance and Strengthening Phase
- begins when the community organization has already
established community members who are actively
participating in community wide undertakings activities.
> Formulation and ratification of constitution and by-laws
> Identification and development of “Secondary” leaders
> Setting up and institutionalization of a financing
scheme for the community health activities
> Formalizing and institutionalization of linkages,
networks and referral systems
> Continuing education and upgrading of community
leaders, CHW’s and CHO members
> Development of medium/ long term community health
and development plans
CRITICAL STEPS (ACTIVITIES) IN BUILDING PEOPLE
AND ORGANIZATION
1. INTEGRATION
***A community becoming one with the people in order to:
A. Immerse himself in the poor community
B. Understand deeply the culture, economy leaders, history
rhythms and life style in the community.
2. SOCIAL INVESTIGATION
- a systematic process of collecting and analyzing data to
draw a clear picture of the community.
- a process of systematically learning and analyzing the
various structures and forces in the community
> Also known as the “Community Study”
3. TENTATIVE PROGRAM PLANNING
- CO to choose one issue to work on in order to
begin organizing the people.
4. GROUNDWORK
- going around and motivating the person on a one
on one basis to do something on the issue that has been
chosen.
5. THE MEETING
- people collectively ratifying what have already
decided individually. The meeting gives the people the
collective power and confidence .Problems and issues
are discussed.
5. ROLE PLAYING
- means to act out meeting that will take place
between the leaders of the people and the government
representative’s .It is the way of training the people to
anticipate what will happen and prepare themselves for
such eventually.
6. MOBILIZATION OF ACTION
- actual experience of the people in confronting the
powerful and the actual exercise of the people power.
7. EVALUATION
- the people reviewing the steps 1-6 so as to
determine whether they were successfully or not on their
objectives.
8. REFLECTION
- dealing with deeper, on going concerns to look at
the positive values CO is trying to build in the
organization. It gives as the people time to reflect on the
starch reality of the life compared in the ideal.
9. ORGANIZATION
- the people organization is the result of many
successive and similar actions of the people .A final
organizational structure is set up with elected officers and
supporting members.
What is IMCI?
Integrated Management of Childhood Illness (IMCI)
is a strategy for reducing the mortality and morbidity
associated with the major causes of childhood illness.
IMCI is an integrated approach to child health that
focuses on the well-being of the whole child.
The IMCI strategy :
• promotes the accurate identification of childhood
illnesses;
• ensures appropriate integrated treatment of all major
illnesses;
• strengthens the counseling of caregivers;
• identifies the need of and speeds up the referral of severely
ill children.
In the home setting:
• it promotes appropriate care-seeking behaviors;
• improved nutrition and preventative care;
• and the correct implementation of prescribed care.
2 Age Categories in IMCI:
1. Young Infant
– up to less than 1 week up to 2 months
(1 week up to 1 month and 29 days)
2. Young Child
– 2 months up to 5 years
(2 months up to 4 years and 11 months)
Principles in IMCI:
1. All sick children must be examined for
GENERAL DANGER SIGNS:
C
> convulsions (fits, jerky movement, spasm)
U
> unable to drink or breastfeed (not eat)
V
> vomiting
A
> abnormally sleepy (difficult to awaken)
2. Assess for MAIN SYMPTOMS:
For Older children
a. Cough/DOB
b. Diarrhea
c. Fever
d. Ear problems
For Young infants:
a. Local bacterial infection
b. Diarrhea
c. Jaundice
3. Assess for nutritional status, immunization status, vitamin
A status, feeding problems and other potential problems.
4. Only a limited number of carefully-selected clinical signs
are used.
5. A combination of individual signs leads to a child’s
classification(s) rather than a diagnosis.
× identify illness = Dx
√ classify illness = classification
6. The guidelines do not describe the management of
trauma or other acute emergencies d/t accidents or
injuries.
7. IMCI management procedures use a limited number of
essential drugs and encourage active participation of
caretakers.
8. An essential component of the IMCI guidelines is the
counseling of caretakers.
THE IMCI STRATEGY
ASSESS THE CHILD
Check the child for Danger Signs
Then Ask:
For any “yes” answer
Does the child have cough or
difficult breathing?
•Ask further
questions
Does the child have diarrhea?
•LOOK,LISTEN, FEEL
Does the child have Fever?
•Based on this
classify illness
Does the child have ear problem
Then Check the child for malnutrition and anemia
Then check the child’s immunization status
Then check the child for other problems
Classify Illness
Pink classification
Yellow classification
Green classification
Identify Treatment
urgent pre-referral treatment and referral,
or
specific medical treatment and advice, or
simple advice on home management
Treat the Child
Teach the mother to give oral drugs at home
Teach the mother to treat local infections at home
Give intramuscular drugs in clinic
Give Increased fluids for diarrhea and continue feeding
If the child needs to be referred, give appropriate prereferral treatment
Counsel the mother
Using the process: ASK, PRAISE, ADVISE, CHECK
Food and feeding problem
Fluid intake during illness
When to return
Care for Development
Her own health
Follow - up
health-care provider gives appropriate follow-up
care, as indicated in IMCI guidelines
If necessary, reassess the child for any new
problems.
Assess and Classify A Sick Child
Aged 2 months to 5 years
1. Ask the mother what the child’s problems are?
greet the mother appropriately
use good communication skills
listen carefully to what the mother tells you
use words that the mother will understand
give the mother time to answer questions
ask additional questions if the mother is not
sure about her answer
2. Determine if it is an initial visit
For ALL sick children ask the mother about the child’s problem, check for general danger signs
and then
ASK: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
If YES
If NO
IF YES, ASK:


For how long?
Fast breathing is:
2 mos – 12 mos. 50 breaths
per minute or more
12 mos – 5 yrs. 40 breaths
per minute or more
LOOK, LISTEN, FEEL:

Count the breaths in one
minute.

Look for chest indrawing

Look and listen for stridor

Look and Listen for wheeze
If wheezing and weather fast
breathing, give a trial of rapid
acting bronchodilator up to 3
times 15 – 20 mins. apart.
Reassess

The child
must be
calm
CLASSIFY the child's illness using the colour-coded classification table
for cough or difficult breathing.
Then ASK about the next main symptoms: diarrhoea, fever, ear problems. CHECK for malnutrition and anaemia,
immunization status and for other problems
Classify Cough
 Any general danger sign or
 Lower chest indrawing or
 Stridor in calm child
 Fast Breathing (if wheezing,
go directly to treat
wheezing)
 No signs of pneumonia or
very severe disease
SEVERE
PNEUMONIA
OR
VERY SEVERE
DISEASE
PNEUMONIA
NO PNEUMONIA:
COUGH OR COLD
Treatment
Safe remedies:
- Instruct
- Follow –up care
after 5 days
NO PNEUMONIA:
COUGH OR COLD
1. Give 3 days antibiotic.
1st line of drugs:
Amoxicillin 2 times daily for 3 days
2nd line of drugs:
Cotrimoxazole 2times daily for 3 days
2. Soothe the throat & relieve the cough using safe
remedies:
- B, T, L, C
Breastmilk, Tamarind, Luya, Calamansi)
•Never give cough syrup, antitussive, decongestant,
mucolytics.
3. Instruct the mother when too return the baby
immediately.
4. Follow up after 2 days.
PNEUMONIA
Pre-referral Treatment:
1. Give 1st dose antibiotic
2. Give Vitamin A
- 2 months to 12 months:
100,000 IU (blue)
-12 months to 5 y/o :
200,000 IU (red)
3. Treat the child to prevent lowering of the
blood sugar (hypoglycemia)
SEVERE
PNEUMONIA
OR
VERY SEVERE
DISEASE
How to prevent lowering of blood sugar level:
*If the child is able to breastfeed:
*If the child is not able to breastfeed but is able to swallow
- give 30-50 ml milk or sugar H2O p.o.
(sugar H2O: 4 tsp. sugar+200 ml H2O)
*Not able to swallow but conscious:
- Insert NGT
*If the child is unconscious:
- (IVF) D10W 5 ml/kg body weight for a few minutes
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing and then
ASK: DOES THE CHILD HAVE DIARRHEA?
If NO
Does the child have diarrhea
IF YES, ASK:
LOOK, LISTEN, FEEL:

For how long?
•

Is there blood in the stool
Look at the child's general condition.
Is the child:

Abnormally sleepy or difficult to awaken?
Restless or irritable?
Look for sunken eyes.

Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?

Pinch the skin of the abdomen.
Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
CLASSIFY the child's illness using the color-coded classification tables for
diarrhea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.
Classify Diarrhea
SIGNS
CLASSIFY AS
Two of the following signs:
 Lethargic or unconscious
 Sunken eyes
 Not able to drink or drinking poorly
 Skin pinch goes back very slowly
SEVERE DEHYDRATION
Two of the following signs:
 Restless, irritable
 Sunken eyes
 Drinks eagerly, thirsty
 Skin pinch goes back slowly
Not enough signs to classify as some or severe
dehydration.
Dehydration present
No dehydration
• Blood in the stool
SIGNS
SOME DEHYDRATION
NO DEHYDRATION
CLASSIFY AS
SEVERE PERSISTENT DIARRHEA
PERSISTENT DIARRHEA
DYSENTERY
Treatment:
Severe Dehydration
PINK
PLAN C
Give IVF : D5LR
< 12 mos. old : 100ml/kg within 6 hrs
12 mos. up to 5 y.o. : 100ml/kg within 3 hrs
Some Dehydration
YELLOW
PLAN B
Give ORS for the 1st 4hrs
Amount of ORS = weight (kg) x 75 = ml/cc
> after 4 hours, re-assess child for signs of dehydration
> if still some dehydration, continue ORS for 4 hours
Age
Amount of ORS
1 week up to 4 mos. old
4 mos. up to 12 mos.
12 mos. up to 2 years old
2 years old up to 5 years old
200-400 ml
400-700 ml
700-900 ml
900-1400 ml
Mild vomiting during ORT
= stop ORS in 10 mins, after 10 mins continue ORS
but give it in a slow manner
Severe Vomiting during ORT
= stop ORS → IVF or refer!
No Signs of Dehydration
Green
PLAN A
Give ORS if with watery or loose stool
1 week up to 2 y/o = 50-100 ml ORS
2 y/o up to 5 y/o = 100-200 ml ORS
If there’s no watery/loose stool (4 Home Rule Management):
1. Continue feeding (BRAT diet)
2. Give extra fluids; soups, milk, plain water, juice, rice water
3. Give Zinc supplement for 10-14 days to increase immune system
4. Advise mother when to return baby immediately.
PERSISTENT DIARRHEA (Young child)
Yellow
1. Give Vit. A
2. Advise mother recommended feeding
3. Follow-up after 5 days
→ if still breastfeeding:
= breastfeed day and night
→ if taking milk supplements:
= replace milk supplements with increased breastfeeding
= replace half of the milk & nutrient rich, semi-solid foods
* Do not use condensed or evaporated milk
= because it is high in CASEINE
SEVERE PERSISTENT DIARRHEA
Pink
1. Give Vitamin A
2. Give IVF = Plan C
DYSENTERY (Young Infant)
DYSENTERY (Child)
Pink
Yellow
Referral
Ciprofloxacin 2 times daily
for 3 days
Cholera:
First Line Antibiotic:
> Tetracycline
Second Line Antibiotic :
> Erythromycin
FEVER
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing, diarrhea and then
ASK: DOES THE CHILD HAVE FEVER?
Does the child have fever?
(by history or feels hot or temperature 37.5C** or above)
IF YES:
Decide the Malaria Risk: Yes or No
If No
THEN ASK:

For how long?

If more than 7 days, has fever been present every day?
Has the child had measles within the last 3 months?

LOOK AND FEEL:

Look or feel for stiff neck.

Look for runny nose.
Look for signs of MEASLES

Generalized rash and

If the child has measles now or within the last 3 months:



Decide Dengue Risk: Yes or No
Ask:
o
Has the child had any bleeding from the nose or gums, or
in the vomitus or stool?
o
Has the child had black vomitus?
o
Has the child evacuated black stool?
o
Has the child had persistent abdominal pain?
o
Has the child been persistent vomiting?
One of these: cough, runny nose, or red eyes.
Look for mouth ulcers.
Are they deep and extensive?
Look for pus draining from the eye.
Look for clouding of the cornea.
Look and Feel:
•Look for bleeding from the nose or gums?
•Look for skin petechiae
•Feel for cold and clammy?
•Check for slow capillary refill.
•If none of the above ask , look and feel signs are
present and the child is 6 months and older and fever
has been present for more than 3 days, perform
tourniquet test.
CLASSIFY the child's illness using the colour-coded classification tables for fever.
Then ASK about the next main symptom: ear problem, and CHECK for malnutrition and anaemia, immunization status
and for other problems.
Malaria Risk
Signs
Signs


Any general danger signs
Stiff neck





Blood Smear (+)
If Blood smear is not done;
No runny nose, and
No measles, and
No other cause of fever




Blood Smear (-) or
Runny nose, or
Measles, or
Other cause of fever
Classification
Classification
Very Severe Febrile Disease/Malaria
Malaria
Fever: Malaria Unlikely
No Malaria Risk
Signs
Signs


Any general danger sign
Stiff Neck

No signs of very febrile disease
Classification
Classification
Very Severe Febrile Disease
Fever: No Malaria
Malaria Risk Treatment
> Give paracetamol for fever
> Advise mother when to return immediately
> Follow-up after 2 days
> Give paracetamol for fever
> Bring the child if there’s CUVAS
> Follow-up after 2 days
> Give antimalarial drugs
First Line Antibiotic: Arthemeter + Lumefantrine
Second Line Antibiotic: Chloroquine, Primaquine,
Sulfadoxine and Pyremethamine
Pre-referral Treatment:
1. Give first dose antibiotic
2. IM Quinine
3. Give paracetamol
4. Treat lowering of blood sugar
5. REFER!
Fever: Malaria
Unlikely
Malaria
Very Severe Febrile
Disease/Malaria
No Malaria Risk Treatment
> Give Paracetamol for fever
> Advise mother when to return
immediately
> Follow-up after 2 days
Fever: No Malaria
Pre-referral Treatment:
> Give Paracetamol for fever
> Treat lowering of blood sugar
> Refer!
Very Severe
Febrile Disease
Measles
Signs



Any general danger signs or
Clouding of the cornea, or
Deep and extensive mouth ulcers


Pus draining from the eyes, or
Mouth Ulcers

Measles now or within the last three
months
Classification
Severe Complicated Measles
Measles with Eye or Mouth
Complications
Measles
Dengue Hemorrhagic Fever
Signs







Bleeding from the nose or gums, or
Bleeding in stools or vomitus, or
Skin petechiae, or
Cold and clammy extremities, or
Persistent abdominal pain, or
Persistent vomiting, or
Torniquet test positive

No signs of severe dengue hemorrhagic
fever
Classification
Severe Dengue Hemorrhagic Fever
Fever: Dengue Hemorrhagic Fever
Unlikely
Measles Treatment
*Pre-referral Tx:
> Give Vitamin A
> Apply tetracycline on eyes if with eye
complication
> Give 1st dose of antibiotic
> Refer!
Don’t give/apply gentian violet on mouth ulcers
> Give Vitamin A
> Apply tetracycline on eyes QID
> Apply Gentian Violet (half
strength) on mouth BID
> Follow-up after 2 days
Give Vitamin A
Severe
Complicated
Measles
Measles with Eye
or Mouth
Complications
Measles
Dengue Hemorrhagic Fever Treatment
Pre-referral treatment:
1. Rapid fluid replacement
2. Paracetamol for fever of 38.5 ˚C without
ASA
3. Treat child to prevent lowering of blood
sugar
4. REFER!
1. Give Paracetamol for fever of 38.5 ˚C w/o
ASA
2. Advise to bring if signs of severe dengue
fever occurs
3. Follow up after 2 days
Severe Dengue
Hemorrhagic Fever
Fever: Dengue
Hemorrhagic Fever
Unlikely
Ear Problem
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing, diarrhoea, fever and then
ASK: DOES THE CHILD HAVE AN EAR PROBLEM?
If No
If Yes
IF YES, ASK:
LOOK AND FEEL:
If yes, for how long?

Is there ear pain?

Is there ear discharge?


Look for pus draining from the ear.
Feel for tender swelling behind the
ear.
CLASSIFY the child's illness using the color-coded classification table for
ear problem.
Then CHECK for malnutrition and anemia, immunization status and for other problems.
Classify Ear Problem
SIGNS
 Tender swelling behind the ear.
 Pus is seen draining from the ear and
discharge is reported for Less than 14
days, or
 Ear pain.
 Pus is seen draining from the ear and
discharge is reported for 14 days or more.
 No ear pain and
No pus seen draining from the ear.
CLASSIFICATION
MASTOIDITIS
ACUTE EAR
INFECTION
CHRONIC EAR
INFECTION
NO EAR INFECTION
Ear Problem Treatment
Pre-referral treatment:
* Give 1st dose antibiotic
* Give Paracetamol for ear pain
* Refer!
MASTOIDITIS
* give 3 days antibiotic
* dry the ear by wicking (roll soft cloth in a wick)
* give Paracetamol for ear pain
* follow-up after 5 days
ACUTE EAR
INFECTION
* dry ear by wicking
* follow-up after 5 days
CHRONIC EAR
INFECTION
* No treatment needed
NO EAR INFECTION
Malnutrition and Anemia
For ALL sick children ask the mother about the child’s problem, check for general danger
signs, ask about cough or difficult breathing, diarrhoea, fever, ear problem and then
CHECKFOR MALNUTRITION AND ANEMIA
CHECK FOR MALNUTRITION AND AN EMIA.
If Yes
If No
Check for Malnutrition
LOOK AND FEEL:
For All Children

Determine the weight for age

Look for visible severe wasting.

Look for edema of both feet.

For children aged 6 mos. or more determine if MUAC I is less than
11 cm.
Check for Anemia
LOOK AND FEEL:

Look for palmar pallor. Is it:
Severe palmar pallor?
Some palmar pallor?

CLASSIFY the child's illness using the color-coded classification table
for malnutrition and anemia.
Then CHECK immunization status and for other problems.
Classify Malnutrition
SIGNS
CLASSIFICATION
If age up to 6 mos.
- Visible severe wasting or Edema of both feet.
• If age 6 months and above and MUAC less than
11 mm or
- edema of both feet, Visible severe wasting
SEVERE
MALNUTRITION
 Very low weight for age.
LOW WEIGHT
 Not very low weight for age and no other signs
or malnutrition.
Classify Anemia
 Severe palmar pallor
Some palmar pallor
 No palmar pallor
NOT VERY LOW WEIGHT
SEVERE ANEMIA
ANEMIA
NO ANEMIA
Malnutrition and Anemia
Severe Anemia/
Severe
Malnutrition
* Give Vitamin A
* Refer!
Anemia
* Give 30 days
of 10 ml or
2 tsp Iron
* Deworm:
Mebendazole
Albendazole
* Follow up
after 14 days
Low Weight
No Anemia, Not
Very Low
Weight
* Counsel
mother
* Follow up after * Assess the
child’s feeding
5 days
No feeding
problem:
* Give Vit. A
* Follow-up after
30 days
* Counsel the
mother
Check Immunization Status, Vitamin A and Deworming Status
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing, diarrhoea, fever, ear problem, and then check for
malnutrition and anaemia and
CHECK IMMUNIZATION STATUS.
AGE
IMMUNIZATION
SCHEDULE:
Birth
6 weeks
10 weeks
14 weeks
9 months
VACCINES
BCG
DPT-1
DPT-2
DPT-3
Measles
OPV-1
OPV-2
OPV-3
Hep B 1
Hep B 2
Hep B 3
DECIDE if the child needs an immunization today, or if the mother should be told to
come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child if the
child is well enough to go home.
Then CHECK for other problems.
Vitamin A Prophylaxis
The first dose at 6 mos. Or
above and subsequent dose
every 6 mos.
Routine Worm Treatment
Give every child mebendazole every
6 mos. From age 1 year and record in
the child’s card
Assess and Classify Sick Young Infant Aged up to 2 Mos.
For ALL sick young infants check for signs of POSSIBLE BACTERIAL INFECTION.
ASK:


LOOK, LISTEN, FEEL:
Is the infant having difficulty in
feeding?
Has the infant had convulsions?






Count the breaths in one minute.
Repeat the count if elevated.
Look for severe chest indrawing.
Look at the umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
Measure axillary temperature
Look for skin pustules. Are there many or severe
pustules?
Look at the young infant's movements.
Does the infant move on his own?
Does the infant move only when stimulated?
Does the infant not moving at all
CLASSIFY the infant's illness using the colour-coded classification table for possible
bacterial infection.
Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status
and for other problems.
Classify Sick Young Infant
Signs
• Not Feeding well or
• Convulsions or
• Fast breathing (60 breaths per minute or
more) or
• Severe chest indrawing or
• Fever (37.5° C* or above or feels hot) or
• low body temperature (less than 35.5°C*
or feels cold)
• Movement only when stimulated or no
movement at all
• Umbilical red or draining pus or
• Skin pustules
• No signs of very severe disease or local
bacterial infection
Classification
VERY SEVERE
DISEASE
LOCAL BACTERIAL
INFECTION
SEVERE DISEASE OR
LOCAL BACTERIAL
DISEASE UNLIKELY
TREATMENT
Pre-referral treatment:
1. Give first dose antibiotic:
Gentamycin - (IM) Right
Vastus lateralis
Benzyl penicillin: Left
Vastus lateralis
2. Keep warm
3. Treat child to prevent hypoglycemia
4. Refer.
VERY SEVERE
DISEASE
1.Give 3 days antibiotics P.O.
2.Apply gentian violet on affected area
(FULL STRENGHT)
3.Follw-up after 2 days.
LOCAL BACTERIAL
INFECTION
SEVERE DISEASE OR
LOCAL BACTERIAL
DISEASE UNLIKELY
Assess Jaundice
Look:
Look for jaundice (yellow eyes and skin)
Look at young infant’s palms. Are they yellow
Classify Jaundice



Signs
Classification
Any jaundice if age less than 24 hours or
Yellow palms and soles at any age
SEVERE JAUNDICE
Jaundice appearing after 24 hours of age
and
Palms and soles are not yellow
JAUNDICE
No Jaundice
NO JAUNCICE
Check for Low Weight Infants for Age in Breastfed Infants
ASK:

Is the infant breastfed? If yes,
How many times in 24 hours?

Does the infant usually receive
any
other foods or drinks?
If yes, how often?

What do you use to feed the
infant?
ASSESS BREASTFEEDING:

Has the infant breastfed in the
previous hour?
Look, Listen and Feel
•Determine the weight
for age
•Look for white ulcers
or white patches in the
mouth
If the infant has not fed in the previous hour, ask the mother to put her infant to
the breast. Observe the breastfeed for 4 minutes.
(If the infant was fed during the last hour, ask the mother if she can wait and tell
you when the infant is willing to feed again.)

Is the infant able to attach?
no attachment at all not well attached
good attachment
TO CHECK ATTACHMENT, LOOK FOR:

Chin touching breast

Mouth wide open

Lower lip turned outward

More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)

Is the infant suckling effectively (that is, slow deep sucks, sometimes
pausing)?
no suckling at all not suckling effectively suckling effectively
Clear a blocked nose if it interferes with breastfeeding.

Look for ulcers or white patches in the mouth (thrush).
Classify the Feeding Problem
Signs
Classification
Not well attached to breast, or
 Not sucking effectively, or
 Less than 8 breastfeeds in 24
hours,
or
 Receives other foods or drinks, or
 Low weight for are age, or
 Thrush (ulcers or white patches in
mouth).
FEEDING
PROBLEM OR LOW
WEIGHT FOR AGE
 Not low weight for age and no other
signs of inadequate feeding.
NO FEEDING
PROBLEM
RECOMMENDED FEEDING
At birth up to 6 months
> exclusively breastfeed
> 8 times or more than 8 times within 24 hours.
SIGNS OF HUNGER:
1. Beginning to fuss.
2. Sucking fingers and fist
3. Sucking movements with their lips.
>6 months up to 12 months:
breastfeeding + 3 times a day complementary food.
If not on breastfeeding:
5 times a day complementary food.
>12 months up to 2 years old:
breastfeeding + 5 times a day of complementary food.
>At birth up to 4 months:
exclusive breastfeeding 8 times in 24 hrs.
>4 months up to 6 months:
breastfeeding with complementary food 1-2 times a day
Gentian Violet:
Half strength: for mouth ulcers
=15 ml GV+30-45 DW = .25% concentration
Full strength: skin pustules &
umbilical redness or pus
=15 ml GV+15 ml DW = .5% concentration
Preparation and Application of Gentian Violet
Mouth ulcers
1. Wash hands
Skin pustules
1. Wash hands
Umbilical Redness/Pus
1. Wash hands
2. Clean affected area 2. Clean affected
using soft cloth
area using soft
dipped in salt water cloth soaked with
soap & water
3. Paint GV
3. Paint GV
2. Clean affected area
using 70% alcohol
4. Wash hands
4. Wash hands
4. Wash hands
3. Paint GV
.