CHN211 QUIZLET; AZI
CU7 National Immunization Program
(EPI)
1976
When as EPI was established in the
Philippines
TB, Poliomyelitis, Diphtheria, Pertussis,
Tetanus, and Measles
Six vaccine-preventable diseases that
were initially included in the EPI
BCG, Hepa B, Pentavalent, Oral Polio
Vaccine, Anti-measles Vaccine (AMV 1),
Measles-mumps-rubella (AMV 2),
Rotavirus Vaccine, Tetanus Toxoid
Immunization coverage improved from
six vaccines to
RA 10152
Mandatory Infants and Children Health
Immunization Act of 2011
Mandatory Infants and Children Health
Immunization Act of 2011
-mandates basic immunization covering
the vaccine preventable diseases.
Added to the six preventable diseases
were hepatitis B, mumps, rubella,
diseases caused by Haemophilus
Influenzae type B (Hib) and other
diseases as determined by the
Secretary of Health in a department
circular.
-It gives directives to govt hospitals and
health centers to provide free mandatory
basic immunization to infants and
children up to 5 years of age.
-This law repealed PD 996
RA 7846
-Compulsory immunization against
hepatitis B for infants and children below
8 years old
-Hepatitis B immunization within 24
hours after birth of babies of women
with hepatitis B
Philippine Measles Elimination
Campaign
Presidential Proclamation No. 4, series
of 1998
National Neonatal Tetanus Elimination
Campaign
Presidential Proclamation No. 1066,
series of 1997
Wednesday
The designated immunization day in the
government health facilities is every
________. Unless otherwise revised by
local traditions, customs, and other
exceptions.
It reduces the chance of the child getting
infected or sick of immunizable
diseases.
Why it is important for children to
receive antigens at the earliest possible
age?
Rotavirus vaccine and Hib vaccine
2 new vaccines that were introduced as
part of EPI in 2012.
Rotavirus
infects large intestine and is the most
common cause of severe diarrhea in
infants and children
Haemophilus influenzae type B
bacterium that causes wide range of
diseases such as meningitis and
pneumonia
There is no need to restart a vaccination
series regardless of the time that has
elapsed between doses.
What if a child misses a dose in a
vaccination series?
No, this might cause chemical reactions
which would make the vaccines non
viable and effective for use
Is it allowed to mix different vaccines in
one syringe before injection?
No, only reconstitute freeze-dried
vaccines such as BCG, MMR, and AMV
only with the diluents supplied with
them.
Is it allowed to reconstitute a freeze
dried vaccine to a fluid vaccine?
2.5-5cm apart.
The infant is scheduled to be given 2
vaccines at a time, these 2 vaccines
should be administered at different sites.
However, if more than one injection is to
be administered on the same limb the
injection site should be ___ -____ cm
apart to prevent overlapping of local
reactions.
OPV first, followed by Rotavirus, then
other appropriate vaccines.
Recommended sequence of
coadministration of vaccines is
Monovalent vaccine such as
monovalent hepa B vaccine must be
used for the birth dose. Pentavalent
vaccine must not be given at birth
because it contains antigens against five
diseases which may be harmful for the
newborn at that time.
What is allowed for birth dose?
Monovalent Vaccine or Pentavalent
Vaccine?
Children who have not received AMV1
as scheduled and children whose
parents do not know whether they have
received AMV1 shall be given AMV1 as
soon as possible, then AMV2 is given
one month after the AMV1 dose.
What if the mother/guardian is not sure
whether her children have received
AMV 1? Or missed a schedule for
vaccination for AMV 1
Measles Immunization
As a school nurse you should know that
all children entering grade 1 or
preschool should be screened for
________ _______________. And
those without that immunization should
be referred to the nearest health facility
for immunization.
Administer the entire dose of Rotavirus
vaccine slowly buccally (one side of the
mouth between cheek and gum). With
tip of the applicator directed toward the
back of the infant's mouth to avoid failed
swallowing and to stimulate sucking
relfex.
How to administer Rotavirus Vaccine?
Live Attenuated Vaccines (LAV)
Available since 1950s these type of
vaccines are derived from
disease-causing pathogens that have
been WEAKENED under laboratory
conditions. They will grow in a
vaccinated individual, but because they
are weak they will cause no or very mild
disease.
Inactivated Vaccines (killed antigens)
made from microbes that have been
KILLED through physical or chemical
processes.
Subunit (purified antigen)
-Protein-based subunit vaccines
-Polysaccharide vaccines
-Conjugate subunit vaccines
Protein-based subunit vaccines
present an antigen to the immune
system without viral particles, using a
specific isolate protein of the pathogen.
Polysaccharide vaccines
-create a response against the
molecules in the pathogen's capsule.
These molecules are small, and often
not very immunogenic. As a
consequence, they tend to be not
effective in infants and young children,
and only induce short term immunity.
-Some bacteria when infecting humans
are often protected by a polysaccharide
(sugar) capsule that helps the organism
evade the human defense system
Conjugated subunit vaccines
-Also create a response against the
molecules in pathogen's capsule.
-In comparison to polysaccharide
vaccine they benefit from a technology
that binds the polysaccharide to a
carrier protein that can induce a long
term protective response even in
infants.
Toxoid (inactivated toxins)
based on the toxin produced by certain
bacteria. The toxin invades the
bloodstream and is largely responsible
for the symptoms of the disease. The
protein-based toxin is rendered
harmless (toxoid) and used as the
antigen in the vaccine to elicit immunity.
Active Immunity
protection that occurs when a body
produces its own antibodies (by own
immune system). This type of immunity
usually lasts for many years, often
during a lifetime
Public Health Nurse
-At the RHU/Health Center level who is
considered as the Cold Chain Officer?
She is also responsible for emergency
plans in the event of an electrical
breakdown or power failure.
-in charge of maintaining the cold chain
equipment and supplies, such as
freezer/refrigerator, transport box,
vaccine bags/carriers, cold chain
monitors, thermometers and cold packs.
Passive Immunity
the short-term immunity (few weeks or
months) that results from the
introduction of antibodies from another
person or animal.
OPV cold chain requirements
* -15C to -25C
*It should be stored in a freezer
*In vaccine bag it should be placed in
contact with cold packs
To maintain the potency of the vaccines,
because vaccines only confer immunity
only when they are potent.
Why is maintaining the cold chain
important?
Measles vaccine, MMR, and Rotavirus
Vaccine
* +2C to +8C
*It should be stored in the refrigerator.
*Should be stocked neatly on the
shelves of the refrigerator.
*Do not stock vaccines at the
refrigerator door shelved.
Cold chain
a system used to ensure that vaccines
are kept at a designated temperature
from the time they are manufactured
until they are used for vaccination.
Cold Chain Officer
Person directly responsible for cold
chain management at each level is
called
Hepatitis B, Pentavalent vaccine,
Tetanus Toxoid
*damaged by freezing, so they should
not be stored in the freezer.
*wrap the containers of these vaccines
with paper before putting them in the
vaccine bag with cold packs.
The refrigerator in lower or door shelves
Diluents should be placed in
6 hours after reconstitution
Until when a reconstituted freeze-dried
vaccines are viable?
First Expiry-First Out Policy
FEFO Policy
Protect BCG from sunlight
Protect BCG from sunlight
One month
At the RHU/health center with a
refrigerator, the duration of the storage
of vaccines should not exceed
maximum of 5 days
Using transport boxes, vaccines can
only be kept to a maximum of how many
days?
Vaccine Vial Monitor (VVM)
round disc of heat-sensitive material
placed on a vaccine vial to register
cumulative heat exposure. A direct
relationship exists between rate of color
change and temperature, lower the
temperature, slower the temperature
change, higher the temp, faster the color
change
Abide by the open-vial policy of the
DOH
Multidose vial may be open for one or
two clients if the health worker feels that
a client cannot come back for the
scheduled immunization session.
Protect Rotavirus from light
Protect Rotavirus from light
BCG side effects
- Koch's Phenomenon: an acute
inflammatory response reaction within
2-4 days after vaccination (indicated
exposure to tuberculosis). NO
MANAGEMENT NEEDED.
- Deep abscess at vaccination site: may
be due to subcutaneous or deeper
injection. REFER TO THE PHYSICIAN
FOR INCISION AND DRAINAGE
- Indolent ulceration: ulcer which
persists after 12 weeks from vaccination
date. TREAT WITH NIH POWDER
- Grandular enlargement: enlargement
of lymph glands draining the injection
site. IF SUPPURATION OCCURS,
TREAT AS DEEP ABSCESS.
Hepatitis B vaccine side effects
- Local reaction at the injection site
Temperature of 37.7c (99.9) NO
TREATMENT NEEDED
Pentavalent vaccine side effects
- Fever that lasts within 1 day. Fever
beyond 24 hours is not due to the
vaccine. ADVISE PARENTS TO GIVE
ANTIPYRETIC
- Local Soreness at the injection site.
REASSURE PARENTS SORENESS
WILL DISAPPEAR AFTER 3-4 DAYS
- Abscess after a week or more usually
indicates that the injection was not deep
enough or needle was not sterile.
INCISION AND DRAINAGE MAY BE
NECESSARY.
-Convulsions: although rare, may occur
in children older than 3 months; caused
by pertussis vaccine. PROPER
MANAGEMENT OF CONVULSIONS;
PERTUSSIS VACCINE SHOULD NOT
BE GIVEN ANYMORE
OPV side effects
None
Anti-measles vaccine side effects
- Fever 5-7 days after vaccination in
some children; sometimes, there is mild
rash. REASSURE PARENTS AND
ADVISE TO GIVE PYRETICS TO THE
CHILD.
MMR side effects
- Local soreness, fever, irritability, and
malaise in some children. REASSURE
PARENTS AND INSTRUCT TO GIVE
ANTIPYRETICS
Rotavirus vaccine side effect
- Some children develop mild vomiting
and diarrhea, fever, and irritability.
REASSURE PARENTS, INSTRUCT TO
GIVE ANTIPYRETICS AND ORESOL
TO THE CHILD
Tetanus Toxoid Vaccine side effects
- Local soreness in the injection site.
APPLY COLD COMPRESS AT THE
SITE. NO OTHER TREATMENT IS
NEEDED.
1) Child over 5 years of age
2) Child with recurrent convulsions or
another active neurological disorders of
the CNS
3) Child who has had convulsions or
shock within 3 days of the most recent
dose.
Do not give pentavalent vaccine/ DPT to
Child with history of hypersensitivity to a
previous dose of the vaccine,
intussusceptions or intestinal
malformation, or acute gastroenteritis
Do not give Rotavirus Vaccine to
Child who has signs and symptoms of
AIDS or other immune system
deficiency conditions or who are
immunosuppressed.
Do not give BCG vaccine to
Malnutrition, Low grade fever (37.5 38.3 C), Mild respiratory infection,
Diarrhea
False contraindications, when seen in
children health worker may continue
with the appropriate immunizations.
Fully immunized child (FIC)
Children who were given BCG, 3 doses
of OPV, 3 doses of Pentavalent Vaccine,
and 1 dose of anti-measles vaccine
before reaching one year of age.
Completely Immunized Children (CIC)
children who completed their
immunization schedule at the age of
12-23 months
Child protected at birth (CPAB)
Child whose mother has received a) 2
doses of TT during this pregnancy,
provided that second dose was given at
least a month prior to delivery or b) at
least three doses of TT anytime prior to
pregnancy
Bacteria: BCG (TB)
Virus: Oral Polio Vaccine, Measles,
Rotavirus, Yellow fever
Live attenuated vaccine examples
Bacteria: Whole-cell pertussis (wP)
Virus: Inactivated Polio Virus (IPV)
Inactivated vaccines examples
Protein-based: Bacteria - Acellular
pertussis (aP) Virus - Hepatitis B
Polysaccharide: Pneumococcal,
Meningococcal, Salmonella typhi
Conjugate: Bacteria - Hib and
Pneumococcal
Subunit vaccine examples
Diphtheria Toxoid and Tetanus Toxoid
Toxoid vaccine examples
Live, attenuated bacteria
mycobacterium tuberculosis.
Freeze-dried, reconstituted with a
special diluent
BCG Content and Form
RNA-recombinant, using Hepatitis B
surface antigen (HBs Ag). Cloudy, liquid,
in an auto-disable injection syringe if
available
Hepatitis B vaccine Content and Form
Diphtheria toxoid, inactivated pertussis
bacteria, tetanus toxoid, recombinant
DNA surface antigen, and synthetic
conjugate of Haemophilus influenzae B
bacilli. Liquid, in an auto-disable
injection syringe
DPT-HepB-Hib (Pentavalent vaccine)
Content and Form
Live attenuated polio virus (trivalent),
Clear pinkish liquid. 2-3 drops. 30 mins
bawal muna mag intake ang baby. Clear
pinkish liquid.
Oral Polio Vaccine Content and Form
Live, attenuated measles virus.
Freeze-dried, reconstituted with a
special diluent
Anti-measles vaccine (AMV1)/ Measles
containing vaccine 1 Content and Form
Live attenuated viruses (mumps,
measles, rubella viruses), freeze dried,
reconstituted with a special diluent.
Measles-mumps-rubella vaccine
(AMV2) Content and Form
Live attenuated rotavirus, clear,
colorless liquid in a container with an
oral applicator.
Rotavirus vaccine content and form
Weakened toxin. turbid in appearance,
clear, colorless liquid
Tetanus Toxoid
At birth, 0.05 ml, Intradermal, Right
deltoid region (arm)
BCG vaccine administration
At birth, 0.5ml, Intramuscular,
Anterolateral thigh muscle (vastus
lateralis)
Hepatitis B vaccine administration
At 14th week of the infant, 0.5ml,
Intramuscular, Anterolateral thigh
muscle
Inactivated Polio vaccine administration
6 weeks-10 weeks-14 weeks, 0.5 ml,
Intramuscular, Anterolateral thigh
muscle
Pentavalent vaccine administration
6 weeks-10 weeks-14 weeks, 2 drops,
Oral, Mouth
Oral polio vaccine administration
9-11 months, 0.5 ml, Subcutaneous,
Outer part of the upper arm
Anti-measles vaccine (AMV1)
administration
12-15 months, 0.5 ml, Subcutaneous,
Outer part of the upper arm
Measles-mumps-rubella vaccine
(AMV2) administration
6 weeks-10 weeks, 1.5 ml, Oral, Mouth
Rotavirus vaccine administration
total population x 2.7%
Estimated number of infants =
total population x 10.8%
Estimated number of 12-59 month old
children
Total population x 3.5%
Estimated number of pregnant women
2x, 1st before opening of the health
center, 2nd before closing the health
center
As a public health nurse assigned in the
RHU, you should check the
refrigerator/freezer's temperature how
many times?
Vaccine carriers
to transport vaccines to outreach sites,
to store vaccines temporarily when
health facility refrigerator is out of order,
to transport monthly vaccine supplies
from the district store to small health
facilities.
Water packs
Used to keep vaccines at the required
temperature range inside cold boxes
and vaccine carriers. Health facilities
should have a minimum of 2 complete
sets of this packs for each cold boxes
and vaccine carriers so that one can be
frozen in the freezer and one is being
used in the cold box.
Foam pad/Slit pad
Usually has slits which vaccine vials can
be inserted snugly and protected. It is a
piece of soft sponge like material that
fits precisely on top of the water packs
inside a vaccine carrier
-15C to -25C
OPV required temperature
+2C to +8C
Measles, MMR, Rotavirus Vaccine
required temperature
No, because studies show that when
vaccine are put in the door shelves the
temperature is not effective as if it is in
the refrigerator compartment.
Is it allowed to stock vaccine on door
shelves?
Hepa B, Pentavalent Vaccine, Rotavirus,
and TT
Vaccines that are damaged by freezing
are
lower or door shelves
Diluents are placed in which part of the
refrigerator?
max of 5 days. max of 48 hours with lid
closed
Transport boxes vaccines can be placed
up to ____________. Vaccine carriers
vaccines can be placed up to
_____________.
4 weeks
Multidose vial vaccines can still be used
for up to maximum of _____________.
CHN211 QUIZLET
CU8 Integrated Management of
Childhood Illness
IMCI (Integrated Management of
Childhood Illness)
- An integrated approach to child health
that focuses on the well-being of the
whole child.
- includes both preventive and curative
elements that are implemented by
families and communities as well as by
health facilities.
Malaria
is one of the most serious diseases to
affect people in developing countries
with tropical and subtropical climates.
What mosquito causes malaria?
infected female Anopheles mosquito
What is the bacteria that causes
malaria?
Plasmodium protozoa
Measles
A highly contagious viral disease. It is
transmitted via droplets from the nose,
mouth or throat of infected persons.
Initial symptoms, which usually appear
10-12 days after infection, include high
fever, a runny nose, bloodshot eyes,
and tiny white spots on the inside of the
mouth.
Pneumonia
A form of acute respiratory infection that
affects the lungs. The lungs are made
up of small sacs called alveoli, which fill
with air when a healthy person breathes.
When an individual has pneumonia, the
alveoli are filled with pus and fluid,
which makes breathing painful and limits
oxygen intake.
Dysentery
An infectious disease characterized by
inflammation of the intestine, abdominal
pain, and diarrhea with stools that often
contain blood and mucus.
What bacteria causes dysentery?
Shigella species (bacillary dysentery) or
Entamoeba histolytica (amoebic
dysentery)
Dengue Fever
An acute mosquito-borne viral illness of
sudden onset with headache, fever,
prostration, severe joint and muscle
pain, swollen glands
(lymphadenopathy), and rash.
Main components of IMCI
1. Improving case management skills of
the health care staff
2. Improving overall health care system
3. Improving family and community
health practices
General Danger signs
1. Convulsion
2. Abnormally sleepy/unconsciousness
3. Not able to drink/breastfeed
4. Severe vomiting/ vomits everything
5. The children and infants are then
assessed for main symptoms.
For children, the main symptoms
include:
1. Cough / difficulty breathing
2. Diarrhea
3. Fever
4. Ear infection
Main symptoms for young children
1. Local Bacteria infection
2. Diarrhea
3. Jaundice
Top 3 Leading causes of mortality
among children aged 1-4 years were
(DOH, 2011)
1. Pneumonia
2. Accidents
3. Diarrhea and Gastroenteritis
Common cause of Children's mortality
(WHO, 2005)
1. Acute respiratory infections (mostly
pneumonia)
2. Diarrhea
3. Measles
4. Malaria
5. Malnutrition
"Up to 5 years" means
the child has not yet reached his fifth
birthday (The child who is 4 years and
11 months)
A child is "not able to drink or
breastfeed" if
the child is too weak to drink and not
able to suck or swallow when offered
fluids or breast milk.
A child who is not able to hold anything
down at all has the sign
"vomits everything" (A child who vomits
several times but can hold down fluids
does not have this danger sign.)
If a child shivers when fever is rapidly
rising, but does not lose consciousness,
this is convulsion.
FALSE
INDRAWING or STRIDOR in a calm
child)
What color is PNEUMONIA?
Yellow (If the child has FAST
BREATHING; No general danger signs:
stridor or indrawing)
During convulsions, the child's arms and
legs stiffen because the muscles are
contracting. The child loses
consciousness or is not able to respond
to spoken directions even if eyes are
open.
What color is NO PNEUMONIA:
COUGH OR COLDS
Green (If child has cough, no general
danger sign, no chest indrawing, no
stridor when calm, no fast breathing)
Pink classification means
urgent pre-referral treatment and referral
Diarrhea
defined as 3 or more loose or watery
stools in a 24- hour period.
Yellow classification means
specific medical treatment and advice
Cough or Difficulty Breathing
The most common causative agents of
respiratory infections are streptococcus
pneumoniae and Haemophilus
influenzae.
Green classification means
simple advice on home management
What color is SEVERE PNEUMONIA or
VERY SEVERE DISEASE?
Pink (If the child has any general danger
signs or any of the ff. signs: CHEST
What color is SEVERE
DEHYDRATION?
Pink (If 2 or more of the signs in the pink
row is present( abnormally sleepy,
sunken eyes, not able to drink or drinks
poorly, skin pinch goes back very slowly)
What color is SOME DEHYDRATION?
Yellow (If 2 or more of the ff signs:
restless, irritable, sunken eyes, drinks
eagerly, thirsty, skin pinch goes back
slowly)
What color is Malaria?
Yellow ((+) blood smear , no runny nose,
no measles, no other cause of fever)
What color is NO DEHYDRATION?
Green (Not enough signs to classify as
some or severe dehydration)
What color is Malaria Unlikely?
Green
Persistent Diarrhea
If a child has diarrhea for 14 days or
more, classify for persistent diarrhea.
What color is Severe Complicated
Measles?
Pink (Any general danger sign; clouding
of the cornea or deep extensive mouth
ulcers.)
What color is SEVERE PERSISTENT
DIARRHEA?
Pink (with diarrhea for 14 days or more
with some or severe dehydration)
What color is PERSISTENT
DIARRHEA?
Yellow (diarrhea for 14 days or more
and no sign of dehydration)
What color is DYSENTERY?
Green (Blood in the stool)
What color is Very Severe Febrile
Disease/ Malaria?
Pink (If with fever, stiff neck)
What color is Measles with eye or mouth
complication?
Yellow (With pus draining from the eye
or mouth ulcers.)
What color is Measles now or within 6
months?
Green
The IMCI focuses on children _______
years of age
under 5 years of age
What elements does the IMCI include
that are implemented by families and
communities as well as by health
facilities.?
preventive and curative elements
STEP 1 (Classify and distinguish the
case management process)
Ask if it is an initial visit of follow up care
STEP 2 (Classify and distinguish the
case management process)
Determine the age
STEP 3 (Classify and distinguish the
case management process)
Choose the right case management
- Age 1 week up to 2 months
- Age 2 months up to 5 years
STEP 4 (Classify and distinguish the
case management process)
Determine the sex, weight and
temperature
STEP 5 (Classify and distinguish the
case management process)
Ask the mother what the child problems
are.
STEP 6 (Classify and distinguish the
case management process)
Determine if this is an initial or follow-up
visit for this problem.
Fast Breathing (2 to 12 months)
50 breaths/minute
Fast Breathing (12 months up to 5
years)
40 breaths/minute
CHN211 QUIZLET
CU9 Integrated Management of
Childhood Illness
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE (EEINC)
a simple cost-effective newborn care
intervention that can improve neonatal
as well as maternal care
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE (EEINC)
Emphasizes a core sequence of actions,
performed methodically (step0by-step)
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE (EEINC)
Is organized so that essential time
bound interventions are not interrupted;
EARLY ESSENTIAL INTRAPARTAL
AND NEWBORN CARE (EEINC)
Fills a gap for a package of bundled
interventions in a guide format
Complete Pre-Natal Package
Provision of eight essential antenatal
care services
Complete Pre-Natal Package
Monitoring of height and weight
Complete Pre-Natal Package
Taking the blood pressure
Complete Pre-Natal Package
Screening and blood testing including
Complete Blood Count, blood Typing,
urinalysis, VDRL or RPR, HbSAg, blood
sugar screening, pregnancy test,
cervical cancer screening using acetic
acid wash and papanicolau smear.
Complete Pre-Natal Package
Micronutrient supplementation (iron,
folate and Vitamin A supplementation)
Complete Pre-Natal Package
Malaria prophylaxis where appropriate
Complete Pre-Natal Package
Deworming
Birth planning
Complete Pre-Natal Package
Promotion of exclusive breastfeeding,
newborn screening, BCG and Hepatitis
B birth dose immunization.
Complete Pre-Natal Package
Counselling on use of modern FP
methods especially lactation
amenorrhea (LAM), with focus on health
caring and health seeking behaviors
Complete Pre-Natal Package
Counselling on contraception including
surgical procedures where appropriate:
bilateral tubal ligation (BTL), no-scalpel
vasectomy (NSV) and management of
complications resulting from
contraception.
Complete Pre-Natal Package
Laboratory screening and medical
management of STI-HIV cases and their
complications.
Complete Pre-Natal Package
Counselling on Healthy Lifestyle with
focus on smoking cessation, healthy diet
and nutrition, regular exercise, STI
control HIV prevention and oral health.
Complete Pre-Natal Package
Complete Pre-Natal Package
Prevention and management of early
bleeding in pregnancy.
Complete Pre-Natal Package
Administration of antenatal loading dose
of steroids for threatened premature
delivery.
Complete Pre-Natal Package
Early detection and management of
signs of complications of pregnancy
Complete Pre-Natal Package
Measurement of fundic height against
the age of gestation, fetal heart beat and
fetal movement count to assess the
adequacy of fetal growth and wellbeing
Complete Pre-Natal Package
Prevention and management of other
conditions as indicated: • Hypertension •
Anemia • Diabetes • Tuberculosis •
Malaria • Schistosomiasis •
STI/HIV/AIDS
Complete Pre-Natal Package
Provision of other support services •
Antenatal registration through active
tracking by the WHTs • Birth Planning •
Home visits and follow up • Safe blood
supply • Transportation and
communication support services
Complete Childbirth Package
For the mother
Monitoring vital signs and the progress
of labor using the partograph
Complete Childbirth Package
For the mother
Identification of early signs and
symptoms and administration of
appropriate management of prolonged
labor, hypertension, abnormal
presentation, bleeding.
Complete Childbirth Package
For the mother
Active management of the third stage of
labor
Complete Childbirth Package
For the mother
Provision of immediate post-partum
nursing care (prior to discharge from the
delivery room)
• Perineal washing • Changing of
hospital gown • Checking vital signs •
Rooming-in
Complete Childbirth Package
For the newborn
Drying to keep the baby warm
Complete Childbirth Package
For the newborn
Provision of appropriate thermal care
through mother and newborn skin-toskin
contact, maintaining a delivery room
temperature of 25-28 degrees
centigrade and wrapping the newborn
with clean, dry cloth.
Complete Childbirth Package
For the newborn
Immediate latching on and initiation of
breastfeeding within first hour after birth.
Complete Childbirth Package
For the newborn
Non-immediate cord clamping (1-3
minutes or until cord pulsation stops)
Complete Post-Partum and Post-Natal
Package
For the mother
Post-partum check up including
identification of early signs and
symptoms of postpartum complications
like hemorrhage, infection and
hypertension
Complete Post-Partum and Post-Natal
Package
For the mother
Micronutrient supplementation, including
iron and folate.
Complete Post-Partum and Post-Natal
Package
For the mother
Counselling on • Proper Nutrition. •
Benefits of exclusive breastfeeding up to
six months. • Benefits of skin to skin
contact especially among preterm
babies. • Essential neonatal care
Complete Post-Partum and Post-Natal
Package
For the mother
• Laboratory screening and medical
management of STI-HIV cases and their
complications
Complete Post-Partum and Post-Natal
Package
For the mother
Provision of FP services and
contraception including surgical
procedures where appropriate: bilateral
tubal ligation (BTL), no-scalpel
vasectomy (NSV) and management of
complications resulting from
contraception.
Complete Post-Partum and Post-Natal
Package
For the mother
Prevention and management of other
diseases as indicated: • Hypertension •
Diabetes • Anemia • Tuberculosis •
Malaria • Schistosomiasis •
STI/HIV/AIDS
Complete Post-Partum and Post-Natal
Package
For the baby
Post-natal care required within 24 hours
after birth
Complete Post-Partum and Post-Natal
Package
For the baby
Cord care
Complete Post-Partum and Post-Natal
Package
For the baby
Breastfeeding
Complete Post-Partum and Post-Natal
Package
For the baby
Vitamin K injection
Complete Post-Partum and Post-Natal
Package
For the baby
Eye prophylaxis
For the baby
Newborn screening
Complete Post-Partum and Post-Natal
Package
• Birth registration • Safe blood •
Transportation and communication
1-early pregnancy-none
2-4 weeks after TT1-1 to 3 years
3-6 months after TT2-5 years
4-1 year after TT3-10 years
5-1 year after TT4-For all childbearing
age years
Tetanus toxoid immunization schedule
for women of childbearing age and
pregnant women without previous
exposure to TT, Td or DTP
Dose-When to give-Expected duration
of protection
CHN211 QUIZLET
CU10 Newborn Screening
Complete Post-Partum and Post-Natal
Package
For the baby
Delayed bathing until 6 hours of life
Complete Post-Partum and Post-Natal
Package
For the baby
BCG and first dose of Hepatitis B
Immunization
Complete Post-Partum and Post-Natal
Package
newborn screening
the ... is a Series of (primarily) blood
tests performed on a neonate with the
goal of early identification and treatment
of disease, that is continually evolving
screening
the features of a good ... test include:
1. High sensitivity
2. Disease with severity which would
warrant early detection
3. Cheap, easy and fast
4. Definitive test is available
5. Early detection can change the
course of the illness
6. Disease incidence high enough to
warrant screening
sensitivity
... is the probability that a person who
truly has a disease will have a positive
test. This is a "true positive"
specificity
... is the probability that a person who
really does not have the disease will
have a negative test. This is a "true
negative
screening
... tests should have a very high
sensitivity rate, though it means
sacrificing specificity.
false negative
a ... is a person who tests as negative
but who is actually positive
false positive
a ... is a person who tests as positive
but who is actually negative
false positives and negatives
Both.... are a disservice to the patientone will have delayed detection of
disease, the other will have
unnecessary testing and therapeutics,
but is Inevitable
positive
...predictive value is the likelihood that a
person has the disease given a positive
test result.
negative
...predictive value is the likelihood that a
person does not have the disease given
a negative test result.
MA
newborn screening started in ... in 1961
looking for PKU, and now has expanded
today looking for many different
diseases
state legislature
Which tests to include in the newborn
screening panel is a decision made by
the ....
newborn screening
All states use public funds to pay for .....
In Colorado, tests are paid for by fees,
required by, and collected by, the state.
Other states use general funds or other
sources
Tests are performed at the State
Department of Public Health and
Environment (CDPHE)
This unusual payment situation is
responsible for the differences in
programs from state to state
colorado
the following are part of the newborn
screening test in ...
Phenylketonuria
Congenital Hypothyroidism
Hemoglobinopathies
Galactosemia
Cystic Fibrosis
Biotinidase Deficiency
Congenital Adrenal Hyperplasia
B.A.E.R. (hearing test)
Medium Chain Acyl-CoA
dehydrogenase deficiency
law
: Initial and second test required by.... on
all newborns
NBS Fee: $85. covers 1st & 2nd screen
colorado
... state demographics: Approximate
Births: 68,500 (+ 6500 Wy)
Major Racial/Ethnic Groups
White 91% Native American 1%
Black 5% Asian/ Pacific Islander 3%
Hispanic Ethnicity 26%
Phenylketonuria
aka PKU is a disorder of amino acid
metabolism, caused by an enzyme
deficiency. Occurs in 1 in 10-15,000 live
births. 58 cases diagnosed in CO
between 1979 and 2003
Prevalence Rate: 0.01% or 27,200
people in USA
PKU
... if Untreated, causes developmental
delay and often, severe mental
retardation, Seizures
Autism, Hyperactivity, Aggressive
behavior
Hair and skin changes incl.
hypopigmentation
PKU
... can be Treated with restricted dietelimination of certain amino acids
Children can live healthy life and be
developmentally normal
Current recommendation is lifelong diet
PKU
Children of mom with ... off special diet
(certain AA elimination) during
pregnancy at risk for congenital heart
disease, so moms with .. should stay on
diet
hypothyroidism
... Most common true positive test
Incidence is 1 in 3600 to 5000 births
and screens for T4 level
TSH
if the T4 level is abnormal on newborn
screening, testers will then look at ...
levels
timing
... is important when screening for
hypothyroidism since all newborns have
a TSH spike after delivery
Check as close to or after 24 hours
Main reason why second screen was
added in 1996
hypothyroidism
Can get false positive ... result if mom
on thyroid hormone
hypothyroidism
... if left untreated can cause
Untreated, causes "cretinism"
Cognitive impairment, growth and
neurologic abnormalities, fatigue, skin
changes, coarse hair, large tongue...
hypothyroidism
... if caught on the newborn screen can
treat with thyroid hormone for life which
leads them to have normal IQ, good
health
Hemoglobinopathies
... primarily refers to sickle cell anemia
anemia but includes other hemoglobin
disorders such as sickle C disease and
sickle thalassemia
Hemoglobinopathies
In the United States have lots of varying
... incidence:
Incidence of Sickle Cell Disease is 1 in
500 African Americans
SCD affects an estimated 70,000 to
100,000 Americans.
The disease occurs in about 1 out of
every 36,000 Hispanic Americans births.
sickle cell
the ... trait occurs in about 1 in 12
African Americans.
isoelectric focusing
the newborn screening test for
hemoglobinopathies is ... because it is
cheaper
hemoglobinopathies
symptoms of various ... include:
Painful crises
Aplastic crises
Predisposition to infection
Tendency toward infarction
Bony changes associated with high
blood cell turnover
sickle cell anemia
treatment for ... includes:
Early immunization against
"encapsulated organisms,"
pneumococcus and H.flu
Penicillin prophylaxis
Early treatment of crises (to avoid
spleen infarction)
Attention toward hydration
Avoid triggers such as infection, hypoxia
(such as altitude)
Genetic counseling of parents
cystic fibrosis
... Disorder of membrane transport of
ions, specifically sodium and chloride.
Incidence is 1 in 3300 white infants, and
Can be caused by many different
genetic mutations
cystic fibrosis
symptoms of ... include:
1. Chronic lung disease
2. Secretions can't be cleared and act
as plugs
3. Chronic infection
4. Malabsorption/ malnutrition
5. Secretions are thick and block
pancreatic function
6. Requires replacement enzymes
lung
chronic .. disease caused by cystic
fibrosis can cause
Recurrent pneumonia, often with
resistant organisms
Atelectasis, ie. Collapse of areas of lung
Asthma-like symptoms
malabsorption
... is another major symptom of cystic
fibrosis caused by inadequate
pancreatic enzymes, in turn, causing
failure to thrive
cystic fibrosis
treatment of ... includes:
1. Antibiotics, preventive and
therapeutic
2. Bronchodilators
3. Exogenous pancreatic enzymes
4. Attention to nutrition
5. strategies to clear lungs of mucus
trypsinogen
in the newborn screening cystic fibrosis
is screened for by measuring the
immunoreactive ...
sweat chloride
the ... test is the definitive test to
determine if someone has cystic fibrosis
cystic fibrosis
Controversy existed as to whether or not
early detection of ....changes outcome
but proven clearly does, especially in
regard to early nutrition intervention
congenital adrenal hyperplasia
.. is an Enzyme defect characterized by
inability to make cortisol in the adrenal
cortex caused by absence of one of
three enzymes in the synthetic pathway
congenital adrenal hyperplasia
... occurs due to a 21-hydroxylase
deficiency that presents in 1 in 15000
births and accounts for 90% of cases of
.... and like All adrenogential syndromes
are it is autosomal recessive.
2. CNS symptoms- seizures,
developmental delay
3. Cataracts
4. Failure to thrive
5. E. coli sepsis
autosomal recessive
.. is the inheritance pattern for
congenital adrenal hyperplasia
galactosemia
treatment of ... includes:
of dietary exclusion of galactose,
especially milk products
congenital adrenal hyperplasia
... presents with :
Salt wasting- severe dehydration
Virilization of genitalia (difficult to
diagnose in boys)
congenital adrenal hyperplasia
treatment for ... includes:
1. Mineralocorticoids to maintain normal
electrolyte balance
2. Glucocorticoids: Maintenance dose,
Stress dose
galactosemia
... is Deficiency of one of the three
enzymes that break down galactose, a
simple sugar contained in milk 1 in 40, 60,000 live births
galactosemia
infants with ... present with the following
symptoms
1. Liver dysfunction- hypoglycemia and
jaundice
congenital hearing loss
... is important to recognize early on as
opposed to age 2 or 3 which cause
irreversible and permanent impairments
in speech, language, and cognitive
abilities when compared to their peers.
Brainstem auditory evoked response
... aka BARE, looks for congenital
hearing loss by measuring brainwave
response to broadband click
(Performed by volunteers in our hospital
, Non-invasive , Most accurate if
performed at 2 weeks but newborns are
captive population)
24 to 72
the best time for the newborn screening
test is somewhere between ... hours of
life because
1. Need several feeds to diagnose
galactosemia
2. Want to wait until after TSH spike
3. Normal values on CF and CAH tests
vary according to age at time of test (so
document age at time of test)
2 weeks
the entire newborn screening should be
repeated at the ... check up
24 to 72
the newborn screening test is
administered at ... by drawing blood
from baby's heel and allowing to dry on
filter paper. Sent to Colorado Dept. of
Public Health and Environment where
individual tests are run
Results sent to hospital, PCP, specialty
follow-up clinics and definitive tests
arranged with families
expanded
the ... newborn screening, has
developed over the Over the past 7
years, due to technology of tandem
mass spectroscopy has enabled testing
of 30 additional metabolic abnormalities.
It is available in all states, though in
various forms (but Not all meet the
requirements for screening tests:
Definitive tests not always available,
Treatments are rare, Incidence of
diseases are low)
mass spectrometry
tandem... is an analytic instrument that
separates and determines the quantity
of ions in a sample based on
mass-to-charge ratios
40
With any given sample, tandem mass
spectrometry can detect up to ...
disorders
Various states follow up and report
selected entities
Primarily disorders of organic, amino
and fatty acid metabolism
Medium chain acyl-CoA dehydrogenase
aka deficiency MCAD deficiency,
Incidence 1 in 6000 to 1 in 50,000,
depending on ethnic group.
In white Americans, 1 in 12,000, the
same as PKU
Medium chain acyl-CoA dehydrogenase
in children with ... deficiency aka MCAD
deficiency Times of stress and fasting,
will cause hypoglycemia and shock
stress and fasting
in children with MCAD deficiency times
of ... will cause hypoglycemia and shock
MCAD
treatment for ... deficiency is to avoid
fasting & dehydration and administer
carnitine
CHN211 QUIZLET
CU11 Integrated Management of
Childhood Illness
NUTRITION
state of well-being achieved by eating
the right food in every meal and the
proper utilization of the nutrients by the
body
GOAL OF NUTRITION
to improve nutritional status
BALANCED DIET
made up of a combination of 3 basic
groups eaten in correct amounts.
3 BASIC FOOD GROUPS
1. Body building food
2. Energy giving food
3. Body regulating food
VITAMINS
1. Vitamin A
2. Thiamine
3. Riboflavin
4. Niacin
5. Biotin
6. Pantothenic
7. Folic Acid
8. Vitamin B12
9. Vitamin C
10. Vitamin D
11. Vitamin E
13. Vitamin K
MINERALS
1. Calcium
2. Chloride
3. Chromium
4. Copper
5. Fluoride
6. Iodine
7. Iron
8. Magnesium
9. Manganese
10. Molybdenum
11. Phosphorus
12. Selenium
13. Sodium
14. Sulfur
15. Zinc
GLOBAL STRATEGY FOR INFANT
AND YOUNG CHILDREN FEEDING
(IYCF)
was issued by WHO and UNICEF in
2002 to reverse the disturbing trend in
infant and young child feeding practices.
- it aimed to improve the nutritional
status and health of children especially
the under-three and consequently
reduce infant and under-five mortality.
GOAL OF IYCF
reduction of child mortality and morbidity
through optimal feeding of infants and
young children
MAIN OBJECTIVE OF IYCF
to ensure and accelerate the promotion,
protection and support of good IYCF
practice
STRATEGY 1
PARTNERSHIP WITH NGO's AND
GO's IN THE COORDINATION AND
IMPLEMENTATION OF THE IYCF
PROGRAM
RA 7600
THE ROOMING IN AND
BREASTFEEDING ACT OF 1992
SEC. 2
DECLARATION OF POLICY
SEC. 3
DEFINITION OF TERMS
STRATEGY 2
INTEGRATION OF KEY IYCF ACTION
POINTS IN THE MNCHN PLAN OF
ACTION/STRATEGY
CHAPTER I SEC. 4
APPLICABILITY
STRATEGY 3
HARNESSING THE EXECUTIVE ARM
OF GOVERNMENT TO IMPLEMENT
AND ENFORCE THE IYCF RELATED
TO LEGISLATIONS AND
REGULATIONS (EO 51, RA 7200 AND
RA 10028)
CHAPTER I SEC. 5
NORMAL SPONTANEOUS
DELIVERIES
STRATEGY 4
INTENSIFIED FOCUSED ACTIVITIES
TO CREATE AN ENVIRONMENT
SUPPORTIVE TO IYCF PRACTICES
CHAPTER I SEC. 7
DELIVERIES OUTSIDE HEALTH
INSTITUTIONS
STRATEGY 5
ENGAGING THE PRIVATE SECTOR
AND INTERNATIONAL
ORGANIZATIONS TO RAISE FUNDS
FOR THE SCALING UP AND
SUPPORT OF THE IYCF PROGRAM
CHAPTER I SEC. 6
DELIVERIES OF CAESARIAN
CHAPTER I SEC. 8
EXEMPTIONS
CHAPTER I. SEC 9
RIGHT OF THE MOTHER TO BREAST
FEED
CHAPTER II SEC. 10
PROVISION OF FACILITIES FOR
BREASTMILK COLLECTION AND
STORAGE
CHAPTER III SEC. 11
CONTINUING EDUCATION,
RE-EDUCATION AND TRAINING OF
HEALTH PERSONNEL
CHAPTER III SEC. 12
INFORMATION DISSEMINATION TO
PREGNANT WOMEN
BEmONC
list of services that can save lives of
women and newborns with obstetric and
neonatal complications
CEmONC
a tertiary level regional hospital or
medical center, provincial hospital or an
appropriately upgraded district hospital
CHILDBIRTH
action of giving birth to a child
EMERGENCY
a serious, unexpected, and often
dangerous situation requiring immediate
action
NORMAL SPONTANEOUS DELIVERY
happen on its own without requiring
doctors to use tools to help pull the baby
out.