[BOARDS REVIEW]
COMMUNITY HEALTH NURSING
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BASIC CONCEPTS
Community → client
Health → goal
Nursing → means
LEVELS OF CLIENTELE
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Individual
Family
Usually shares a common blood relationship
Familys is very fluid, do not limit the definition
of family to blood relation
Basic unit of service
Basic unit of the society
Health of the family influence the health of the
community
Community
A group of people that shares a common
geographic location, interest, institutions and
population/ aggregates
o Population aggregates: e.g. pregnant
mothers, elderly
Composed of group of families
We direct our services to the community, but
we focus our interventions to the family
Population Groups
A group of individuals that share common
health needs
HEALTH
Complete physical, mental and social well-being
and not merely the absence of disease or infirmity
(WHO, 1958)
Dynamic state fluctuating patterns of death or
OLOF (Optimum Level of Functioning) (Dun, 1961)
Individual or group is able to realize aspirations and
satisfy needs and change or cope with the
environment
Health as resource for everyday life, not objective of
living
Positive concept emphasize social and personal
resources, and physical capabilities (WHO, 1986)
Absence of disease
Multifactorial
Address the root cause of the problem
HEALTH AS RIGHT
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Art 25, Sec. 1, Universal Declaration of Human
Rights (GA Res. 217 A III, 1948)
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Health is the right of every individual
regardless of age, gender or socioeconomic
status
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Art 2, Sec. 15 of the Phil. constitution
State and government is responsible to
protect the rights of every individual and instill
consciousness among them
Art. 13, Sec 11 of the Phil. constitution
The government must adapt a comprehensive
and integrated health programs
All levels of health care (primary, secondary
and tertiary facilities)
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SOCIAL DETERMINANTS OF HEALTH
Economic Stability
Employment
Income
Expenses
Debt
Medical bills
Support
Neighborhood and Physical Environment
Housing
Transportation
Safety
Parks
Playgrounds
Walkability
Education
Literacy
Language
Early childhood education
Vocational training
Higher education
Food
Hunger
Access to healthy options
Community and Social Context
Social integration
Support systems
Community engagement
Discrimination
Health Care System
Health coverage
Provider availability
Provider linguistic and cultural competency
Quality of care
Health Outcomes
Mortality
Morbidity
Life Expectancy
Health care expenditures
Health status
Functional limitations
OVERARCHING GOALS:
● Attain high quality, longer lives, free of preventable
disease, disability, injury and premature death
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Achieve health equity, eliminate disparities, and
improve the health of all groups
Create social and physical environment that
promote good health for all
Promote quality of life, healthy development and
health behaviors across all life stages
NURSING
Assisting sick or well individuals to help him gain
independence (Virginia Henderson. 1964)
The focus is more on primary care services
COMMUNITY HEALTH NURSING
Direct, goal-oriented and adaptable to the needs of
the individual, the family and community during
health and illness (American Nurses Association,
1973)
An area of human services directed toward
developing and enhancing the health capabilities
of people (Ruth Freeman & Janet Heinrich, 1981)
Either singly, as individuals or collectively as
groups and communities
General Philosophy of CHN: Community health
nursing is based on the worth and dignity of man
(Margaret Shetland)
SALIENT POINTS IN CHN
● Goal: Promotion of OLOF through teaching and
delivery of care
● Philosophy: based on the worth and dignity of man
● Primary focus: Health Promotion
● Primary Activity: Health Education
● Unit of Service: Family
COMMUNITY HEALTH NURSING FOCUSES ON THE
COMMUNITY
● Setting: Natural environments of people
Home → PHN
School → SHN
Workplace → OHN
● Fields of CHN Practice
OCCUPATIONAL HEALTH NURSING
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RA 1054 - Occupational Health Act
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Mandate owners, lessee or operator of any
commercial,
industrial
or
agricultural
establishment to furnish free emergency,
medical and dental attendance to employees
and laborers
30 employees (none)
1-100 within 1 km from health facility (none)
1-100 beyond 1 km health facility - OHN
101 & 200 - OHN
201 & 300 - OHN, Physician
301 & above - OHN, physician and permanent clinic
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E.O 442 - Labor Code of the Philippines
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First aid medicines and equipment
o > 50 but < 200 - Full time RN except when
hazardous
o > 200 but < 300 - Full time RN, part time
MD & RD
o > 300 - Full time RN, MD, RD and dental
clinic, infirmary or ER hospital with 1 bed
capacity for every 100 employees
E.O 307 - Occupational Safety and Health Center
(OSHC)
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Medical Inspection of Children in private
schools, colleges and universities in the
Philippines with students 300 or more to
provide part or full time MD for annual
medical examination
DepEd Order No. 43 - Redesigned Approach in
School Health Nursing
Activities:
Health promotion
Disease prevention and early detection
Emergency care
Referral
Health screening, case finding, health
education and nursing procedures
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employees
compensation
Health risk management at work e.g. health
hazard identification, risk assessment, control
measures, surveillance, information, training,
monitoring, record keeping
Identify
health
hazards
or
so-called
environmental scanning
Are there slippery wet floors?
Are
they
using
personal
protective
equipments
Health Promotion
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Under
the
commission
Health protection
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RA 124
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8 hours/day for 5 days a week exclusive of time
for meals (RA 5901)
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SCHOOL HEALTH NURSING
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Health risk assessment e.g. environment,
lifestyle, employee information, assistance
program
PUBLIC HEALTH
Philosophy: health and longevity as birthrights
Objectives:
Prevent disease
Prolong life
Promote health and efficiency
Through organized community effort
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The application of science in the context of policies
to removes inequalities in health and deliver the
best health for the greatest number (WHO)
Public health + nursing + social assistance
Promotion of health
Improvement of the physical and social
environment
Rehabilitation
Prevention of illness and disability
NATIONAL LEAGUE OF PH GOVERNMENT NURSES
STANDARDS OF PHN PRACTICE IN THE PH (2006)
● In Public health nursing, it focuses on policies and
programs that will ensure health equity
Refers to the practice of nursing in the local,
national and city health departments which
include health centers and public schools
View health as macrocosm
Ensure that health as received by the
community
A subfield of community health nursing
● In community health nursing, we do not only look
at the group or community but also at the
individuals and families. We provide direct nursing
care to client
Is a broader as it encompasses nursing
practice in a variety of roles, which at times
includes independent nursing practice
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PREVENTIVE APPROACH TO HEALTH
Health Promotion - activities that enhance
resources directed at improving overall well-being
Disease Prevention - activities that protect people
from disease and its effects
PRIMARY
● Health promotion and specific protection
● E.g. Immunization, breastfeeding
SECONDARY
● Early detection and prompt intervention
● E.g. Newborn screening, IMCI, hearing screen,
sputum microscopy, PhilPEN, feeding program
TERTIARY
● Limitation of disability and rehabilitation
● Referral of a severely malnourished child
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HEALTH CARE DELIVERY SYSTEM
Refers to the overall field of practice where health
services are provided with and for the community
Characterized by different levels of service
RESTRUCTURED HEALTH CARE DELIVERY SYSTEM OF THE
PH
PRIMARY LEVEL
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STANDARDS OF CARE IN PHN
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Assessment
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Hospitalization
Early diagnosis and treatment
District hospital
Provincial hospital
TERTIARY LEVEL
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Specialized care
Specially trained personnel
Highly departmentalized
Sophisticated equipment
Regional hospital
National / DOH/ medical centers/
university
Develop programs based on the identify needs
Assurance
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Planning
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Partner to identify outcomes to status of
populations
Set goals and objectives
Define the planning process
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Instituting implementation policies
Policies serves as guide
Procedures involves on how we are going to
implement the programs (e.g. gather the
weight of underweight children and monitor
every month)
Evaluation
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Prevention
Management
of
prevalent
conditions
Out-patient services
Ambulatory clients
Barangay health center
Rural Health Unit (RHU)/ Barangay
Health Center
SECONDARY
LEVEL
Give meaning to needs
Outcome Identification
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Status of populations
Diagnosis
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Status based on set programs
Determine whether the outcomes have been
achieved
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INTER-LOCAL HEALTH ZONE
Defined catchment population within a defined
geographical area
Does not only cover government health services
but includes NGOs and private sector
PPM - Public and Private Mix
TWO-WAY REFERRAL SYSTEM
● Communication among facilities
● Efficiency of health care delivery
Minimize cost
Maximize resources
Competency of care
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RA 7160 - Devolution Code
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Local Government Code of 1991
Aim: to trandorm local government unit into:
SARAD
o Self-reliant communities
o Active partnership with the people
o Responsive to the needs of the people
o Accountable government representatives
o Decentralization
system
of
health
decision making
LOCAL GOVERNMENT CODE
Department of Health
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Chair: Health Secretary
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National hospital/ DOH
hospital/ Medical centers
Provincial Health Board
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Chair: Governor
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Vice-chair: PHO
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Members:
Chairman,
NGO, DOH
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Regional hospital
Provincial
hospital
District hospital
Municipal Health Board
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Chair: Mayor
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Vice-chair: MHO
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Members:
Chairman,
NGO,
DOH Rep.
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RHU
(RA
1:20,000
BHS: 1:5,000
1082):
Appointment of the position in the health center is
the responsibility of the Mayor or the Governor
Centralize
Top level (DOH) is the only one involved in
decision making process
Decentralize
All levels are involved in the decision making
process
PUBLIC HEALTH NURSE
● Supervises and guides all RHMs in the municipality
● Prepares the FHSIS quarterly and annual reports
● Utilizes the nursing process, health education
● Collaborates with other members of health team
● 1:10,000
RURAL HEALTH MIDWIFE
● Manages the BHS and supervises, and trains BHWs
● Provides midwifery services and executes health
care programs and activities for women, family
planning and services
● Conducts patient assessment and diagnosis for
referral
● Organizes the community
● Facilitates barangay health planning and other
community health services
● 1:5,000
RURAL SANITARY INSPECTOR
● Ensure a healthy physical environment in the
municipality. Activities are advocacy, monitoring,
regulatory activities, inspections of water supply
and household conditions
BARANGAY HEALTH WORKERS
● Serves as interface between community and the
RHU
● Provides basic services
● 1:20 households
● Grassroots health care workers
Non-professionals
They do not have formal training
Also called as Frontline health care workers
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RA 1082
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For every one RHU, there should only be
20,000 population (1:20,000)
ROLES AND FUNCTIONS OF
PUBLIC HEALTH WORKERS
MUNICIPAL HEALTH OFFICER (MHO) / RURAL
HEALTH PHYSICIAN (RHP)/ PHYSICIAN-IN-CHARGE
(PIC)
● Administrator
Prepares the municipal health plan and
budget
Monitor implementation of basic health
services
Management of staff
● Community physician
Conducts epidemiological studies
Formulates health education campaign
Prepares and implement control measures
plan
● Medico-legal officer
1:20,000
RA 7305 - Magna Carta for Public Health Workers
40 hours per week
Salary Scale (RA 6758)
Hazard Allowance 25% of monthly salary for SG
19, 5% (SG 20) and above
PRIMARY HEALTH CARE
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Legal Basis: Letter of Instruction (LOI) 949
October 1979 by Ferdinand Marcos, 1 year after
the First International Conference on Primary
Health Care in Alma Ata (Russia) sponsored by
WHO & UNICEF
Goal: Health for All Filipinos and Health in the
Hands of the People by the year 2020
Mission: To strengthen thea health care system
by increasing opportunities and supporting
the conditions wherein people will manage
their own health care
Essential health care made universally Accessible,
Available,
Appropriate and Affordable to
individual and families in the community by mean
Acceptable to them (5As)
Accessible: Health center must be found
within 5km of the location of the barangay
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Available: health care worker
Appropriate according to the needs of the
client
Affordable: depending on the availability of the
medications, services or equipments
Acceptable: must no contradict their beliefs
and practices
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PRIMARY ELEMENTS/ COMPONENTS
Environmental sanitation
Control of communicable diseases
Immunization
Health education
Maternal and child health
Family planning
Adequate food and proper nutrition
Provision of medical care and emergency
treatment
Treatment of locally endemic diseases
Provision of essential drugs
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RA 6675: Generic Act
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RA 7581: Price Act
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RA 9502: Cheaper Medicine Act
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Botika ng Barangay (BnB): essential medicines at
cheaper price
Compack/ Complete Treatment Pack - monthly
supply of medicines for HPN and DM in BHS
Amlodipine
Losartan
Metformin
Simvastatin
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USE OF HERBAL MEDICINES
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Legal Basis: RA 8423 - Traditional and Alternative
Medicine Act of 1997
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Promotes use of indigenous resources
Traditional Medicine
Sum total of the knowledge, skill, practices
based on the theories, beliefs and experiences
of indigenous to different cultures
Complementary Medicine
Combination
of
both
traditional
and
conventional methods
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PHC CORNERSTONE/ PILLARS
Acronym: AIUS
Active Community Participation
Intra and inter-sectoral linkages
Intra: LGU
Inter: NGO, PO & IO
Use of appropriate technology
Focus on indegenous resources
Support mechanisms made available
LGU create policies and implement the
programs
DOH provide financial assistance, support
mechanisms and develop programs
Support mechanisms: Technical and financial
assistance
PRIMARY HEALTH WORKERS
Village/BHWs
Trained community health workers, health
auxiliary
volunteers,
traditional
birth
attendants, healers
Grassroot Levels
Intermediate Level - professional group
Primary: RHM
Secondary: PHN
Tertiary: Physician
COMPLEMENTARY MEDICINE
Acupressure - pressure on acupuncture points
Acupuncture - needles to puncture and stimulate
points
Aromatherapy - senses of smell using oils
Chiropractic - static and dynamics of locomotor
system
Herbal/ Phytomedicine - plants
Massage - soft parts of body
Nutritional therapy - food as medicine
Pranic healing - balancing energy
Reflexology - reflex points
10 HERBAL PLANTS
● Acronym: LUBBY SANTA
● Lagundi
Pain reliever, asthma, cough, fever, dysentery,
skin diseases (dermatitis, scabies, ulcer,
eczema), rheumatism, spasm, contusions,
aromatic bath
● Ulasimang Bato (pepperomia)
Lowers uric acid blood level
● Bawang
For HPN (more on arteriosclerosis), toothache
● Bayabas
Toothache, antiseptic wash
● Yerba Buena/ Herba Buena
Pain reliever, for menstrual pain, arthritis pain,
colds, bleeding gums, fainting, for relief of
insect bites and itching
● Sambong (camphor)
Diuretic
● Ampalaya
For mild NIDDM
● Niyog-niyogan
Intestinal parasitism
● Tsaang-gubat (wild tea)
For diarrhea, high in chlorine content
● Akapulko (ringworm bush)
Fungal infection
THINGS TO REMEMBER
BONUS!
● Boling - remove cover
● One kind of plant for each type of symptom
● No insecticides
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Use clay pot and plant part advocated
Stop in case of untoward reactions; seek
consultation if s/sx not relieved after 2-3 doses
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Herbal medicines may be prepared by decoction,
infusion (tea) or poultice
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ASTANA DECLARATION ON PRIMARY HEALTH CARE
2018
● Celebrated the 40th year
● Commences the implementation of the Astana
Declaration
Marks the change the landscape of healthcare
delivery system all over the world
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ASTANA DECLARATION
Alma Ata Declaration (1978) → focused on health for all
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Astana Declaration (2018) → strengthen PHC; realize UHC
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Held in Astana, Kazakhstan
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Global Conference on Primary healthcare → PHC should be
integrated with all tiers of healthcare to give better services →
focus on PHCs to prevent diseases and not just fight specific
disease; strive towards UHC
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Acknowledgement of rising threat of lifestyle and
non-communicable disease
DETERMINANTS OF SUCCESS OF PHC ASTANA
DECLARATION
● Knowledge and Capacity Building
Health education
● Human Resources for Health
Multidisciplinary approach
Includes all health workers to collaborate with
the health care plan
● Financing
Involves implementation of Universal Health
Coverage
● Technology
Effective,
safe,
affordable,
sustainable,
acceptable
The delivery of basis care services
DOH RHR PROGRAMS
● Fixed term basis; special programs by the
government
● Medical Pool Placement and Utilization Program
MDs in DOH hospitals
● Doctors to the Barrios (DTTB)
2 years in 4th or 5th class municipality
● Nurse Deployment Project
6 months renewable up to 2 years
● Rural health Midwives Placement Programs MW
● Rural Health Team Placement Program (RHTPP)
Med tech and nutritionist
● DOH Pre-services scholarship programs
Medical and midwifery scholarship program
THE OTTAWA CHARTER
Output of the first International Conference on
health promotion, meeting in Ottawa this 21st day
of November 1986
A call for action to achieve Health for All by the year
2000 and beyond
HEALTH PROMOTION
Is the process of enabling people to increase
control over and to improve, their health
A behavior motivated by the desire to increase
well-being and actualize human health potential. It
is an approach to wellness
Key to achieving Health for all by the year 2000 and
beyond
STRATEGIES TO HEALTH PROMOTION
● Build healthy public policy
E.g. RA 7600 - Breastfeeding policy
● Create supportive environments
E.g. Breastfeeding stations
● Strengthen community action
Organize projects that involves participation of
the community to promote health
E.g. Breastfeeding campaign programs educate mothers about the benefits of
breastfeeding
● Develop personal skills
Teaching them skills that enhances their
capacity to implement health promotion
● Reorient health services
Integrate the health promotion strategy in
different health programs
E.g. Breastfeeding is integrating in EIMC
PREREQUISITES FOR HEALTH PROMOTION
● Advocate
Advocating for positive health behavior
Health education
● Enable
To make decision
Give opportunities by telling them the benefits
● Mediate
Guiding them to make decision
E.g. Family Planning
MILLENIUM DEVELOPMENT GOALS
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2015; 8 MDGs
To eradicate extreme poverty and its implications
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MDGs 4,5, and 6 are specific for health
Goal 4: Reduce Child Mortality
o Target is 2/3
Goal 5: Improve Maternal Health
o Target is ¾ or 75%
Goal 6: Combat HIV/AIDS, Malaria and other
diseases
SUSTAINABLE DEVELOPMENT GOALS
abuse,
road
traffic
accidents,
UHC,
hazardous chemicals
OTHER SDGs RELATED TO HEALTH
● DOH is the principal health agency in the
Philippines
● SDG 1: poverty
● SDG 2: malnutrition
● SDG 5: violence against women and girls/ sexual
reproductive health and rights
● SDG 6: safe and affordable drinking water/
sanitation and hygiene
● SDG 8: safe and secure working environment
● SDG 11: housing and basic service/ air quality. Waste
management in cities
● SDG 13: climate-related hazards and natural
disasters
DEPARTMENT OF HEALTH
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2030; 17 MDGs
SDG 3 is specific for health
HEALTH MDGs
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MDG 4
Reduce the under-five
mortality
rate
by
two-thirds
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MDG 5
Reduce the maternal
mortality
ratio
by
three-quarters
Achieve
universal
access to reproductive
health
DIRECT HEALTH SDG
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MDG 6
Halt and reverse the
spread of HIV/AIDS
Achieve
universal
access to treatment
for HIV/AIDS
Halt and reverse the
incidence of malaria
and
other
major
diseases
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SDG 3
Reduce
the
global
maternal
maternal
mortality ratio
End preventable death
of
newborns
and
children under 5yrs of
age
End current epidemics
and
combat
communicable
Reduce
premature
mortality
from
non-communicable
diseases
Strengthen
the
prevention
and
treatment of substance
abuse
Halve the number of
global
deaths
and
injuries from road traffic
accidents
Ensure universal access
to
sexual
and
reproductive healthcare
services
Achieve UHC
Reduce
deaths
and
illness from hazardous
chemicals and air, water
and soil pollution and
contamination
New:
Communicable
diseases,
substance
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Original name: Board of Health of the Philippine
Island
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Vision: Filipinos are among the healthiest people
in Southeast Asia by 2022, and Asia by 2040
Mission: To lead the country in the development of
a
productive,
resilient,
equitable
and
people-centered health system (PREP)
The DOH holds the overall technical authority on
health as it is a nation health policy-maker and
regulatory institution
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3 MAJOR ROLES IN THE HEALTH SECTOR
● Leadership in health
● Enable and capacity builder
● Administrator of specific services
IMPACT OF DEVOLUTION IN THE DELIVERY OF
HEALTH SERVICES
DOH
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LGUs
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Health governance
national level
in
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Health governance
subnational level
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Overall
steward
and
technical authority in
health
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In-charge of delivery of
primary and secondary
health services
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Develop national plans,
technical
standards,
guidelines
Standard
is
universal
Policy is different
from one another
at an institutional
level
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Prepares
plans,
manages,
implement
local health programs
and services
HEALTH SECTOR REFORMS
FOURmula One (2005-2010)
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Kalusugan Pangkalahatan or Aquino
Agenda (2011-2015)
Duterte Health Agenda (2016-2022)
FOURmula 1 Plus (2017-2022)
Health
DUTERTE HEALTH AGENDA
All for Health towards Health for All
“Lahat para sa Kalusugan tungo sa Kalusugan
Para sa Lahat”
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Advance health promotion, primary care and
quality
Cover all Filipinos against financial health risk
Harness the power of strategic HRH
Invest in eHealth and data for decision-making
Enforce standards, accountability and transparency
Value clients and patients
Elicit multi-stakeholder support for health
FOURMULA 1 PLUS
3 GOALS
● “The health system we aspire for”
● Financial Protection
Filipinos, especially poor, marginalized, and
vulnerable are protected from high costs of
healthcare
● Better Health Outcomes
Filipinos attain the best possible health
outcomes with no disparity
● Responsiveness
Filipinos
feel
respected,
valued
and
empowered in all of their interaction with the
health system
3 GUARANTEES
● Guarantee 1: All Life Stages & Triple Burden of
Disease
Communicable diseases: HIV/AIDS, TB. Malaria,
Diseases for Elimination, Dengue, Lepto, Ebola
● Guarantee 2: Services are delivered by networks
that are
Fully
functional:
complete
equipment,
medicines, health professional
Compliant with clinical practice guidelines
Practice gatekeeping
Located close to the people: mobile clinic or
subsidize transportation cost
Enhanced by telemedicine
3:
Services
are
financed
● Guarantee
predominantly by PhilHealth
Philhealth as the gateway to free affordable
care
o 100% of Filipinos are members
o Formal sector premium paid through
payroll
o Non-formal sector premium paid through
tax subsidy
Simplify Philhealth rules
o No balance billing for the poor/ basic
accommodation and fixed co-payment
for non-basic accommodation
Philhealth as main revenue source for public
health care providers
o Expand benefits to cover comprehensive
range of services
o Contracting networks of providers within
SDNs
STRATEGY
● Acronym: ACHIEVE
Figure 1: FOURmula One Plus for Health Strategy Map
STRATEGIC FRAMEWORK
VISION
Filipinos are among the healthiest people in
Southeast Asia by 2022, Asia by 2040
MISSION
To lead the country in the development of
PREP system
GOALS
Better health outcomes,
protection, responsiveness
STRATEGIC
PLAN
financial
Financing, Service Delivery, Governance and
Regulation
“PLUS”
Performance Accountability
VALUES
Integrity, Excellence and Compassion
PILLAR
FINANCING
OBJECTIVE
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SERVICE
DELIVERY
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PERFORMANCE
MEASURES
Sustain
investments
in health
Ensure
equitable
and efficient
use
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Increase in share of
Philhealth and
government
expenditures (DOH
& LGU) in total
health
expenditures
Available
essential
quality
health care
at
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Achieve adequate
health facility and
HRH ratios
Attain targets for
basic services
●
appropriate
level
REGULATION
GOVERNANCE
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(immunization,
rates, facility based
deliveries, etc)
Ensure safe,
high quality,
and
affordable
health
products,
services,
devices and
facilities
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Strengthen
capacity,
coordination
and support
to people
centered
SDNs
Leading a
participatory
approach
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Reduce mean
market price of
services, labs and
medicines
Reduce incidence
of adverse health
events due to poor
quality product
and services (e.g.
antimicrobial
resistance, post op
complications, etc)
Improve rating in
SWS and other
government trust
surveys
Reduce stock-outs,
improve utilization
of budget, and
increase % of
facilities with EMRs
F1
PLUS
(PERFORMANCE
ACCOUNTABILITY)
STRATEGIES
● Transparency and Accountability
Identifying performance metrics
Regular monitoring and performance review
Publishing scorecards and performance
reports
● Shift to result-oriented management approach
Efficiency of tools, systems and processes
Develop and explore mechanisms to link
performance to incentives
●
People-oriented
services
approach
for
delivery
health
SALIENT FEATURES/ TERMS
MEMBERSHIP
● Automatic inclusion of every Filipino into National
Health Insurance Program
● Simplification of PhilHealth membership into:
Direct
Contributors:
capacity
to
pay
premiums, are employed and are bound by an
employer-employee
relationship. Or are
self-learning,
professional
practitioners,
migrant
workers,
including
qualified
dependents and lifetime members
Indirect Contributors: not direct contributors
and their qualified dependents, premium
subsidized by the national government
o Point of care (POC) - shouldered by
PhilHealth
Co-payments: flat free or predetermined rate
paid at point of service
FINANCING SOURCE
● Pooling of funds from Sin Tax, PagCOR, PCSO
premium, DOH annual appropriations, and national
government subsidy to DOH and PhilHeath
● Population-based health services financed by
DOH/ LGUs
Population group as recipient paid
E.g.. health promotion, disease surveillance,
vector control, Immunization, maternal health
program
● Individual-based health services financed by
PhilHealth
Can definitely be traced back to 1 recipient
limited effect at population level
Prepayment schemes (Philhealth, private
health insurance, HMOs)
UNIVERSAL HEALTH CARE
●
RA 11223 - Universal Health Care Act of 2019
●
Prescribing reforms in the health care system and
appropriating funds
OBJECTIVES OF UHC ACT
● Progressively realize universal health care in the
country through a systemic approach and clear
delineation of roles of key agencies and
stakeholders towards better performance in the
health system
● Ensure that all Filipinos are guaranteed equitable
access to quality and affordable health care goods
and services and protected against financial risk
IMPACTS OF UHC
● Integrated and comprehensive approach to ensure
health for all Filipinos
● Access to comprehensive set of health services
without casing financial hardships
FINANCING
● 50% PAGCOR Income
● 40% PCSO Charity Fund
● DOH Funding from the national budget
● PhilHealth subsidy from the national government
● Premium contributions from PhilHealth member
(direct contributions)
ENTITLEMENT TO BENEFITS
● Free of charge at point of service for population
based health services
● Immediate eligibility for health benefit package
under National Health Insurance Program
No Philhealth ID card required
No co-payment for services in basic/ ward
accommodation
Fix, regulated co-payment for non-basic
accommodation
POPULATION COVERAGE
● Healthy population
CRUZ, DCR | BATCH 2022 | 9
●
●
Health promotion
Disease prevention and wellness program
Population at risk
Risk identification
Screening and early detection
Sick population
Clinical primary care (diagnosis and treatment,
continuing and coordination)
Referral to secondary hospital
Referral to tertiary hospital
Referral to quaternary/ specialized care
●
●
DELIVERY OF HEALTH SERVICES
● Contracting of province-wide and city-wide health
system for population-based health services by
DOH with the following minimum requirements:
Primary Care Provider network
Epidemiologic surveillance system
Health promotion programs
health
services
refer
to
● Population-based
intervention such as health promotion, disease
surveillance and vector control, which have
population groups as recipients
●
HUMAN RESOURCES FOR HEALTH
● National Human Resource Master Plan to provide
appropriate health workforce based on population
health needs
● National Health Workforce Support System to
assist LGUs in human health resource needs
● Expansion of existing and new allied and
health-related degree and training programs
● Return Service Agreement for all allied and
health-related government-funded scholars for at
least 3 years with compensation
●
●
REGISTRY OF HEALTH PROFESSIONAL
AND WORKERS
The PRC and the DOH shall set up a registry of
medical and allied health professionals indicating
among other their current number of practitioners
and location of practice
The DOH and the PRC shall issue guidelines for the
eligibility requirements, standard competencies,
training
mechanisms,
and
post-graduate
certification process for primary care workers
CLINICAL GUIDELINES AND PATHWAYS
FIRST VISIT
● History and Physical Examination
Elicit symptoms of hyperglycemia
o Polyuria, polyphagia, polydipsia, nocturia
and weight loss (A-II)
General physical examination focus on cardiac
renal,
peripheral
pulse,
retinopathy,
neuropathy, skin an BMI (A-II)
Conduct risk screening for asymptomatic and
BMI > 25kg/m2 or > 45yrs old (A-II))
● Laboratory
Request for FBS or RBS or OGTT or Hgb A1C
(A-I)
This can be done in patients with classic
symptoms or in asymptomatic adults with BMI
>25 kg/m2 and with risk factors or in
asymptomatic adults >45yrs old with BMI>25
kg/m2
Pharmacologic intervention
Not advisable to give routine vitamin
supplementation with antioxidants such as
vitamins E & C and carotene (A-I)
Non-pharmacologic interventions
Patient intervention
o Structured health education on lifestyle
changes (alcohol and smoking)
o Moderate weight loss
o Regular physical activity
o Reduced calories, sugar and dietary fat
intake (A-III)
Family-focused
and
community-oriented
interventions
o Arrange
for
development
and
implementation of family-focused and
community-oriented intervention (A-III)
Patient outcomes
Aware of DM type 2 and management plan
(A-III)
Follow up visit: In 0-2 weeks (A-III)
-
VARIATIONS
● History and Physical examination
If during the first visit the patient has
laboratory results that fit the classification of
DM type 2, follow the recommendation during
the second visit (A-III)
● Laboratory
If the doctor has doubts about the accuracy of
available laboratory test, the test can be
repeated for confirmation (A-III)
HEALTH CARE PROVIDER NETWORK
● Healthcare Assessment
Gatekeeping of the health care services
TYPES OF HEALTHCARE PROVIDER NETWORKS
PUBLIC
PRIVATE
To deliver population-based
and individual-based health
services
To deliver
services
individual-based
Limitation: Geographic
political boundaries
Limitation:
forces
Market-based
or
Contractual agreement: public health care system may
contract a prove facility (and vice versa) to provide services not
available to augment existing services within the network
CRUZ, DCR | BATCH 2022 | 10
TIMELINE AND MILESTONES OF UHC
DATE
HEALTH AND
NUTRITION
TARGET
Feb 20, 2019
UHC Law
March 8, 2019
UHC Law took effect after 15 days
Sept. 8, 2019
UHC IRR took effect after 180 days
Pilot implementation of UHC in 33
accredited institutions
2020-2022
Registration of Primary Care Providers
(PCP)
2022-2028
Organization
of
networks
integration of local health systems
and
Full implementation of UHC
SOCIAL PROGRAMS
PANTAWID PAMILYANG PILIPINO PROGRAM (4Ps)
● Rights-based and social development program of
the national government to reduce poverty by
providing Conditional Cash Transfer (CCT) grants
to extremely poor households to improve their
health, nutrition and education particularly of their
children 0-18y/o
● In 2011, it became a law
Extended the inclusion of qualified Filipinos
●
RA 11310 - Pantawid Pamilyang Program Act
-
-
-
-
Max of 12 months
(Php 6,000)
The cash grants shall be received by the
mother through Land Bank cash card, OTC,
G-cash remit, Rural Banks
Under the provision of 4Ps, the most
responsible member of the family (usually the
mother) is responsible for holding the ATM
card or receiving the cash
Given every month per child
-
July to December
2019
2029
Php 750/ month/
household or
higher
The government will provide conditional cash
transfers to qualified poor households for a
maximum period of 7 years. The National
Advisory Council, however, may recommended
a
longer
period
under
exceptional
circumstances
Qualified for the program are farmers,
fishermen, homeless familie, indigenous
people, those from the informal sector and
those living in isolated and disadvantaged
areas including places without electricity
Livelihood
programs
and
employment
assistance may also be availed by eligible
beneficiaries at the Department of Social
Welfare and Development
Persons who will be found of falsifying their
information in the registry for conditional cash
transfer may be imprisoned for a month or up
to a year, and may be fined with not less than
Php 10,000 but not more than Php 100,000
BENEFICIARY
AMOUNT
DURATION
ELEMENTARY
Php 300 or higher
(max of 3 children)
Max of 10 months
(Php 9,000 for 3
child)
SENIOR HS
Php 700 or higher
Max of 10 months
●
PROGRAM CONDITIONS
● Pregnant must avail pre/post-natal care and be
attended by a trained health professional
● 0-5 children must receive regular preventive health
check-ups and vaccines
● 6-14 y/o must receive deworming pills 2x/yr
● 3-5 y/o children must attend daycare or preschool
classes and must attend at least 85% of the time
● 6-18 y/o children must enroll in elementary or high
school classes and must attend at least 85% of the
time
● Parents must attend Family Development Sessions
(FDS) on effective parenting, husband and wife
relationships , child development, laws affecting
the Filipino family, gender and development and
home management
Paglalatag ng Pundasyon ng Programang
Pantawid Pamilya
Paghahanda
at
Pangangalaga
ng
Pamilyang Pilipino
Partisipasyon ng Pamilyang Pilipino sa
Gawing pang Komunidad
●
●
●
●
●
●
●
●
●
●
GENERAL PRINCIPLES OF CHN
The Family - basic unit of service
Comprehensive Care
Developmental Service - self reliance
Pre-payment mechanism
Through the taxes we pay
Preventive Care - primary, secondary, tertiary
Ecology Orientation
Continuity of Care - throughout the lifespan
Multidisciplinary Approach - intra/intersectoral
Population Focused - greater good of majority
Consumer Involvement - allow them to make
decision for their health after we educate them
LEGAL BASIS OF PHN PRACTICE
●
RA 9173 Sec 28 - Philippines Nursing Act of 2002
-
Provide nursing care using nursing process
Establish linkages with community resources
and coordination with health team
Provide health education to IFC
Teach, guide and supervise students in
nursing education programs
CRUZ, DCR | BATCH 2022 | 11
-
Undertake nursing and HRD training and
research
ROLES AND FUNCTIONS OF PUBLIC HEALTH NURSE
● Healthcare Provider
● Healthcare Educator
● Leader/Manager
● Advocate
● Counselor
● Researcher/ Epidemiologist
● Community Organizer
ADDITIONAL INFO
Roles - title of the position
Functions - activities related to the role
●
●
●
●
●
●
●
ROLES OF PHN
HEALTH CARE PROVIDER
Secondary health care provider
Provider of direct nursing care
Health educator and change agent
Role model
Health monitor of the individual and family
Sick and well individuals, families and communities
E.g. administering vaccine
●
●
●
●
●
●
●
●
●
●
●
●
●
-
BHW - Vitamin A, Vital Signs
Authority, Responsibility &
(ARA)
Accountability
EPIDEMIOLOGIST
Researcher
Participant in epidemiologic investigations
Health monitor of the community
Statistician
Presentation of municipal health statistics
through tools such as graphs and tables
Epidemiological Investigation
Secondary Prevention
Performed during an outbreak using graphs
and tables to analyze data
Pie Graph: Percentage
Line Graph: Relationship
Recorder/ reporter: RA 3573
Diseases that require weekly monitoring:
o Acute flaccid paralysis (AFP) polio
o Measles
o Severe acute diarrhea (SAD)
o Neonatal tetanus
o AIDS
-
LEADER/MANAGER
Planner/programmer: nursing component of
health plan
E.g. Planning of budget
Coordinator of services
Make referrals
Coordinate nursing services with other health
programs
Supervisor of RHM’s
Organize work force
o Schedule of RHU personnel (RHM visits
BHS at least 1x/week)
o E.g. Coordinate with the physician in
charge to know what are the resources
needed such as procurement of vaccines
Provide technical assistance to RHM’s in
implementing
o Standard case definitions
o Management guidelines
Trainer
Training programs of RHM’s, BHW and
traditional healers (TBA’s, herbolario, etc.)
Resource person
Property custodian of the RHU
o E.g. cold chain officer in EPI
Evaluator of work performance
Utilize the process of Directing
Delegate
some
responsibilities
to
subordinates, but it is important they are
oriented and trained regarding their task. We
cannot delegate something beyond their task.
E.g. Follow-up postpartum mothers to visit the
health center
E.g. Midwives - BCG, Vitamin A, Deworming
●
●
RA 11166 - Philippines HIV and AIDS Policy Act of
2018
Repealed the RA 8504 also known as the
Philippines AIDS Prevention and Control Act
of 1998
Allows minors 15 - 17y/o to give their own
consent for taking HIV test
Any person below 15 who is pregnant, married
or in high-risk behavior should be considered a
mature minor and be allowed to give their
own consent for HIV testing
Mandates HIV and AIDS education in the
workplace
All public and private employers and
employees, including AFP and the PNP shall
be provided with basic information and
instructions on HIV and AIDS, including on
confidentiality in the workplace and reduction
or elimination of stigma and discrimination
Diseases targeted for eradication
Acute flaccid paralysis
Neonatal tetanus
Measles
Rabies
Diseases that require reporting within 24hrs
Acute flaccid paralysis polio
Measles
-
●
●
●
●
●
●
FAMILY NURSE CONTACT
Home Visit
Clinic Visit
Telephone Contact
Group Discussion
CRUZ, DCR | BATCH 2022 | 12
●
Telehealth/ telemedicine
CLINIC VISIT
The family initiates the care
Resources are readily available
Has higher number of patients
PHASES OF A CLINIC VISIT
PRE-CONSULTATION PHASE
● Perform nursing history taking
● Perform physical assessment
● Review records
● Pre-consultation lecture
●
●
●
●
●
●
FAMILY AND COMMUNITY HEALTH NURSING
CONSULTATION PHASE
● Assist client to consultation room
● Work with physician
● Comfort and safety of client throughout the
procedure
● Confidentiality of results
● Carry out physician’s orders
POST-CONSULTATION PHASE
● Explain physician’s orders and advice
● Give health teaching and counseling
● Refer to other agency
● Schedule next visit
●
●
●
Consider all articles belonging to the family as
contaminated - place a lining below the bag
The outside of the lining is considered as
contaminated, therefore touch the outer
portion because the inside portion is
considered sterile
Save time and effort of nurse
Effectiveness of care: not overshadow
Performed in variety of ways: do not spread
infection
-
FAMILY HEALTH
FAMILY NURSING
FAMILY HEALTH
CARE NURSING
Health status of a
given family at a
given
point in
time
Philosophy
and
way of interacting
with families
Process
of
providing for the
healthcare needs
of families that are
within the scope
of nursing
4 CONCEPTS OF FAMILY/ APPROACHES TO FAMILY
NURSING
HOME VISIT
Professional face-to-face contact made by the
nurse to a patient of the family
The nurse initiates the care
Resources are limited
Personalized but time-consuming
To provide necessary healthcare activities
To further attain an objective of the agency
CHARAC
TERISTIC
F. AS A
CONTEXT/
FAMILY-CENT
ERED/
FAMILY-FOC
USED
Focus
of Care
Individual
members
F. AS A
CLIENT/
UNIT/
FAMILY
GROUP
Family
PHASES OF HOME VISIT
Initiation - Assessment
Pre-visit - Planning
In-home - Implementation
Termination/Summarization - Implementation
Post-visit - Evaluation
BAG TECHNIQUE
● is commonly utilized during home visit
● Equipment: Public Health bag
Principles:
● Minimize and prevent spread of infection
Handwashing
Start with a well member towards the sick
member
F. AS A
COMPONE
NT OF
SOCIETY
Individual
members
and
family
Family as
on of the
institution
s in the
society
How the
individual
interact
with one
another
PRINCIPLES IN PLANNING FOR A HOME VISIT
● Have a purpose or objective
● Make use of all available information
● Focus on essential needs of the Individual and
family but prioritize needs recognized by the family
● Should involve the individual and family
● Flexible and practical
●
●
●
●
●
F. AS A
SYSTEM
Resourc
es
of
care
●
●
●
●
●
●
●
●
Family
Individual
members
Interactio
n
How can
the
resources
of
the
communit
y
contribute
towards
the health
concern of
the family
Other
institution
s
GENERAL FUNCTIONS OF FAMILY
Physical maintenance
Socialization of family members
Allocation of resources
Maintenance of order
Division of labor
Reproduction, recruitment and release of members
Placement of members into the larger society
Maintenance of motivation and morale
CRUZ, DCR | BATCH 2022 | 13
●
●
●
●
●
●
●
●
●
9 AREAS OF FAMILY ASSESSMENT
Physical independence
Therapeutic competence
Knowledge of health condition
Application of principles of general hygiene
Health attitude
Emotional competence
Family living
Physical environment
Use of community resources
●
●
TYPES OF PROBLEMS IN THE COMMUNITY
FAMILY
COMMUNITY
●
Wellness condition
E.g. Breastfeeding
-
●
Health Status
Morbidity, mortality
or fertility
●
Health deficit
Actual problem
-
●
Health Resources
Manpower,
facilities,
financial/budget
●
●
Health
Threat
predisposes the family
E.g. Family living
near the river
●
Health Related
Political,
environmental
social
Has the highest weight: 2
MODIFIABILITY
SCORE
EASILY MODIFIABLE
2
PARTIALLY MODIFIABLE
1
NOT MODIFIABLE
0
●
Foreseeable Crisis or
Stress
increases
demand
E.g. Death of a
family member
PREVENTIVE POTENTIAL
Nature and magnitude of future problems that can
be minimized or totally prevented if intervention is
done. This is affected by:
Seriousness of the existing problem
Duration of the existing problems
Measures that have been implemented
Probability
POTENTIAL
SCORE
HIGH
3
MODERATE
2
LOW
1
SALIENCE
SCORE
SERIOUS PROBLEM
IMMEDIATE CONCERN
2
1
0
●
Highest score is 5
●
Scoring - the higher the score the higher the
priority
NOT CONSIDERED AS A
PROBLEM
NATURE OF THE PROBLEM
Based on the type of family problem (wellness
condition, health deficit, health threat, foreseeable
crisis)
SCORE
WELLNESS
3
HEALTH DEFICIT
3
HEALTH THREAT
2
CRISIS
1
WEIGHT
1
𝑆𝑐𝑜𝑟𝑒 𝑜𝑓 𝑐𝑟𝑖𝑡𝑒𝑟𝑖𝑎
ℎ𝑖𝑔ℎ𝑒𝑠𝑡 𝑠𝑐𝑜𝑟𝑒 𝑜𝑓 𝑡ℎ𝑒 𝑐𝑟𝑖𝑡𝑒𝑟𝑖𝑎
●
1
× 𝑤𝑒𝑖𝑔ℎ𝑡
COMMUNITY PROBLEM PRIORITIZATION
Highest score is 10
NATURE OF THE PROBLEM
-
MODIFIABILITY
The probability of success in eliminating or
reducing the problem by nursing interventions.
This is affected by:
Available technology
Resources of the family
Resources of the nurse
Resources of the community
WEIGHT
SCORING FORMULA
NATURE
1
●
WEIGHT
SALIENCE
Family’s perception of the problem and evaluation
of the condition or the problem in terms of
seriousness and urgency of attention needed
PROBLEM NOT NEEDING
URGENT ATTENTION
NATURE
2
or
CRITERIA FOR PRIORITIZING FAMILY PROBLEMS
●
WEIGHT
SCORE
HEALTH STATUS
Increased
or
decreased morbidity,
mortality, fertility
3
HEALTH DEFICIT
Manpo
wer,
money,
materials,
institutions
3
HEALTH THREAT
Social,
economic,
environmental,
political factors
2
CRUZ, DCR | BATCH 2022 | 14
WEIGHT
1
MAGNITUDE OF THE PROBLEM
MAGNITUDE
SCORE
75-100% AFFECTED
4
50-74% AFFECTED
3
●
WEIGHT
DEPARTMENT OF HEALTH PROGRAMS
Also known as Public Health Programs
It addresses public health concerns
Implemented by the LGUs
Created by DOH
MATERNAL HEALTH PROGRAM
3
25-49% AFFECTED
2
<25% AFFECTED
1
SCORE
HIGH
3
MODERATE
2
LOW
1
NOT MODIFIABLE
0
WEIGHT
PREVENTIVE POTENTIAL
SCORE
HIGH
3
MODERATE
2
LOW
1
●
The right to health: every woman has a right to safe
pregnancy and childbirth
Crafted based on the maternal mortality ratio
Based on the 2015 data, the maternal mortality
ratio is 114:100,000
CAUSES OF MATERNAL DEATH
● Unsafe abortion - 14%
● Severe bleeding - 21%
● Infection - 8%
● Eclampsia - 13%
● Obstructed labor - 11%
● Other direct causes - 11%
● Indirect causes - 25%
4
POTENTIAL
“Ligtas Buntis, Ligats Pagbubuntis”
●
MODIFIABILITY
MODIFIABILITY
●
WEIGHT
THREE DELAYS MODEL
1
SOCIAL CONCERN
●
●
●
●
CONCERN
SCORE
URGENT COMMUNITY
CONCERN
2
A PROBLEM, NOT
NEEDING URGENT
ATTENTION
1
NOT A COMMUNITY
CONCERN
0
WEIGHT
1
PARADIGM SHIFT
EVALUATION OF NURSING CARE
Effectiveness
Attainment of the objectives
Efficiency
Relates to cost, time and resources
Appropriateness
The ability of the intervention to solve the
problem
E.g.
Feeding
program
to
address
undernutrition
Adequacy
Looking at the number of interventions to
solve the problem
E.g. Feeding program may not be adequate to
solve undernutrition
PARADIGM SHIFT
Risk Approach → Identifies high risk pregnancies; For referral
during the prenatal period; treatment; encourage them to
deliver in a healthcare facility
↓
EmOC Approach → considers all pregnant women to be at risk
of complications at childbirth; preventive
BASIC EMERGENCY OBSTETRIC AND NEWBORN
CARE (BEMONC) SERVICES
● Administer Parenteral Antibiotics
● Parenteral Uterotonic drugs (oxytocin) to prevent or
treat postpartum hemorrhage
● Parenteral Anticonvulsants for pre-eclampsia and
eclampsia (e.g. MgSO4)
● Manual Removal of Placenta
● Removal of retained placental products (vacuum or
DNC)
CRUZ, DCR | BATCH 2022 | 15
●
●
Performed
assisted
Vaginal
Delivery
(vacuum/forceps)
Performed basic neonatal resuscitation with
bag/mask
Performs vaginal delivery by midwife, but
there’s an on-call physician
COMPREHENSIVE EMERGENCY OBSTETRIC AND
NEWBORN CARE (CEMONC) SERVICES
● 7 Functions of BEMONC Facility plus
Perform surgery (CS or Hysterectomy)
Give safe blood transfusion
● There must be 5 EmOC facilities (at least 1 CEmoc)
for every 500,000 population (WHO)
DOMICILIARY
OBSTETRICAL
SERVICE:
QUALIFICATIONS
● Full term
● Not a primigravida, with less than 5 pregnancies
● Without coexisting disease
● No history of complications/ abnormalities in
present and previous pregnancies and deliveries
● Imminent delivery
●
●
●
●
●
●
BIRTH PLAN
A birth plan is a document prepared during the
prenatal care which states the woman’s conditions
during pregnancy
Also check whether a mother is a Philhealth
member
Usually part of the mother baby book
Her preferences for her place of delivery
Includes materials to be prepared for the
mother and baby during the 3rd trimester
Choice of birth attendant
Her available resources for her childbirth and
newborn baby
The preparation needed should an emergency
situation arise during pregnancy, childbirth and
postpartum
As a nurse, it is our role to prepare the mother for
childbirth
CMMNC FRAMEWORK
●
Community Managed Maternal and Newborn
Care Framework
●
Availability of maternal and child health services
Skilled birth attendant
Facilities
Supplies/ equipments
Policies/ standards
EMOC
Communication and mobilization
Birth plan
Philhealth
Funding support
Provide care and support
Partners/ spouse
Family members
●
●
Established strengthened referral systems
In case they encounter an emergency during
deliver (e.g. bleeding), they can refer the
mother to a tertiary hospital (may be public or
private)
● Transportation Communication
Stakeholders, barangay officials, LCEs, NGOs
Some barangay owns a vehicle or ambulance
to assist mothers in transportation
PERINATAL CARE
PRENATAL/ ANTENATAL VISITS
● Home-based mother’s record
● Encourage all women to deliver in the health
facility
At Least minimum of 4 pre-natal visits
Mothers are encouraged to deliver in a healthy
facility
If the mother do not have at least 4 pre-natal
visits, they are requiring the mother to delivery
in a hospital
●
NO. OF VISITS
WHO/ UNICEF/
DOH CPG 2005/
2006
PHN 2007 BOOK
FIRST
Before the 4th
month
1st trimester
SECOND
Between 6th - 7th
month
2nd trimester
THIRD
8th month
3rd trimester
FOURTH
9th month
After 8th month;
every 2 weeks
IDEAL PRENATAL CHECK UP
AOG
INTERVAL
NO. OF VISIT
1st 28 weeks
Every 4 weeks
7 visits
28-36 weeks
Every 2 weeks
4 visits
36-40 weeks
Every week
4 visits
ASSESSMENT DURING PREGNANCY
● History taking
● Weight and height
Check for normal weight gain
If the mother is less than 149cm, the mother is
considered as high risk
● Vital signs
Check for pre-eclampsia
● Physical examination
Check for the presence of edema: normal
during the 3rd trimester but NOT on the 1st or
2nd trimester
LABORATORY EXAMINATIONS
● Glucose screening 24-28 weeks if (+) DM history,
obese, recurrent vaginal infections, history of
unexplained fetal death, large fetus
CRUZ, DCR | BATCH 2022 | 16
●
Urinalysis
Benedict’s test
o Test for sugar in the urine; test for
diabetes
o Heat the test tube with 5cc of Benedict’s
Solution (blue) in the burner then add
3-5gtts of urine (amber yellow) then heat
again. Observe for change in color
COLOR
INTERPRETATION
BLUE
(-) sugar in urine
GREEN
Trace of sugar in
urine
+1 | +
Traces of sugar in
urine
+2 | ++
ORANGE
More traces of
sugar in urine
+3 | +++
BRICK RED
Surely diabetic
+4 | ++++
YELLOW
-
-
RESULT
But in the board exam, they still utilize the 3%
in determining the amount of vial to be
requested for children
Choose the nearest option
DOSE
SCHEDULE
DURATION OF
PROTECTION
%
PROTECTION
OF THE
MOTHER
1ST
Anytime
At any point
Immed
iate
2ND
After 1 month
3 years
80%
3RD
After 6
months
5 years
95%
4TH
After 1 year
10 years
99%
5TH
After 1
year
Lifetime
99%
MICRONUTRIENT SUPPLEMENTATION
-
Acetic Acid test
o Test for albumin in urine; test for
pregnancy induced HPN
o Collect urine in a test tube, heat it in a
burner then add 3-5gttsof acetic solution
(clear white). Observe for change in color
o If it remains clea: (-) CHON or albumin in
urine
o If it turns cloudy: (+) CHON = proteinuria
TETANUS TOXOID DIPHTHERIA IMMUNIZATION
● Protects the mother and baby against tetanus
Mothers: Artificial Active
Fetus: Natural Active
● Fully Immunized Mother (FIM) - 5 TT (doses)
Should be given during 2nd trimester of
pregnancy because studies show may have
teratogenic effect if given on the 1st trimester
After 1st dose, there is an immediate
protection to the mother
After giving 2 doses, the baby is already
protected
● 3 doses of DPT = 2 doses of TT
Nowadays, tetanus toxoid is usually given with
diptheria
● Given through IM injection at the deltoid
Ask the dominant hand of the mother, and
administer it to the nondominant hand.
Educate the mother about the side effects
such as local tenderness.
Apply cold compress
Do not massage the site of injection
● For determining the amount of TT to be requested:
3.5% of the (catchment) population
Based on the recent DOH, they lower it to 3%
for mothers and 2.7% for children
IRON SUPPLEMENTATION
TARGETS
PREPARATIONS
PREGNANT
MOTHERS
●
LACTATING
WOMEN
●
●
●
●
DOSE/ DURATION
Tab
containing
60mg El with
400mcg
Folic
Acid
●
Tab
containing
60mg El with
400mcg
Folic
acid
●
●
●
1 tab 1x/day for
6 months or
2 tabs/day if
2nd or 3rd
trimester
1 tab 1x/day for
3 months or
90 days
Iron Deficiency - can cause neural tube defects
Anemia - presence of pallor, N= 11g/dl
Instruct mother how to take Ferrous Sulfate and its
side effects
Best taken with Vitamin C rich foods for better
absorption
Preferably taken before meals, but sometimes
causes gastric upset. Therefore, advised to be
taken after meals
Side effects: discoloration of stools, metallic
taste
Advice mother to take iron rich foods:
green-leafy vegetables, red meat products
VITAMIN A SUPPLEMENTATION
TARGETS
PREPARATIONS
DOSE/ DURATION
PREGNANT
MOTHERS
●
10,000 IU
●
1
cap/tab
2x/wk
(4th
month until
delivery)
POSTPARTUM
WOMEN
●
200,000 IU
●
1
cap
(within
CRUZ, DCR | BATCH 2022 | 17
1x
4
weeks
after
delivery)
●
●
●
●
●
●
●
Vitamin A Deficiency - can cause congenital
problems
Do not give Vitamin A if woman is taking
multivitamins
E.g. Clusivol OB
Best source of Vitamin A
Plant sources (yellow fruits and vegetables)
Carotene
Animal Sources: retinol
Given during the 2nd trimester because it is
teratogenic during the 1st trimester
10,000 IU - yellowish
100,000 IU - blue
200,000 IU - red
CHILDREN OF
SCHOOL AGE
●
WOMEN
5-45YRS OLD
●
ADULT MALES
●
●
●
PREPARATIONS
●
●
●
●
●
●
IODINE SUPPLEMENTATION
TARGETS
POSTPARTUM CARE
● Breast
● Uterus- if contracting
● Bowel
● Bladder
● Lochia
Rubra, serosa, alba
● Episiotomy
● Skin
● Homan’s Sign
● Emotions
DOSE/ DURATION
Iodized
oil
capsule
with
200mg iodine
●
Iodized
oil
capsule
with
200mg iodine
●
Iodized
oil
capsule
with
200mg iodine
●
1 cap for 1yr
●
●
1 cap for 1 yr
1 cap for 1 yr
Iodine deficiency - can cause congenital
hypothyroidism or cretinism
Usually given to mothers in far flank areas (such as
mountains) which are iodine sources are limited
Sources: seafoods
Avoid foods that inhibit the absorption of
iodine: root crops (broccoli, cauliflower)
Advise to use iodized salt
POSTNATAL VISITS
NO. OF VISITS
WHO/ UNICEF/
DOH CPG 2005/
2006
PHN 2007 BOOK
FIRST
First 24 to 48
hours after
delivery
Within 3 to 5 days
SECOND
6 weeks after
delivery
6 weeks after
delivery
If the mother delivered in a lying-in clinic, the
mother will visit the health center after 3 to 5 days
● If the mother delivered at home, the nurse will visit
the mother at home after 24hrs of delivery, to
check for postpartum hemorrhage
● 6 weeks - expect the uterus will return to its
prenatal state
FAMILY PLANNING
To ensure quality of life
Usually done before pregnancy
We do NOT impose what kind of family planning
they are going to acquire, but we only educate
them about all the options
Decisions should be taken by both marital partners
Only if the parents have sincere inner motivation
for FP may they persist with it.
Health workers cannot assume that their clients
hold the same attitude toward FP
When a couple expresses hostility toward FP it is
both wrong to and useless for health worker to
insist on it
FOUR PILLARS
● Responsible Parenthood
No. of child desired by the parents as long as
they can provide
● Child Spacing
At Least 3 to 5 years interval
● Respect for Life
● Informed Choice
●
RA 6365
POPCOM
-
National
Policy
on
Population,
●
PD 69 - Limit to 4 children for Tax Exemption
●
LOI 47 - Schools to Integrate Family Planning
●
PD 965 - Family Planning before Marriage
License
FAMILY PLANNING PRIORITIES
● Couples in the reproductive age: 20 to 44 years
Based on WHO. the reproductive age is 16-49
years old
● 3 or more children
● Close interval pregnancies
● (+) Chronic Disease
CONCEPT OF FAMILY PLANNING
● Decision should be taken by both marital partners
● Only if the parents have sincere inner motivation
for FP may persist with it
● Health workers cannot assume that their clients
hold the same attitudes toward FP
CRUZ, DCR | BATCH 2022 | 18
●
When a couple expressed hostility towards FP, it is
both wrong to and useless for health worker to
insist on it
FP COUNSELING (GATHER)
● Greet warmly and politely
● Ask about him/herself
● Tell health center and the services provided
● Help make the decision that is best for him/her
● Explain relevant information abou the sx, dx, tx
● Return schedule a return visit
ROLES OF THE NURSE IN FAMILY PLANNING
● Provide counseling to increase number of
acceptors
● Provide packages of health services among the
reproductive age group
● Ensure availability of FP supplies and logistics to
clients
SAMPLE SCENARIO
If the mother forgot to drink her pills yesterday and
remember it today. How many pills will she take today?
Take only one pill and do a follow up check
FORMULA
No. of pills to be requested = 3.5% of the population x
28 days
●
●
EARLY CHILDHOOD CARE AND DEVELOPMENT
(ECCD) PROGRAMS
Previous names: Under 5 clinic programs,
Well-baby clinic programs
Services are expanded therefore there’s a
change in the name
RA 8980 Early Childhood Care and Development
(ECCD)
-
Refers to the full range of health, nutrition,
early education, and social services programs
that provide for basic holistic needs of young
children from birth to 6 years of age, to
promote
their
optimum
growth
and
development
CENTER-BASED PROGRAMS
● Facility-based programs
● Day Care Service (RA 6972)
Age 3 years old staying for 1 to 2 hours
● Public and Private Pre-schools
● Kindergarten
● Community or school-based early childhood
● Child-minding Centers
Not available in the country
● Health Centers and Stations
HOME-BASED PROGRAMS
● Neighborhood-based Play groups
● Family Day Care Programs
● Parent Education
● Home Visiting Programs
AGE
NO. OF VISITS
0 - 11 months
Every month
12 - 23 months
Every 2 months
24 - 35 months (3rd yr)
Every 3 months
36 - 47 months (4th yr)
Every 6 months
48 - 59 months (5th yr)
Once a year
ECCD Card
Include core developmental milestones they
must manifest according to age
This is usually required during the first day of
classes
● Growth Chart
Normal growth should be within the normal
range
ESSENTIAL NEWBORN CARE OR THE UNANG YAKAP
●
●
DOH Administrative Order 2009-0025
●
●
●
Safe motherhood month: May
EINC includes the intrapartal care
Yakap ng buhay, Yakap ng Pagmamahal
FOUR CORE STEPS IN ESSENTIAL NEWBORN CARE
(ENC)
● Immediate and thorough drying to prevent
hypothermia
Two towels are prepared. One linen is for
drying and the other is to cover the child when
they are in the mother’s abdomen
● Early skin-to-skin contact to reduce infection and
hypoglycemia
Mother contains natural flora
● Properly timed cord clamping to prevent
intraventricular hemorrhage
We wait for the pulsations to stop before
cutting
● Non-separation of the newborn and mother for
early initiation of breastfeeding
NEWBORN SCREENING
●
RA 9288 Newborn Screening Act of 2004
●
Detect congenital metabolic disorder that may
lead to mental retardation, physical disability,
motor impairment or even death if left untreated
The blood specimen is acquired from the heel of
the child by a nurse, midwife, medtech or
physician, regardless whether the mother delivered
at home or in a health facility
●
CRUZ, DCR | BATCH 2022 | 19
●
28 Disorders in the NBS Package (Screened)
-
-
-
From 5 to 6 to 28 disorders: the 28 disorders is
called the Expanded Newborn Screening
Test
Screened:
o Congenital Hypothyroidism (CH)
o Congenital adrenal hyperplasia (CAH)
o Galactosemia (GAL)
o Phenylketonuria (PKU)
o G6PD Deficiency
o Maple syrup urine disease (MSUD)
Current 6:
o Cystic fibrosis
o Biotinidase disease
o Organic acid disorders
o Fatty acid oxidation disorders
o Amino acid disorders
o Urea cycle disorders
o Urea cycle disorders
o Hemoglobin
●
Ask the mother to sign a waiver if the mother do
not consent for newborn screening
NEWBORN SCREENING
● 24hr at least
● Trained MD, RN, midwife, medical technologist
● Using heel prick method
A few drops of blood are taken from the baby’s
heel
● Blotted on a special absorbent filter card
● Blood is dried for 4hrs and sent to the NBS center
● After 7 working days, parents claim the result from
their physician, nurse, midwife, or health worker
● If positive (+) screen:
Released within 24hrs for confirmatory testing
Referred
to
a
specialist
for
further
management
UNIVERSAL
PROGRAM
NEWBORN
HEARING
SCREENING
●
RA 9709: Universal Newborn Hearing Screening
and Intervention Act of 2009
1500 pesos
●
50 pesos
50 pesos
●
TOTAL
600 pesos
1550 pesos
COST PER
DISORDER
TESTED
100 pesos x 6
55 pesos x 28
TOTAL
600 pesos
1550 pesos
Early detection of congenital hearing loss and
referral for early intervention for infant
Newborn Hearing Screening Reference Center at
the National Institutes of Health
On any healthcare practitioner who delivers, or
assists in the delivery of a baby in the Philippines
the obligation to inform the parents or legal
guardian of the newborn of the availability, nature
and benefits of hearing loss screening among
newborns or infants 3 months old and below
PHILHEALTH
MEMBER
FREE
950 pesos
BASIC
EXPANDED
PRICE
550 pesos
FACILITY
COLLECTION FEE
●
RARE DISEASE PROGRAM
●
ROLES OF RHU STAFF IN NBS
● Advocacy for NBS for every baby. This starts during
pregnancy.
The family is advised to save Php 550
● Collection of samples by a trained healthcare
professional (MD, RN, midwife, medtech) within at
least 24 hours after birth when the mother has
initiated breastfeeding
● Assures transport of specimen within 24hrs
following collection of the sample
Dry the card for 4 hours before transport
Initial results will be released within 7 days
● Advice and counsel parents upon receiving the
screening results
Monitor the child in case the child tested
positive in any of the disorders
If the result tested positive, we conduct a
confirmatory test.
Then if it remains positive, we refer the child to
a specialist
● It is the option of the parents to avail basic or
expanded newborn screening test
RA 10747:
Philippines
●
●
●
Rare
Diseases
Act
of
the
An act promulgating a comprehensive policy
in addressing the needs of the person with
Rare Disease
RA 7277: Magna Carta for Disabled Persons
Under the law, the patients with rare diseases
will be considered as persons with disabilities.
With this, they will also enjoy the rights and
benefits of persons with disabilities (PWDs)
Undergo clinical trials - with consent
As a nurse, we can inform them about the available
resources provided for Rare Disease (e.g. support
groups, NGOs
A Healthcare System for Rare
Department of Health (DOH) together with
the National Institutes of Health (NIH-UP
Manila) shall create a system for the
identification, management and registration
of persons with rare disease
Under this system, all rare disease patients
shall:
o Be referred to a Regional Newborn
Screening Continuity Clinic (NSCC)
-
●
The
CRUZ, DCR | BATCH 2022 | 20
Be included in the National Rare Disease
Registry, a secured health information
system on the data on rare diseases,
persons with rare diseases, orphan drugs
and products.
o Have better access to a support system
through the Rare Disease Management
Program, a comprehensive program that
encompasses
diagnosis,
clinical
management, genetic counseling, and
drug research development.
The RDTWG
The DOH shall organized the Rare Disease
Technical Working Group for the identification
of rare diseases, orphan drugs and orphan
products
Reporting to the Registry
Healthcare institutions and practitioners are
required to report diagnosed cases and the
status of patients to the Rare Disease registry.
A Practitioner's Responsibility
Healthcare practitioner attending to a person
with a rare disease as the responsibility of
informing patients and their families of
available resources and the nearest available
specialist
Continuing Education and Training Programs
The DOH, together with the NIH, professional
societies and academic institutions shall
conduct continuing education, information
and
training
programs
for
healthcare
practitioners on the identification, referral, and
medical management of persons with rare
disease.
Public Education and Information Campaign
The act recognizes the importance of a
"culturally-sensitive public education and
information campaign" on the nature of rare
disease in helping the public understand the
special needs of persons afflicted with rare
diseases, as well as their right against ridicule
and discrimination. Such campaign would
involve
participation
of
concerned
government agencies, professional societies
and non-government organization
o
●
●
●
●
●
BREASTFEEDING PROGRAM
ADVANTAGES OF BREASTFEEDING
● Mother
Oxytocin help the uterus contracts
Uterine involution
Reduce incidence of breast cancer
Promote maternal-infant bonding
Form of Family planning method (LAM)
● Baby
Provides antibodies which contains IgA
Contains Lactoferrin (binds with iron)
Leukocytes
-
Contains bifidus factors that promotes growth
of the lactobacillus which inhibits the growth
of pathogenic pacilli
LAWS FOR BREASTFEEDING
●
RA 7600: Rooming-In and Breastfeeding Act of
1992,
-
●
EO 51: Milk Code
-
●
Breastfeeding Week: August 1-7
As a healthcare professional, we are prohibited
from promoting formula milk
RA 10028: Expanded Breastfeeding Promotion
Act
-
Lactation stations
There must be a refrigerator for milk storage
●
AO 2006-0012: Revised Implementing rules and
regulations in the EO 51
●
AO 2005-0014: National Policies on Infant and
Young Child Feeding
BREASTFEEDING PRACTICE
● Exclusive breastfeeding (for the first 6 months)
Allows to receive ORS, drops, vitamins,
medicines
● Predominant breastfeeding
H2O, fruit juice, ORS, vitamins, medicines
● Complementary feeding
Foods and liquids with breast milk
● Bottle feeding
Food or drink (including breast milk) from a
bottle
● Early initiation of breastfeeding
After birth within first 90 minutes of life
● 1st trimester
Discomfort of pregnancy
● 2nd trimester
Accept pregnancy and baby
● 3rd trimester
Birth preparation (labor and delivery)
POSITION FOR BREASTFEEDING
● Cradle Hold
For mothers who delivered NSD
● Football Hold
For SGA baby, twins
● Side-lying position
Usually utilized by CS section mothers
● Kangaroo position
TECHNIQUE FOR BREASTFEEDING
● The mother hold her breast in C-hold
To anchor the breast
Stimulate the baby’s rooting reflex
CRUZ, DCR | BATCH 2022 | 21
Clean the breast with saline or water., not with
alcohol, betadine or soap because it causes
dryness
How to get baby to latch on
Stimulate the baby’s rooting reflex
When the baby’s mouth opens wide, put the
nipple and as much of the areola as possible
into his mouth
How to make baby let go of the breast without
hurting the mother
Press down on the breast near his mouth
Pull down on his chin and insert a small finger
in the corner of his mouth. This will break his
seal on the nipple
Then remove him from the breast
Signs that the baby has latched on properly to
the breast
The baby’s mouth is wide open
Much of the mother’s areola is inside the
baby’s mouth
The mother does not feel nipple pain
o When in pain, withhold feeding on the
affected side. The mother may apply
warm compress on the affected side
For inverted nipples, we encourage the
mother to do nipple stretching or nipple
rolling exercise
The baby and the mother are in tummy to
tummy position
The baby is relaxed and happy
-
●
●
●
BREASTFEEDING CAMPAIGN
● Storage of breast milk
At room temperature (8hrs), ref (24hrs), frozen
(1 month)
● Galactogen
Foods that increases the production of
breastmilk
Whole grains, especially oatmeal, dark, leafy
greens (alfalfa, kale, spinach, broccoli), garlic,
chickpeas, nuts and seeds, especially almonds,
ginger, papaya.
● Breastfeeding should be fed on demand at least
8x/day
Baby can be fed more than 8x/day
● Diet during lactation:(+) 550 calories, high CHON,
high calcium, sufficient fluids
●
●
●
●
NATIONAL IMMUNIZATION PROGRAM (NIP) 2016
Old name: Expanded Program on Immunization
Launched by DOH, WHO & UNICEF last July 1976
Objective: To reduce morbidity and mortality
among infant and children caused by childhood
immunizable diseases
DOH mandated to allot Wednesday as an
Immunization day “Bakuna Wednesday”
NATURAL
ACTIVE
●
●
Exposure
Carrier
ARTIFICIAL
●
Antigens
●
Sick of
disease
the
-
-
PASSIVE
●
●
●
●
●
●
●
December 30, 1994
Hepa B immunization
RA 10152 (2011)
Mandatory Infants
Immunization Act
and
Children
PP 46
-
●
Sept. 16, 1976
Compulsory basic immunization for infant and
children below 8y/o
RA 7846
-
●
●
Gamma globulin
(6months-1yr)
antitoxin/
antiserum/
serum
PD No. 996
●
●
Active immunity
Xxposed to an antigen (bacteria, virus, fungi)
the body will develop antibodies
Provides long term protection
Passive immunity
The
body
developed
antibodies
(immunoglobulin, antitoxin)
Provides short term protection
Natural
Person acquired immunity through natural
means
Artificial:
Inoculate the antigen or antibodies coming
from another individual or animal
Natural active: e.g. carrier
Natural passive: e.g. breastfeeding, through
placenta
Artificial active: e.g. COVID-19, tetanus toxoid,
measles
Artificial passive: e.g. got bitten by a dog and
went to a bite center to acquire anti-rabies
shot
-
●
Breast
milk
(IgA)
Placenta (IgG)
Attenuated
(BCG, OPV, AMV,
Rotavirus)
Killed (P, HBV)
Weakened toxins
(TT,DPT)
Polio eradication
PP No. 6
-
April 3, 1996
UN Universal Child Immunization
7 PRIORITY AREAS
● Diet and Exercise
● Environmental health
● Vaccines and immunizations
CRUZ, DCR | BATCH 2022 | 22
Health
●
●
●
●
Substance use
Sexual and reproductive health
Mental health
Violence and injury prevention
PROGRAM GOALS
● Targets at least 95% of eligible child within the
catchment area are immunized before 1 year old
Eligibility qualifications: 1 year old and below;
children below 5 years old are susceptible in
communicable
diseases
because
they
immature organs
Fully Immunized Child (FIC): received all before
1y/o
Completely Immunized Child (CIC): all after
1y/o
● Maintenance of polio eradication
● Elimination of measles
● Elimination of maternal and neonatal tetanus
● Control of diphtheria, pertussis, hepatitis B
infection, TB meningitis and other disseminated
forms of TB
NOT CONTRAINDICATIONS
● Fever up to 38.5 degree Celsius
● Simple or mild acute respiratory infection
● Simple diarrhea without dehydration
● Malnutrition (it is indication for immunization)
ROUTINE IMMUNIZATION FOR CHILDREN
●
-
-
PRINCIPLES OF EPI
● Epidemiological situation - schedules are drawn on
the basis of occurrence and characteristic feature of
the disease
● Mass approach
● Integrated to the health services of the unit
ELEMENTS OF THE EPI
● Target setting - all children before 1 y/o
● Cold chain logistics
● IEC: Information, Education and Communication
● Assessment and evaluation of the program overall
performance
● Surveillance, studies and research
All vaccines are investigated by HTA (health
technology assessment) of DOH to ensure
safety and effective
-
-
-
●
-
●
0 t 11 months or 0 to 1 yr
Anytime after birth
0.5ml ID, right upper deltoid
o Subcutaneous abscess will form if
injected via subcutaneous: treated with
incision and drainage + local INH. Expect
the child to develop a fever. Advise the
mother to give antipyretics every 4 to 6
hours; Antibiotics may be prescribed
o Indolent ulcer: does not health within 12
weeks; secondary bacterial infection;
treated with local INH
Freeze dried then reconstituted with diluent
Once diluted, it must be consumed within 4 to
6 hours. Discard the remaining medication if
not consumed.
Clean the site with saline
o DO NOT apply alcohol to the site of
injection
A formation of a wheal for 30mins to 1 hour
and will cause an inflammatory reaction for 2
weeks
Apply warm compress on the site of injection
DO NOT expose BCG to sunlight
Expected side effects: local inflammatory
reaction/ superficial abscess/ ulcer 2 to 12
weeks after immunization (permanent scar)
If no side effect: repeat BCG after 2 months
Hepa B
-
SUPPLEMENTARY IMMUNIZATION ACTIVITIES (SIAs)
● Catch-up or speed-up campaigns for the new
vaccine to rapidly increase immunity in older age
groups that are outside of the immunization
schedule
● Intended to reduce o interrupt transmission of the
targeted disease with the goal of elimination or
eradication
CONTRAINDICATIONS
● History of seizures/ convulsions - for DPT 1
If the child develops convulsions once, 3 days
after immunizations, administer DNT. If more
than 3 days, it's a sign of neurological
problems, DO NOT Administer the remaining
dose of DPT
● Clinical AIDS - Infant BCG
● Immunosuppression
DO NOT give any live attenuated vaccines
Infant BCG “Bacille-Calmette-Guerin”
1 dose
2 types: plasma derived and recombinant
hepa b surface antigen
Target age: birth (health facility delivery within
2hrs), (home delivery - no more than 7 days)
0.5ml IM, vastus lateralis (upper outer thigh)
Side effect: local tenderness - apply cold
compress
If the mother delivered at home, the mother is
asked to bring the child to the health center
within 7 days of delivery
Doesn’t need dilution
Pentavalent
-
3 doses, 4 weeks or 1 month interval
Target age: 6, 10, 14 weeks
0.5ml IM, vastus lateralis
Reduces chance of acquiring pneumonia,
meningitis
CRUZ, DCR | BATCH 2022 | 23
-
Tetanus-diphtheria booster dose at grade 1
and grade 7
OPV
Killed viruses
Oral (mucosal immunity)
When a child receives
OPV, the vaccine virus
enters the child's mouth
and gut and replicates.
The child then mounts
immune responses in
three places: (1) antibody
response in the blood
that protects against the
virus
invading
the
nervous
system
and
causing paralysis, (2)
immune response in the
mouth which prevents
shedding of virus in oral
secretions and spread
from those secretions
and
(3)
intestinal
immunity (also called
gut
or
mucosal
immunity),
which
prevents shedding of the
virus in the stool
IM (serum immunity)
3 doses (6, 10, 14 weeks)
1 dose (14 weeks)
2 doses (14 weeks and 9
months) in some regions
-
from
-
-
-
●
Individual immunity
-
Swelling, fever
NPO for 30 mins after
administration
If the child vomits within
30 mins, a single drop is
repeatedly given.
Apply warm compress
Do not massage
Give antipyretics
Very low risk for vaccine
associated
paralytic
poliomyelitis
(VAPPs)
or
Circulating vaccine-derived
polioviruses (cVDPVs)
No risk for VAPPs or cVDPVs
9 to 11 months
o In case an epidemic of measles, we
administer it during 6 months
o The child still has maternal antibodies
that lasts for 6 to 9 months
0.5ml, subcutaneous, bevel down, any arm
(outer part of the upper arm)
Fever and measles rash lasting for 1 to 3 days
within 2 weeks after immunization (modified
measles)
Vitamin A is given with Measles: 100,000 IU
o Vitamin A enhanced the antibody
response to measles vaccine given at 9
months of age significantly, especially in
boys. The effects were sustained over
time; the children who had received
vitamin A with their measles vaccine were
more protected against measles at 6-8
years of age.
At least 85% can be prevented by
immunization at this age
Freeze dried then reconstituted with diluent
water
Measles Mumps, Rubella (MMR)
-
Side effects: none
●
Attenuated Measles Vaccine (AMV)
IPV
Live, weakened viruses
Assess
immunity
person-to-person
●
12 to 15 months
0.5ml, SC, any arm (outer part of the upper
arm)
Vitamin A is given with MMR: 200,000IU
Freeze dried then reconstituted with diluent
water
MR booster dose at Grade 1 and 7
Side effects: Fever and measles rash within 2
weeks after immunization lasting for 1 to 3
days
ANTIGEN
AGE
DOSE
SIDE EFFECTS
BCG
At birth
0.05m
ID
Right
deltoid
Local
inflammation
Scar
fever
HEPA B
At birth
0.5ml
IM
Vastus
lateralis
Local tenderness
PENTA
6, 10, 14wks
0.5ml
IM
Vastus
lateralis
Local tenderness
OPV
6, 10, 14wks
2gtts
Oral
None
IPV
14 wks
0.5ml
IM
Vastus
lateralis
Local tenderness
Fever
Not given to children with
allergy
to
streptomycin,
neomycin or polymyxin B
(inactive components of IPV)
Pneumococcal Conjugate Vaccine (PCV)
-
3 doses (6, 10, 14 weeks)
0.5ml via IM
Protects children from meningitis
Healthy children aged 2-5 y/o maybe given 1
dose of PCV 13 or 2 doses of PCV 10 at least 8
weeks apart
CRUZ, DCR | BATCH 2022 | 24
PCV
6, 10, 14wks
0.5ml
IM
Vastus
lateralis
AMV
9mos
0.5ml
SQ
Outer,
upper arm
Rashes
Fever
0.5ml
SQ
Outer,
upper arm
Rashes
Fever
MMR
12-15mos
-
Local tenderness
VACCINES FOR HIGH RISK POPULATION
●
Cholera Vaccine
-
FOR SPECIAL POPULATION GROUPS & EXPANSION
VACCINE
AGE
DOSE
REMARKS
TETANUSDIPHTHERIA
(TD)
Grade 1 &
7
0.5ml
IM, single
Public schools
MEASLESRUBELLA (MR)
Sulu
Davao oriental
Sarangani
North cotabato
●
Typhoid vaccine
-
●
Given per orem, 1.5ml
Given at a minimum age of 12 months
2 doses with 2 weeks interval
NPO 1hr before and after because it causes
gastric upset
Given ONLY when there is an outbreak
Given IM, single dose, 0.5ml
At 2yrs old with revaccination every 2-3yrs
Japanese Encephalitis (JE) Vaccine
For introduction in 2017
JE is responsible for 7.4$ to 40% of
meningitis-encephalitis syndrome in the
Philippines Affecting children younger than
15yrs old
Given SQ at a minimum age of 9 months
Children 9 months to 17yrs of age should
receive on primary dose followed by a booster
dose 12-24months after the primary dose
Individuals 18yrs and older should receive a
single dose only
Only given to affected regions
o Central Luzon has the highest case
● Pamamantal
Not a normal side effects of other vaccine,
therefore it is recommended to consult the
health center if there are any presence of
rashes
ENSURING POTENCY OF BIOLOGICALS
● Maintenance of the cold chain
-
0.5ml
SQ, single
HUMAN
PAPILLOMAVIR
US (HPV)
9 to 14yrs
old
female
(Grade 4)
0.5ml
IM
For 2 doses
with 6mos
interval
In 20 provinces
Parent’s consent
needed
PNEUMOCOCC
AL
POLYSACCHAR
IDE VACCINE
(PPV)
INACTIVATED
1st - 60
y/o
2nd 65y/o
0.5ml, IM or
SC for
single dose
Indigent senior
citizens
INFLUENZA
(INACTIVATED)
60yrs old
and
above
annually
0.5ml, IM
for single
dose yearly
20 POOREST PROVINCES TO RECEIVE HPV BASED
ON NEDS 2016
● Luzon
Pangasinan
Ifugao
Apayao
Masbate
Camarines sur
Quezon
● Visayas
Leyte
Eastern & Northern Samar
Ilo-ilo
Negros Occidental
Negros Oriental
Cebu
● Mindanao
Maguindanao
Lanao del sur
Zamboanga del sur
MOST SENSITIVE
TO HEAT
TYPE OF VACCINE
STORAGE
TEMPERATURE
OPV
-15c to -25C
Freezer
AMV (freeze dried)
LEAST SENSITIVE
TO HEAT
2C to 8C
Refrigerator
If vaccine is a live microorganism, they are
stored in the freezer
Discarding unused biologicals
Vaccine Vial Monitor (VVM): the square must
be lighter than the circle
-
●
DPT, PCV, Hepa B,
diluent
BCG, TT,
Pentavalent,
Rotavirus, MMR
CRUZ, DCR | BATCH 2022 | 25
Inner square is lighter than the outer
circle. If the expiry date has not been
passed, USE the vaccine
o At a later time, the inner square is lighter
than the outer circle. If the expiry date has
not been passed, USE the vaccine
o Discard point: inner square matches color
of outer circle. Do NOT use the vaccine.
Inform your supervisor.
o Beyond the discard point: inner square
darker than outer circle. Do NOT use the
vaccine. Inform your supervisor
Unopened, exposed may be put back in the
refrigerator or freezer twice
Discard
BCG
and
MAV
4-6hrs
after
reconstitution
If we dispose of the vaccine, sterilize it first.
Then discard it in a biological bins
Shake the vial before use
If after shaking the vial, there are formation of
sediments, or granular particles DO NOT use
the vial
Maximum storage and transport
RHO/PHO/DHO: 3 months each
Rural health unit: 1 month
Maximum transport period (with cold packs): 5
days
FEFO: first expiry, firs out
3% or 2.7% in requesting vaccine for adults
o
●
●
PEDIATRIC DOSE FOR COVID (5-11Y/O)
Tozinameran,, COVID-19 mRNA vaccine
(nucleoside-modified) [Cominarty]
Other name
Pfizer-BioNtech COVID-19 vaccine
LEGISLATIONS
AFFECTING
NUTRITION PROGRAM
●
Pfizer Manufacturing Belgium
Vaccine platform
mRNA vaccine (nucleoside modified)
Dose strength &
administration
through better
and
increase
THE
PHILIPPINE
PD No. 491
-
Declared July as the Nutrition Month and
creation of Nation Nutrition Council
LOI 441
-
●
Manufacturer/s
Goal: Improve quality of life
nutrition,
improved
health
productivity
NUTRITION PROGRAM & PROJECTS
● Nutritional assessment
Ex. Operation Timbang
● Micronutrient Supplementation
Ex. Vitamin A is given every 6 months
● Food Fortification
● Maternal and Child Health Service Packages
● Nutrition Information, Communication, Education
● Home, School and Community Food Production
● Food Assistance
● Livelihood Assistance
of
Conditions
Associated
with
● Treatment
Malnutrition
Presence of parasitism
Deworming is done every 6 months or 2x/year
Mebendazole is chewable; given during
vacation because one of the side effects is
diarrhea
●
Trade name
Integration of Nutrition Education in the
school curriculum
DEWORMING
Deworming of children aged 1 to 12 years is done
every 6 months
AGE
Two doses of 0.2ml each (containing
10micrograms/dose)
3 weeks apart
ALBENDAZOLE
400mg/tab
MEBENDAZOLE
500mg/tab
1-23 months
1/2
1
Route of
administration
Intramuscular (IM)
24-59 months
1
1
Drug delivery
system
A white to off-white frozen dispersion of
10 micrograms/dose
One multidose vial contains 10 doses of
0.2ml after dilution
Storage condition
●
●
Store frozen at -90C to -60C (shelf life: 6
months0
Once thawed, store at 2C to *c (can be
used within 10 weeks)
COMMON INTESTINAL PARASITES
●
Ascaris (giant roundworm)
-
●
Ancylostoma (hookworm)
-
NUTRITION PROGRAMS
As of 2015, 33.4% of the Filipino children are affected
by stunting
●
Nutritional competition, source: soil, fecal-oral,
vomit worms
Blood sucker
Heavy infestation is seen as severe anemia
Enters the human body by skin penetration,
abdominal pain
Enterobius (pinworm)
-
Habitat is the rectum; source: finger nais
CRUZ, DCR | BATCH 2022 | 26
●
Symptom is pruritus ani
Highly contagious
<60%
Taenia saginata/ solium (tapeworm)
-
Longest intestinal parasite
SIDE EFFECTS:
● Local sensitivity or allergy
Give antihistamine
● Mild abdominal pain
Give an antispasmodic
● Diarrhea
Give oral rehydrating solution
● Erratic worm migration
Pull out worm from mouth/ nose or from other
body orifices
●
●
●
●
NUTRITIONAL ASSESSMENT METHODS
A - Anthropometry
B - Biochemical Or Lab Exams
C- Clinical Exam
D - Dietary History
H- Health History
Height for Age
Weight for height (BMI)
Adults
Diagnosis of acute malnutrition
Body mass index:
o BMI of 20-25 is desirable (WHO)
o BMIof 18.5-22.9 is desirable (Asian Criteria)
Mid upper arm circumference (MUAC)
1-4 year old
Rapid screening for malnutrition, but cannot
determine the degree of malnutrition
Procedure:
Determine the midpoint between acromion
and olecranon process
Interpretation:
Measure circumference at midpoint
> 115mm: normal nutritional status
< 115mm: acute undernutrition (wasting)
Skin fold thickness
Thickness of subcutaneous tissue
o Femoral
o Abdominal
o Triceps
Utilized the Harpenden Caliper
Adults: Acute Malnutrition
MALNUTRITION IN CHILDREN
A - ANTHROPOMETRY
● Weight for age
Gomez Classification Formula
CATEGORY
TYPE
SD OF WHO
CHILD GROWTH
STANDARDS
MEDIA
PROTEIN ENERGY
MALNUTRITION
(PEM)
Underweight weight for age
< -2 Standard
deviation (SD)
Stunting height for age
< -2 SD
Wasting weight for height
< -2 SD
“Baggy pants”
Overweight weight for height
+2 SD
Associated with a
higher probability
of obesity in
adulthood
In children 6-59
months of age
●
𝐴𝑐𝑡𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡
x 100
𝐸𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡
-
Referral to hospital
𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔
𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚𝑒𝑡𝑒𝑟𝑒𝑑 𝑠𝑞𝑢𝑎𝑟𝑒
CONTRAINDICATIONS
● Serious illness such as that requires referral to a
hospital
● Abdominal pain
● Diarrhea
● History of hypersensitivity to the drug
● Severe malnutrition
●
●
●
●
●
3rd degree
undernutrition
(Severe)
o Determine the degree of malnutrition
o Under the age of 9
Under 5yrs old: Operation Timbang every
month
Do not use when the pt has edema
Used in dx of
o Chronic Undernutrition → stunting
o Acute (current) malnutrition
● Overweight → obesity
● Underweight → wasting
%
INTERPRETATION
MGT
>110%
Overweight
91-110%
Normal
No management
76-90%
1st degree
undernutrition
(Mild)
Home
management
61-75%
2nd degree
undernutrition
(Moderate)
Home
management
SEVERE ACUTE
MALNUTRITION
(SAM)
CRUZ, DCR | BATCH 2022 | 27
Weight
for
height
less
than -3 SD of
the
WHO
Child Growth
Standards
median
●
●
For infants less
than 6 months of
age
●
Presence
of
edema
of
both feet
MUAC
less
than 115mm
Presence
of
visible severe
wasting and
edema,
together with
difficulties in
breastfeeding
MACRONUTRIENT DEFICIENCIES
REFERENCE
KWASHIORKOR
MARASMUS
ETIOLOGY
The word comes
from Africa means
the sickness of the
older child when the
next baby in born
Greek word which
means wasting
DEFINITION
Results from severe
CHON
deficiency,
qualitative def.
Results from fatal
CHO
deficiency,
quantitative def.
HISTORY
Improper weaning or
diarrhea
Starvation
Malabsorption
Toddler weaning
Various age even
infants
AGE
●
age
of
or
DIFFERENCE
KWASHIORKOR
MARASMUS
WASTING
Present but no
obvious
Present very
obvious
APPETITE
Poor
Good
MENTAL
OUTLOOK
Irritable
apathetic
MAJOR
FEATURE
Edema: ascites,
pedal
Wasting: skin and
bone
FACIAL
APPEARANCE
Moon face
Old man’s face
HAIR CHANGES
Sparse
Flag sign
depigmentation
absent
SKIN CHANGES
Flaky paint
dermatoses
desquamation
Absent
WEIGHT
May be normal
Abnormal - 2nd or
3rd degree
malnutrition
VITAMIN A DEFICIENCY
● VAD/ Xerophthalmia
Vitamin A is the precursor of rods
● Susceptible population: 1-4 year; usually occurs
together with PEM
● Foods rich in Vitamin A
Rich source: animas sources (retinol) such as
liver, egg yolk and milk
Best source: plant sources (carotene) such as
dark green leafy vegetables; yellow fruits and
vegetables
(considering socio-economic
status of family)
● Treatment
6 to 12 months: 100,000 IU
12 months and above: 200,000 IU
Give now, after 2 weeks and every 6 months
● Prevention
Every 6 months or 2x a year
● Diagnosis: Vitamin A assay test
IRON DEFICIENCY
● Susceptible population: 1-4 year; usually occurs
together with PEM
● Food rich in Iron:
Rich source: plant sources
Best sources: animal sources
● Iron supplement:
10-19yrs old: 60mg iron with 400mcg folic acid
(1tab/day)
Pregnant: 60mg iron with 400mcg folic acid
(1tab/day for 6 months or 2tab/day for 2nd or
3rd trimester)
Lactating /postpartum: 60 mg iron with
400mcg folic acid(1tab/day for 3 months)
Older persons: 60mg iron with 400mcg folic
acid (1tab/day)
● Administered for 2 weeks. After 2 weeks, check if
there is still the presence of Palmar Pallor.
IODINE DEFICIENCY
● Manifest poor memory
● Iodine supplement:
Children or school age: iodized oil capsule with
200mg Iodine (1 cap for 1 year)
FORTIFICATION
● Addition of a nutrient to food during processing
● Products without any nutrient are added with
nutrients
● Sangkap Pinoy Seal - placed on label of fortified
foods
Yellow: Vitamin A
Green: Iron
Red: Iodine
MICRONUTRIENT DEFICIENCIES
A substance found in very small amounts in the
body ( <0.005% of body weight)
CRUZ, DCR | BATCH 2022 | 28
●
RA 8976 - Philippines Food Fortification Act of
2000
-
This provides for mandatory fortification of the
following products:
o Rice with iron
o Wheat flour with vitamin A and iron
o Refined sugar with vitamin A
o Cooking oil with vitamin A
-
-
ClASSIFY
●
Severe Classification: Pink
-
●
E.O 382
-
●
-
●
●
●
National
Food
●
Fidel Salt (fortification of Iodine Deficiency
Elimination)
Iodized salt: “Patak sa asin” by secretary Flavier
on December 1-5, 2003 where DOH workers go
to market to check if salt sold contains iodine
by placing few drops of reagent:
o Salt color turn to blue violet → fortified
with iodine
o Salt color show no change → not fortified
FVR (Fortified Vitamin Rice) by secretary
Flavier order FVR, Erap Rice under Erap, Gloria
Rice or Bigas ni Gloria under PGMA
INTEGRATED MANAGEMENT FOR
CHILDHOOD ILLNESS (IMCI)
Distribution of deaths among children < 5 for 1990
and projected for 2020
The main 5 killers: Acute Respiratory infection,
diarrhea, measles, malaria and nutrition
Perinatal conditions, other communicable diseases,
non-communicable diseases and injuries
Objectives:
To reduce significantly global mortality and
morbidity associated with the major causes of
deaths in children
To
contribute to health growth and
development of children
BASIC STEPS IN IMCI
ASSESS
● Child’s problem
Ask the reason for bringing the child to the
health facility
● Check for general danger signs (VACU)
Vomiting
Abnormally sleepy/ lethargic/ unconscious
Convulsion
Unable to breastfeed, eat or drink
● Then ask for main symptoms
Pneumonia - cough or DOB
Dehydration - diarrhea
Malnutrition - weight/age
Anemia - palmar pallor
●
Referral
to
hospital
+
Pharmacological treatment
1st
dose
of
Some/ Disease Condition: Yellow
-
RA 832 - Rice Fortification
-
●
as
RA 8172 - Asin Law
-
●
November 7 declared
Fortification Day
Malaria, measles, dengue - fever
o Fever: feels hot or temperature of 37.5C
via axilla or 38C via rectal
Ear problem - ear pain or ear discharge
RHU + Pharma
Follow up: 3 days
o Improving: continue giving the antibiotic
o Did not improve/ remains the same:
change the antibiotic
o Becomes worse: refer to the hospital
No classification: Green
Home management
Follow up: 5 days
TREAT
● Based on the classification
FOLLOW-UP
●
●
●
●
●
●
TREATMENT FOR DANGER SIGNS
Diazepam if convulsing now
Complete assessment
Give pre-referral treatment
Treat to prevent low blood sugar
Can breastfeed: breastfeed the child
Cannot breastfeed but can swallow: give
expressed breastmilk or 30-50ml milk or sugar
H2O
Cannot swallow: 0ml of milk or sugar H2O by
NGT
Not awaken or unconscious: IVF
o 5ml/kg of 10% Dextrose for a few minutes
o 1ml/kg of 5% Dextrose in 50cc by slow IV
push
Keep the child warm
Refer urgently
MALNUTRITION
ASSESSMENT
● Look and feel
Edema of both feet
WFH/L - Z score
MUAC - for children 6 months or more
● If WFH/L less than -3 z scores or MUAC less than
115mm:
Check for medical complication
Danger sign, severe classification, pneumonia
with chest indrawing
● If no medical condition:
Child is 6 months or older: offer RUTF (ready to
use therapeutic food) to eat
CRUZ, DCR | BATCH 2022 | 29
-
●
●
12 months to 2yrs
5ml OD for 3
months
1.5ml
2 to 5 yrs
5ml 23x for 3
months
2ml
●
●
MUAC less than 115 mm
No edema and medical complication present
Give oral antibiotics for 5 days
●
MUAC 115 - 125mm
●
MUAC 125mm or more
Micronutrient
powder
is
commercially
prepared. If not available, continue feeding the
child
●
PNEUMONIA
CONTROL OF ACUTE RESPIRATORY INFECTION
(CARI)
Main symptoms: cough or DOB
Ask how long
Acute (Pneumonia): lasts for 3 days
Chronic (Asthma/PTB): lasting for more than 2
weeks
Look and Listen: child must be calm
Stridor
Chest indrawings
Count RR/min
Wheezing: if with chest indrawing, fast
breathing and wheeze
Trial of Rapid Acting Bronchodilator for 3x,
15-20mins apart.
1st choice: inhaler
2nd choice: oral salbutamol
Most common in the community is bacterial
pneumonia
Causative agent: Streptococcus Pneumoniae
FAST BREATHING MEANS:
Severe Anemia
Some palmar pallor
Give iron supplement for 2 weeks
Give mebendazole and anthelmintic for 1 y/o or
older and has not had a dose in the previous 6
months
No anemia
-
AGE
RR
Below 2 months
60/min and above
2-12 months
50/min and above
12 months to 5yrs
40/min and above
Severe palmar pallor
Refer urgently to hospital
Anemia
-
●
Edema of both feet
Medical complication present
1st dose: Gentamicin via IM
Feed the child if tolerated
Sugar water or milk
NGT if not tolerated
Unconscious: D5 OR D10
ANEMIA
Look for palmar pallor: severe or some?
If the palm is lighter than the back of the hand
●
assess
No acute Malnutrition
-
●
months:
Moderate Acute Malnutrition
-
●
6
Uncomplicated Severe Acute Malnutrition
-
●
than
Complicated Severe Acute Malnutrition
-
●
Child is less
breastfeeding
MANAGEMENT OF WHEEZING (Salbutamol)
● Metered dose Inhaler (100 micrograms/puff)
Give 2 puffs → repeat up to 3x every 15 mins
3cc of NSS + 1cc of Salbutamol
● Inhalation - at home, every 6 hrs
● Oral
No palmar pallor
If the child is less than 2 yrs old, assess the
child’s feeding and counsel the mother
according to the feeding recommendations
o If feeding problem, follow up in 5 days
o Give micronutrient Powder (MNP)
AGE OR WEIGHT
IRON SYRUP
30mg Iron/5ml
IRON SYRUP
FeSO4
15mg/0.6ml
Low birth weight
infants less than
2.5kg
0.3ml OD 2-6
months
6 to 12 months
0.6 2-3x for 3
months
AGE OR WEIGHT
SUSPENSION
2mg/5ml TID for 5
days
TABLET
2mg TID for 5
days
2 to 11 months
5 to 9kg
2.5ml
½ tab
10kg and above
5ml
1 tab
MANAGEMENT OF PNEUMONIA
●
Severe Pneumonia or Very Severe Disease
-
Any general danger sign: Stridor in calm child
Give first dose of an appropriate antibiotic
Refer urgently to the hospital
CRUZ, DCR | BATCH 2022 | 30
-
IM antibiotic for children being referred
urgently:
o Gentamicin: 7.5mg/kg
o Benzylpenicillin: 50,000 units/kg
●
●
●
●
Pneumonia
-
-
-
-
●
Chest indrawing or fast breathing
Give oral Amoxicillin (for 5 days) → change to
cotrimoxazole if not improving for 3 days
If wheezing (or disappeared after rapidly
acting acting bronchodilator) give an inhaled
bronchodilator for 5 days
If chest indrawing in HIV exposed/ infected
child: give first dose of amoxicillin and refer
Soothe the throat and relieve the cough with a
safe remedy
o Safe remedy: calamansi or breast milk
(except codeine cough syrups or nasal
decongestants)
If coughing for more than 14 days or recurrent
wheeze, refer for possible TB or asthma
assessment
Advise mother when to return immediately
o Return immediately: fast breathing, fever,
not breathing
Follow up in 3 days
Cough or cold
-
-
-
-
-
No signs of pneumonia or very severe disease
If wheezing (or disappeared after rapidly
acting bronchodilator) give an inhaled
bronchodilator for 5 days
Soothe the throat and relieve the cough with a
safe remedy
o Safe remedy: calamansi or breast milk
(except codeine cough syrups or nasal
decongestants)
If coughing for more than 14 days or recurrent
wheeze, refer for possible TB or asthma
assessment
Advise mother when to return immediately
o Return immediately: fast breathing, fever,
not breathing
Follow up in 5 days if not improve
●
CLASSIFICATION OF DIARRHEA
ACUTE (less than 14 days)
● Severe dehydration
● Some dehydration
● No dehydration
CHRONIC (14 days or more)
● Severe persistent (with dehydration)
● Persistent (no dehydration)
DYSENTERY
● Blood in stool
CHOLERA
● Rice watery stools
CLASSIFICATION OF ACUTE DIARRHEA
SEVERE DEHYDRATION
Look for at least 2 of the following signs:
● Abnormally sleepy or difficult to awaken
● Sunken eyes
● Not able to drink or drinking poorly
● Skin pinch goes back very slowly
SOME DEHYDRATION
Look for at least 2 of the following signs:
● Restless, irritable
● Sunken eyes
● Drinks eagerly, thirsty
● Skin pinch goes back slowly
NO DEHYDRATION
● Not enough signs
ORAL ANTIBIOTIC
● First line: amoxicillin for 5 days, BID
●
●
Main symptom: At Least 3 loose watery stools
Ask
How long?
Blood in the stool?
Look and feel
Abnormally sleepy or difficult to awaken
Restless and irritable
Sunken eyes
Not able to drink
Pinch the skin
If it is caused by a pathogenic agent, antibiotic is
given
In diarrhea, we need 2 signs for us to classify
AGE
AMOUNT OF AMOXICILLIN
100mg/5ml
2 to 6 months
1.5ml
6 to 12 months
2.5ml
12 months to 3yrs
3.5ml
3 to 5yrs
5ml
CLASSIFICATION OF CHRONIC DIARRHEA
SEVERE PERSISTENT DIARRHEA
● If the age of the child is less than 2 months, with
chronic diarrhea
● Dehydration present or less than 2 months with
chronic diarrhea
PERSISTENT DIARRHEA
● No dehydration
CONTROL OF DIARRHEA DISEASES (CDD)
Leading cause of morbidity is diarrhea
CRUZ, DCR | BATCH 2022 | 31
MANAGEMENT OF CHRONIC DIARRHEA
●
Treat dehydration
Give vitamin A if not give in the last 30 days
Refer to the hospital
Plan C + Vitamin A
Advise feeding
Give Vitamin A if not given in the last 30 days
Give zinc supplements for 14 days
Follow up in 5 days
Advise when to return
Plan A + Vitamin A
MANAGEMENT OF ACUTE DIARRHEA
PLAN A
●
No dehydration
●
Managed at home
AGE
FIRST GIVE
30ml/kg in
THEN GIVE
70ml/kg in
Infants under 1 yr
1 hour
5 hours
Children 1yr and
above
30 mins
2 and ½ hours
Give IV Fluid immediately: Plain LR or PNSS
If IVF is not available, give ORS by mouth if
tolerated
If the child cannot swallow, give ORS via NGT
If no health facility, use NGT
If any of the above steps is not possible, bring child
immediately to the hospital for IVF or NGT
treatment
If the age of the child is 2 yrs old or there is an
epidemic of cholera, give antibiotics
●
●
ANTIBIOTICS
Dysentery
●
-
Cirpofloxacin 15mg/kg for 3 days BID
Cholera
●
-
Cotrimoxazole or Furazolidone for 3 days BID
REMEMBER
Pneumonia
1 pink + 1 yellow = pink
Diarrhea
1 pink + 1 yellow = yellow
PLAN B
●
Some Dehydration
●
●
Managed in RHU
Give reformulated ORS in the first 4hrs
Amount of ORS = wt. in kg x 75ml/kg of BW
o Consumed in the health center
Home made oresol: 1 LH + 1 tsp NaCl + 4 tsp
sugar (1:1:4)
For under 6 months: give 100-200ml in the first
4hrs
Advise mother to continue to breastfeeding
After 4hrs → continue feeding and give zinc
If mother must leave before treatment → explain 4
rules
At home: Continue Plan A
Follow up in 5 day if not improving
●
Severe dehydration
●
●
4 RULES (X2B5)
● Give extra fluid and food
Every after loose stools
Soup, rice water, buko juice or ORS
o Below 2yrs old: 50 to 100ml
o 2 to yrs old: 100 to 200ml
● Zinc supplement for 14 days
2 to 6 months: 10mg/day
6 months to 5yrs old: 20mg/day
● Continue breastfeeding
● Follow up in 5 days if not improving
●
●
●
960-1600
PLAN C
Persistent Diarrhea
-
●
12 to <19kg
Severe Persistent Diarrhea
-
●
2 to 5yrs
AGE
WEIGHT
AMOUNT (ML) IN
4HRS
Below 4 months
< 6kg
200-450
4 to 12 months
6 to <10kg
450-800
12 months to 2yrs
10 to <12kg
800-960
NOTE: : If the baby vomits the oresol twice, stop giving
oresol and bring the baby back to the health center
SUMMARY: PHARMA
●
●
●
●
●
●
●
●
●
For convulsions: diazepam
Anemia: FeSO4
Dysentery: Criprofloxacin
Cholera: Cotrimoxazole /Furazolidone
Antihelminthic: Mebendazole/Albendazole
Wheezing: Salbumtamol (Bronchodilator)
Chronic Diarrhea (Severe Persistent / Persistent):
Vitamin A
ORS + Zinc (Plan B +A): Dehydration
ORS: 1 liter water, 1 tsp salt, 4 tsp sugar
Sugar water = 200ml water + 4 tsp sugar
PLR, NSS
Prevent low blood sugar: D5 or D10
CRUZ, DCR | BATCH 2022 | 32
-
SUMMARY: FOLLOW UP
●
●
●
●
●
Malnutrition
Complicated severe acute: refer
Uncomplicated severe acute: 5 days
Moderate acute: 30 days
No malnutrition: 5 days
Anemia
Severe anemia: refer
Anemia: 14 days
No anemia: 5 days
Pneumonia
Severe: refer
Pneumonia: 3 days
Cough or colds: 5 days
Dehydration
Acute
o Severe dehydration: refer
o Some dehydration: 5 days
o No dehydration: 5 days
Chronic
o Severe persistent: refer
o Persistent: 5 days
Awareness of available services
Able and willing to obtain services
FACTORS AFFECTING ADOLESCENT HEALTH ISSUES
● Lack of life skills
● Lack of access to health services
● Lack of safe and supportive environment
ADOLESCENT HEALTH
10-19y/o (WHO)
ADOLESCENT HEALTH ISSUES
● Early pregnancy and childbirth - 30% of births
● HIV
● Malnutrition
● Mental health
● Tobacco use
● Harmful use of alcohol - starts at 13-15y/o
● Violence
● Injuries
ADOLESCENT HEALTH AND DEVELOPMENT
PROGRAM (AHDP) 2018-2022
● Vision: A country with well informed, empowered,
responsible, and healthy adolescent who are
leaders in society
● Mision: Ensure that all adolescents have access to
comprehensive health care and services in an
adolescent-friendly environment
ADOLESCENT HEALTH SERVICES
● Adolescent sexual and reproductive health
15 to 24 years old
Highest adolescent fertility rates
● HPV vaccination
Grade 4 (9-14y/o) public schools
● Violence against women and children
● Weekly Iron and Folic acid supplementation (WIFA)
● Assessment of health, nutritionally at risk and
provision of RTU supp;ementary food for
adolescent female
● Antihelminthic drugs for deworming
● Micronutrient supplementation
● Promotion of consumption of iodized salt and
foods fortified with micronutrients
● Age-appropriate immunization
● Oral health
on
personal
hygiene
and
● Counseling
environmental sanitation
● Referral for management for menstruation
irregularities,
complicated
illness
including
malnutrition
● Counseling on proper nutrition, mental health,
avoidance of risk-taking behaviors, smoking
cessation, adoption of healthy lifestyle practices
and family health
RELATED LAWS AND POLICIES FOR ADOLESCENT
HEALTH PROGRAMS
●
Proc. 99 - Second week of December as Linggo
ng Kabataan
●
DepEd Order 0031, 2018
-
STRATEGIES
● Health education and promotion
● Like skills building
● Medical service provision
GAPS IN ADOLESCENT HEALTH SERVICE PROVISION
● Facility / provider
Available services
Appealing and respectful
Non judgment and considerate
Appropriate delivery
● Community
Support the provision of service
● Adolescents
●
Guidelines on the Implementation of the
comprehensive sexuality education (CSE) on
the development of an age-appropriate and
developmentally-appropriate curriculum on
reproductive
health
and
gender-based
violence
RA 11166 - Phil HIV and AIDS Policy Act
-
-
Repeals RA 8504 (Phil AIDS Prev and Control
Act) on the access of adolescents to HIV
services from 21 y/o to 15-17 y/o for HIV testing
Allows below 15 y/o that is pregnant or
engaged in high-risk behavior for HIV testing
and counseling with assistance of licensed
social worker or health worker
CRUZ, DCR | BATCH 2022 | 33
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
●
ADULT MEN AND WOMEN HEALTH PROGRAM
Management of Illness
Counseling substance abuse, sexuality and
reproductive tract infections (RTI)
Nutrition and diet counseling
Mental health
Family planning and responsible sexual behavior
Dental care
Screening and management of lifestyle related and
other degenerative diseases
Men - accidents and injuries, liver disease, BPH,
prostate malignancies
Women - goiter, malignancies (breast), DM
●
OLDER ADULTS HEALTH PROGRAM
Global Aging Population
According to DOH, at least 7% of the
population is older adult to be considered as
aging population
By the year 2050, 24% will be coming from the
older adult
Potential Support Ratio: ratio between older
adult and below 60yrs old
Aged 60 years and older
1 billion (2017)
1.4 billion (2030)
2.1 billion (2050)
Young-old (65-74yrs)
Middle-old (75-84yrs)
Old-old (85 yrs and older)
●
RESPONSE TO AGING POPULATION
United Nations International Plan of Action on
Aging (2002)
WHO Active Aging: Policy Framework (2002;
Strategy and action plan on aging and heath
(2016-20202)
Philippines Plan of action for Senior Citizens
(2012-2016)
Vision is to have a society for all ages where
the senior citizens are empowered to achieve
active aging
It has 3 priority directions or major areas:
o Senior citizens and development
o Advancing health and well-being into old
age
o Ensuring
enabling
and
supportive
environments
OLDER ADULTS IN THE PHILIPPINES
Article XV, Sec. 4 of the 1986 Philippine
Constitution which states “The family has the duty
to care for its elderly members although the state
may do so through programs of social security”
Expanded Senior Citizen Act
-
Senior citizens center were also established in
the Philippines pursuant to RA 7876,
otherwise known as the Senior Citizen Center
Act of the Philippines
●
●
Life Expectancy:
Male = 64.10 y/o
Females = 70.10y/o
Mortality - CVD, cancer
Morbidity - Influenza, pneumonia, TB (infectious)
BENEFITS OF SENIOR CITIZEN
●
RA 7432
-
●
RA 9257
-
Expanded Senior Citizen Act
-
Seniors to render services to the community
RA 9994
-
●
Senior Citizens Center Act
Access to vital facilities in the community in all
cities and municipalities
RA 10645
-
●
Amended 7432 to include additional services
RA 7876
-
●
An act to maximize the contribution of senior
citizens (60y/o) to nation building, grant
benefits
and
special
privileges
and
opportunities
Mandatory Philheth coverage for ALL senior
citizens
Proc. 470
-
1st week of October every year as “Elderly
Filipino Week”
BENEFITS OF SENIOR CITIZEN
● 20% discount on:
Medical related privileges: medicine, medical
supplies, accessories and equipment, medical
and dental services, PF of physician and
license health workers providing home health
services
Transportation: air, sea, land (MRT, LRT, PNR,
buses, jeepneys, taxi, shuttle services)
Hotels, restaurants, recreational facilities,
places of leisure: hotels, restaurants, theaters,
cinemas, concert halls, circuses, leisure and
amusement
Recreation centers: fees, charges and rental for
sports facilities and equipment
Funeral services: funeral and burial expenses
include casket or urn, embalming, cremation
cost and other services
Utility discount: grant 5% discount relative to
the monthly use of water and electricity,
provided that the meter is registered under
the name of the senior citizen residing therein
and does not exceed 100kWh and 30m
● Exemptions
CRUZ, DCR | BATCH 2022 | 34
Tax Exemptions: payment of individual income
tax of those who are considered
to be
minimum wage earners
Training fee: for socio-economic programs
conducted by private and government
agencies subject to the guidelines issued by
DTI, DOLE, DA, TESDA and DOST-TRC
Freebies: medical, dental services and
vaccinations
Government Assistance
Social Pension: indigent entitled to monthly
stipend to Php 500 to augment subsistence
and medical needs
Mandatory PhilHealth Coverage
Social Safety Nets:
shall include but not
limited to food, medicines and financial
assistance for house repair to cushion effects
of economic, disaster and calamity shocks
Death benefit: minimum of Php 2,000 shall be
given to the nearest surviving relative who
took care of the deceased senior citizen
Others
Express lanes: private, banking, commercial
and government establishments
Education: provision of scholarships, grants,
financial aids, subsidies and other incentives
Benefits for retirees: continuance of same
benefits by GSIS, SSS and PAGIBIG as enjoyed
those in active service
Privileges on special discounts in special
programs
VIOLENCE AGAINST WOMEN AND CHILDREN
-
●
●
●
HEALTH SERVICES FOR OLDER ADULTS
Management of Illness
Counseling substance abuse, sexuality and
reproductive tract infections (RTI)
Nutrition and diet counseling
Mental health
Family planning and responsible sexual behavior
Dental care
Screening and management of lifestyle related and
other degenerative diseases
Screening and management of chronic debilitating
and infectious diseases
Post productive care
●
●
●
●
●
FACILITIES FOR ADULTS IN THE PHILIPPINES
National center for Geriatric Health (Manila)
Golden Acres Home for the Aged (Govt)
Mountain Crest Residential Care (Cavite)
Kanlungan ni Maria
Blessed family Home Care Facility (QC)
●
●
●
●
●
●
●
●
●
RA 9262 - Anti Violence against Women and
their Children Act of 2004
ESSENTIAL HEALTH SERVICE PACKAGE FOR VAW
Identification of Survivors of intimate partner
violence
Allow them to state or verbalize what happen
and their emotions with consent
Don't pressure her, give her time
Document
● Written information in the health facility
● Identification of women suffering intimate partner
violence
● Provide information regarding available services
● First line of support
Being non-judgemental
Ask about history of violence
Referral
Mandatory reporting is not recommended
● Care of injuries and urgent medical issues
History taking is standard but avoid redundant
questions
Explain and obtain informed consent for
medical examination, treatment, forensic
evidence collection, release of information
Emergency treatment
PERSONS WITH DISABILITIES (PWDs)
NATIONAL HEALTH PROGRAM FOR PERSONS WITH
DISABILITIES (PWD)
● Individuals who have impairments, activity
limitation or restrictions on participation
Disability: impairments, activity limitations and
participation restrictions
Impairment: problem in body function (e.g.
deaf, mute)
Activity limitations: difficulty in executing a
task or action
Participation restriction: problem experiences
with regard to involvement in life situations
●
ISSUES AMONG PWD
● Poor health outcomes
● Low educational outcomes
● Less economic participation
CRUZ, DCR | BATCH 2022 | 35
●
●
●
Higher rates of poverty
Increased dependency
Restricted participation
disability
than
people
without
●
BARRIERS TO SERVICE
● Inadequate policies and standards
● Negative attitudes of people
● Lack of provision of services
● Poor service delivery
● Inadequate funding
● Lack of accessibility
● Lack of involvement
● Lack of data and evidence on disability
●
●
MAGNA CARTA
●
RA 7277 - Magna carta for Disabled Persons
●
●
●
National Health Program for PWD
Medical rehab Centers in provincial hospitals
Comprehensive, integrated and affordable health
services
CATEGORIES OF PWD
● Psychosocial behavioral disabilities
● Chronic illness and disabilities
● Learning disabilities
● Mental disabilities
● Visual disability
● Orthopedic /moving
● Communication deficits
●
●
●
RA 11036 MENTAL HEALTH ACT
An Act Establishing a National Mental Health
Policy for the purpose of enhancing the delivery of
integrated mental health services, promoting and
protecting the rights of persons utilizing psychiatric
neurological and psychosocial health services
June 1, 2018
MENTAL HEALTH FACILITY
Establishment or any unit of an establishment
which has as its primary function of provision of
mental health services
Mental health services at all levels in the national
health system
MENTAL HEALTH SERVICES AT COMMUNITY LEVEL
Basic mental health services at all LGUs down to
the barangay
● Community resilience and psychosocial well-being
training in all barangays, including the availability
of mental health and psychosocial support services
during and after natural disasters and other
calamities
● Training and capacity-building programs for local
mental health workers in coordination with mental
health facilities and departments of psychiatry in
general or university hospitals
● Support services for families and co-workers of
mental health services
● Dissemination of mental health information and
promotion of mental health awareness among the
general population
●
HEALTH AND WELLNESS PROGRAM FOR PWDs
Vision: a country where all persons with disabilities,
including their children and families have full
access to inclusive health and rehabilitation
services
● Mission: promote highest attainable standards of
health and wellness for PWDs by fostering
multisectoral approach towards a disability
inclusive health agenda
●
●
●
●
●
●
Portion of the burden relating to impact of
mental health problems to person other than
the individual directly affected
Felt by families and relatives of mentally ill
Hidden burden
Stigma and violations of human rights
Rejection, shame suffered by mentally ill
Future burden
Burden in the future resulting from the aging
of the population, increasing social problems
and unrest inherited from the existing burden
-
MENTAL HEALTH PROGRAMS
MENTAL HEALTH IN THE PHILIPPINES
1 in 5 Filipinos suffer from mental disorders
3.3% of total population has depression and 3.1%
has anxiety
2,558 cases of Filipinos resorting to suicide (WHO,
2012)
4 FACETS OF MENTAL HEALTH PROBLEMS AS
PUBLIC HEALTH PROBLEM
Defined burden
Burden of currently affecting persons with
mental disorders
Quality of life indicators, Disability adjusted life
years (DALY)
Undefined burden
●
●
SUPPORTED DECISION MAKING
A service use may designate up to 3 persons or
supporters, including the legal representative for
supported decision making
Access the service user’s medical information
Consult with the service user vis-a-vis any
proposed treatment or therapy
Be
present during appointments and
consultations
with
mental
health
professionals, workers and other service
providers during the course of treatment or
therapy
Deinstitutionalization
CRUZ, DCR | BATCH 2022 | 36
-
-
Discourage patients to be admitted in mental
health facility wherein there is a controlled
environment
Be present in the community in order to adjust
and cope with stress
INTEGRATED COMMUNITY BASED
NON-COMMUNICABLE DISEASE PREVENTION &
CONTROL PROGRAM
● Mortality - Lifestyle Related/Chronic
Cardiovascular Diseases
Cancer
COPD
DM
● Risk Factors of Diseases
Smoking
Physical Inactivity
Unhealthy diet
Excessive alcohol drinking
STRATEGIES FOR THE CONTROL & PREVENTION OF
NON-COMMUNICABLE
● “Mag HL tayo Program” → healthy lifestyle
● Promote physical activity and exercise
Physical activity: body movement that results
in expenditure of energy (occupational,
leisure-time, routine daily activities)
o E.g. washing the dishes, walking
Exercise: planned, structured, repetitive aimed
at improving or maintaining physical fitness
(performed activities with vigor and alertness
without undue fatigue)
o Moderate intensity for 30 mins for 5 days
o E.g. Zumba, weightlifting, jogging
● Prompt proper nutrition (ABC)
A: aim for physical fitness (ideal body weight)
B: build healthy nutrition-related practices
C: choose foods sensibly
● Promote smoke free environment (5A’s to
quitting smoking)
Ask smoking status
o “Ilang sticks per day?”
Advise to stop smoking, can cause death
o Educate them about the adverse effects
Assess willingness to quit
Assist quitting
Arrange follow up monitor progress
RA 10352 Excise Tax on Alcohol and Tobacco
for 5 years for the Universal Health Care
program of the government
12 STRESS MANAGEMENT TECHNIQUES
● Spirituality
● Self-awareness
● Scheduling activities
● Siesta
● Stretching
● Sensation techniques
E.g. Spa
● Sports
●
●
●
●
●
●
●
Socials
Sounds and songs
Speak to me
Stress debriefing
Smile
WHO PEN
WHO Package of Essential Non-Communicable
Disease Interventions
Enable early detection and management of
cardiovascular disease, diabetes, chronic respiratory
diseases and cancer to prevent life threatening
complications
Ex. heart attacks, stroke, kidney failure,
amputations, blindness
PACKAGE OF ESSENTIAL NCD INTERVENTIONS -PEN
CVD
● Primary prevention of heart attack and strokes
● Acute myocardial infarction
● Secondary prevention: post MI
● Secondary prevention: post stroke
● Secondary prevention: rheumatic heart disease
DIABETES MELLITUS
● Type 1 DM
● Type 2 DM
of
foot
complications
through
● Prevention
examination and monitoring
● Prevention of onset and delay in progression of
chronic kidney disease
● Prevention of onset and delay in progression of
diabetic retinopathy
● Prevention of onset and delay in progression of
neuropathy
CHRONIC OBSTRUCTIVE LUNG DISEASES
● Bronchial asthma
● Prevent exacerbation of COPD and
progression
disease
CANCER
● Early diagnosis
●
NCD CARE
Package of Essential Noncommunicable (PEN)
Disease interventions for primary health care in
low-resource settings:
Prevention
Treatment
Rehabilitation
Palliative care
PRIMARY HEALTH CARE CENTER
STAFF TEAM & ROLES
PHYSICIAN
●
●
●
CRUZ, DCR | BATCH 2022 | 37
Receives NCD referrals from
nurse
Physically examines pt
Prescribed medications and
promote adherence
NURSE
●
Conduct risk assessment and
screening
Measure height and weight
Perform UA and blood sugars, if
needed
Healthy lifestyle counseling
●
●
●
Dietitian
Smoking cessation specialist
Health educator
●
●
●
OTHERS
●
PHILPEN
Philippine Package of Essential Noncommunicable
disease intervention
●
AO No. 2012-0029
-
the continuing education of health care
providers, all in the interests of advancing the
health of individuals and their communities
(WHO)
●
-
●
●
An adaptation of the WHO guidelines in
managing non-communicable diseases in low
resource setting such as thing country
RISK FACTORS
● Age > 40 yrs old
● Smokers
● Waist circumference of
> 90cm in women
> 100cm in men
● Known hypertension
● Known DM
● History of premature CVD in first degree relatives
● History of DM or kidney disease in first degree
relatives
Information Communication Technology (ICT)
-
-
●
Example technologies:
o Computers
o The Internet
o Television
o Mobile phones
●
PD 856 - Code on Sanitation
●
RA 9003 - Ecological Solid Waste Management
Act
●
RA 8749 - Clean Air Act
-
●
Electronic Medical Records
-
●
●
●
●
●
Comprehensive patient records that are stored
and accessed from computer or server
Community health information tracking
system (CHITS) of the UP Manila
Prevents burning as a way of waste disposal
RA 9275 - Clean Water Act
-
●
●
Is the use of ICT for health (WHO, 2012)
ENVIRONMENTAL SANITATION
Is the control of factors in man’s physical
environment that maybe deleterious to man’s
well-being
The program covers the following areas
Water Sanitation
Food Sanitation
Waste Management
PD 825 - Anti-littering Act
●
●
eHealth
-
●
A diverse set of technological tools and
resources used to communicate, create,
disseminate, store and manage information
(Blurton, 2002)
The use of electronic tools aid in teaching
Instructional videos, informational text blasts,
interactive simulations
●
TELEMEDICINE
●
eLearning
Separate disposal system for human waste
o E.g. Septic tank
PP 1101 - November as Clean Air Month
9 ENVIRONMENTAL HEALTH INDICATORS
Households with access to improved or saafer
water-stratified to Level I, II and III
Households with sanitary toilets
Households with satisfactory disposal of solid waste
Households with complete basic sanitation
facilities
Food establishments
Food establishments with sanitary permit (PD 522)
Acquired from the municipal hall
Food handlers
Food handlers with health certificates
Acquired from the municipal hall
Must submit a stool for fecalysis
WATER SANITATION
WATER FACILITIES
LEVEL
I (Point source)
●
DESCRIPTION
●
Telemedicine
-
Using ICT for exchange of valid information for
diagnosis, treatment and prevention of disease
and injuries, research and evaluation and for
CRUZ, DCR | BATCH 2022 | 38
●
●
A protected well or spring with
outlet
No distribution system - source
Adaptable for rural areas, 15-25
household
II
●
Within 250m from the farthest
user
●
Sourcer + reservoir + piped
distribution
Within 25m from the farthest
house
100 households
E.g. poso
●
●
●
III
●
●
●
●
Sourcer + reservoir + piped
distribution + household tap
Suited for urban areas
Undergoes treatment at water
facility
Recommended
because
it
ensures safety of consumers
WATER TREATMENT IN A LEVEL II WATER SUPPLY
SYSTEM
● Sedimentation
Settles at the bottom
● Flocculation or coagulation
E.g. alum or tawas
● Filtration
E.g. sand, gravel
● Chlorination
● Aeration
Used after chlorination
This is used to improve the taste and smell of
the water
● Fluoridation
PROHIBITIONS OF THE CODE OF SANITATION ON
WATER SUPPLY
● Washing and bathing within a radius of 25m from
any well or other source of drinking water
● Construction of artesians, deep or shallow well
within 25m from any source of pollution
Including septic tanks and sewage systems
● Drilling a well within 50m distance from a
cemetery
● Construction of dwellings within the catchment
area of protected spring water source
TOILET FACILITIES
LEVEL
I
DESCRIPTION
●
●
●
Non-water carriage toilet
Ex. Pit latrine
Toilet facilities requiring small
amount of water to wash the
waste into the receiving space
Ex. pour flush toilet & aqua
privy
Other type 1:
Trench latrine/ temporary
toilet
Chemical toilet
Cathole
-
II
●
On site toilet of the water
carriage type with water-sealed
(flush type) with septic tank
III
●
Water carriage type connected
to
sewerage
system
to
treatment plant
FACTORS COVERED BY SANITATION CODE
● Toilet
● Two consideration in constructing toilets:
Construct at a distance of 25:30m from
identified sources of water like deep well,
faucet, etc.
Construct at a level lower than the source of
water
●
●
●
●
●
●
SOLID WASTE MANAGEMENT
Need for sorting/ waste segregation
Reuse - all solid and semi-solid except human
excreta
Garbage: biodegradable wastes
Rubbish / trash: non biodegradable wastes
SOLID WASTES
Municipal wastes - non hazardous household
commercial
and institutional waste, street
sweepings, debris
Healthcare Wastes (Biomedical Waste)
Infections: contain bacteria, viruses, paratise,
fungal
Pathological: tissues, organs, body parts,
human fet
Pharmaceutical: drug, vaccines, sera
Chemical: from lab, housekeeping, disinfectant
Sharps: cause cuts, puncture
Radioactive: liquids or gaseous materials
Industrial Wastes
Agricultural and mining
Hazardous Wastes
Toxic, corrosive acids, explosions, cytostatic
drugs, genotoxic drugs
WASTE SEGREGATION
● Black or colorless
Non-hazardous, non-biodegradable wastes
● Green
Non-hazardous biodegradable wastes
● Yellow with biohazard symbol
Pathological / anatomical wastes
E.g. cotton ball used to clean the shoes
● Yellow with black band
Pharmaceutical, cytotoxic or chemical wastes
(label separately)
● Yellow bag that can be autoclaved
Infectious wastes
● Orange with radioactive symbol
Radioactive wastes
CRUZ, DCR | BATCH 2022 | 39
METHODS OF SOLID WASTE MANAGEMENT
● Recycling - other names:
Total recycling
Waste recovery method
Zero waste management
Volume reduction method
● Sanitary land-fill
● Incineration
● Open dumping
● 3Rs: Reduce, reuse & recycle
●
●
●
AGE COMPOSITION
● Dependency ratio
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒𝑑 <15 𝑦𝑟𝑠 + > 65𝑦𝑟𝑠 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒𝑑 15−64𝑦𝑟𝑠 𝑜𝑙𝑑
●
●
FOOD SAFETY
The food establishment must have a sanitary
permit from the city or municipality that has
jurisdiction over the business
No person shall be employed in any food
establishment without a health certificate properly
issued by city/ municipal health officer
No person shall be allowed to work on food
handling while he/ she is afflicted with a
communicable disease, including boils, infected
wounds, respiratory infections, diarrhea and
gastrointestinal upset
●
●
●
●
FIELD HEALTH SERVICES AND INFORMATION
SYSTEM (FHSIS)
Reproductive age
Ability to conceive
Productive age
Ability to work
Below 18yrs old can work with consent of the
parent
Individual / family health record
Building blocks of information in the
healthcare system
Target/ client list
Used in monitoring compliance to treatment
E.g. list of patients undergoing TB treatment
Tally report
Prepared by RHU
E.g. tally of the morbidity case
Output report
Collation of tally reports
4 Rs
● Right source
● Right preparation
● Right cooking
● Right storage
●
●
PROCESS
Tally report (RHU)
↑
Output report (PHO)
↓
Regional Health Office
↓
National office, DOH
VITAL STATISTICS
Demography - the study of a population
Demographic data:
Population size
Population composition
Distribution of population in space
MEASURING POPULATION GROWTH
● Natural increase
How many is added
No. of births - no. of deaths
● Rate of natural increase
Speed of increase
Crude birth rate - crude death rate
o Crude birth rate: total number of births/
total number of population
o Crude death rate: total number of deaths/
total number of population
Ex. Philippines data, 2003
o 25.2/ 1000 population - 5.72/ 1000
population → 19.48/ 1000 → 1.95%
POPULATION COMPOSITION
SEX COMPOSTITON
● Sex ratio (M:F)
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠
SR = 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠 𝑥 100
-
𝑥 100
100 - equal males and females
> 100 - more males
< 100 - more females
TYPES OF DATA ACCORDING TO SOURCE
PRIMARY
● Census:
An official and periodic enumeration of
population
Data gathering about 100% of the population
Done every 5 years between June to July
De jure: place of usual residence
De facto: where people are physically present
at the time of census
● Experiment
SECONDARY
● Registry of vital events
Birth certificates
o May be signed by midwife or nurse
o Must be filed within 30 days and
submitted to the municipal hall
o Filed by the mother and signed by the
birth attendant
o In the hospital, the hospital files the birth
certificate
Death certificate
o Must be filed within 48hrs from the
occurrence of death
CRUZ, DCR | BATCH 2022 | 40
o
o
o
o
-
Death registry is almost complete →
mortality data most accurate data/ best
reflection of health status of a population
Signed by physician or mayor
If signed by mayor - unknown cause of
death
Submitted to the municipal where the
person died
SWAROOP’S INDEX
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 50𝑦𝑟𝑠 𝑜𝑙𝑑 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
●
High swaroop’s index means there is a good
indication that the health status of the population
MATERNAL MORTALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑝𝑟𝑒𝑔𝑛𝑎𝑛𝑐𝑦, 𝑙𝑎𝑏𝑜𝑟, 𝑎𝑛𝑑 𝑝𝑢𝑒𝑟𝑝𝑒𝑟𝑖𝑢𝑚
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 11 𝑚𝑜𝑛𝑡ℎ𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
PD 651: Birth Registration Law
●
●
●
Records and reports
Publications
Informal sources
NEONATAL MORTALITY RATE
●
●
●
FERTILITY RATES
Percentage distribution - 100
Small population of the barangay - 10000
Whole country/ large population - 100,000
●
●
●
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 28 𝑑𝑎𝑦𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
CRUDE BIRTH RATE
𝑥 1000
●
GENERAL/ TOTAL FERTILITY RATE
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
𝑁𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠 𝑜𝑓 𝑟𝑒𝑝𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑎𝑔𝑒
●
𝑇𝑜𝑡𝑎𝑙 𝑐𝑎𝑠𝑒𝑠 (𝑜𝑙𝑑+𝑛𝑒𝑤) 𝑜 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 100
●
●
INCIDENCE RATE
𝑥 100, 000
MORTALITY RATES
CRUDE DEATH RATE
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 1000
AGE-SPECIFIC DEATH RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎𝑛 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
●
●
𝑥 100, 000
CAUSE-SPECIFIC MORTALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
●
𝑥 100, 000
PROPORTIONATE MORTALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒/𝑎𝑔𝑒 𝑎𝑡 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
𝑥 1000
CASE FATALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
𝑁𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒
●
●
𝑥 100, 000
SEX-SPECIFIC DEATH RATE
𝑁𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒/ 𝑓𝑒𝑚𝑎𝑙𝑒 𝑑𝑒𝑎𝑡ℎ𝑠
𝑁𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠/ 𝑓𝑒𝑚𝑎𝑙𝑒𝑠
𝑥 1000
𝑥 1000
NARS
Nurses Assigned in Rural Service
Joining hands against global crisis
President Arroyo announced during her speech in
the Multi-Sectoral Jobs Summit at the Heroes Hall
in Malacañang the launch of the Nurses Assigned
in Rural Areas (NARS) program.
Those who will be hired under the program will
each receive P8,000 from the national government
aside from a P2,000 stipend given by local
governments to rural nurses.
𝑥 1000
MORBIDITY RATES
PREVALENCE RATE
𝑁𝑜. 𝑜𝑓 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 1000
INFANT MORTALITY RATE
RA 3753: Civil Registry Law
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 100
𝑥 100
Case fatality rate - killing power of the disease
RN HEALS
Registered Nurses for Health Enhancement And
Local Service
By PNoy
Currently the RN Heals nurses received a monthly
allowance of P8,000 from the DOH, the agency
according to Sec. Ona could receive a monthly
compensation of P16,000, if they will be hired or
regularized
NDP MECHANISMS
The nurse shall be hired with a Nurse 1, salary grade
11, monthly salary of P18,549 (2018)/ grade 15 P31,765
(2019)
Contract is for 6 months that can be renewed
based on satisfactory performance for a maximum
of 2 years.
Nurses who completed the project shall be:
awarded with a Certificate of Employment
COMMUNITY ORGANIZING
Community Development
An organized effort of people to improve the
conditions of the community life and the
capacity of the people for participation, self
direction, and integrated efforts in community
affairs in which development is accomplished
by the people
APPROACHES TO COMMUNITY DEVELOPMENT
● Social welfare/ Dole-out
CRUZ, DCR | BATCH 2022 | 41
The immediate and / or spontaneous response
to ameliorate the manifestation of poverty,
especially on the personal level
Assumes poverty is God given
The poor should accept their condition since
they will receive their just reward in heaven
Believes that poverty is caused by bad luck
and natural disaster
Not advocated in community organizing
o Causes dependence
Only acceptable during times of disaster
o E.g. distribute groceries, feed the
community
Modernization / Project Development
Poverty is caused by lack of education
Considered a national strategy which adopts
the
western
mode
of
technological
development
E.g. training, seminars
Participatory Action
Process of empowering/ transforming the poor
and the oppressed sectors of society so that
they can pursue more just and humane
society
Poverty is due to lack of cooperation
Key Solution: Cooperation and collaboration
o To develop self-reliance
-
●
●
●
●
●
●
●
●
●
●
PARTICIPATORY ACTION RESEARCH
Participatory action research (PAR) is an approach
to research that aims at promoting change among
the participants.
Members of the group being studied participate as
partners in all phases of the research, including
design, data collection, analysis, and dissemination
Work with the people, not for the people
Continuous and sustained process of:
Educating the people to understand and
develop their critical consciousness of their
existing conditions
Working with people to work collectively and
efficiently
Mobilizing the people to develop their
capability and readiness to respond to take
action on their immediate needs towards
solving their long term problems
PRINCIPLES OF COPAR
People, especially the most oppressed, exploited:
and deprived sectors are open to change, have the
capacity to change, and are able to bring about
change.
COPAR should be based on the interests of the
poorest sectors of society..
COPAR should lead to a self-reliant community and
society.
PHASES
PRE - ENTRY PHASE / PREPARATORY
Site / Area/ Community Selection
●
●
Courtesy Call to GU/ Barangay level
To get the approval of the leaders from LGUs
Community consultations / dialogues
Converse with the key persons of the
community (e.g. barangay captain, nurse)
Establish rapport
Gather data
CRITERIA FOR POTENTIAL SITE: SIPRAN
● Socio-economically depressed
● Inaccessible health services
● Poor community health status
● Relative peace and order situation
● Acceptance of the program by the community
● Not currently served by similar agencies/
organizations
●
●
●
ENTRY PHASE / PREPARATORY
Sensitization of the community / Integration/
Immersion/ Information Campaigns
Prepares the people in the community
Sensitization:
establish
rapport
in the
community by living in the community for 2
weeks
Social
investigations/
Community
Profiling
(Demographic,
Geography,
Socio-cultural,
Economic Indices, Environmental, Health Indices,
Physical/Infrastructure Resources)
Draw a clear picture of the community and
involve barangay health workers
Community Diagnosis/Research/Analysis
GUIDELINES IN INTEGRATION
● Recognize local authorities
● Adapt the lifestyle of the community
● Choose a modest dwelling
● Avoid expectation from the people.
● Be clear with your objectives & limitations
● Participate in the production process
● Participate in social activities
●
●
●
●
●
●
ORGANIZATION BUILDING/IMPLEMENTATION
Social Preparation through community assembly
Presents the problems
Political leaders are prohibited because of
political motives
Spotting Potential leaders
Core group Formation (SALT)
SALT: Self awareness Leadership Training
Formation of Organization/CommitteE
Planning Phase (SMART)
Mobilization/Implementation/ Action
They are responsible in implementing the
programs, we only facilitate and guide them
CRITERIA FOR SELECTION OF POTENTIAL LEADERS
● Belong to the poor sectors and classes and is
directly engaged in production
● Well respected by members of the community and
has relatively wide influence
CRUZ, DCR | BATCH 2022 | 42
●
●
●
●
Desirous of change and is willing to work for
change
Must be able to communicate effectively
SUSTENANCE AND STRENGTHENING /
MAINTENANCE PHASE
Evaluation
Criteria: Effectivity, Efficiency, Appropriateness,
Adequacy
Evaluates
how
the
programs
was
implemented
Impact evaluation
o How does the program affect the lives of
the family
o Qualitative study
Linkaging
Arrange partnerships, organize activities that
will entail participation of NGOs
Organizing activities in partnership with
government
and
non-government
organizations
METHODS OF ESTABLISHING PARTNERSHIP
NETWORKING
●
●
●
●
Exchanging information about the
organizational goals and objectives,
services or facilities
It provides awareness of the
organization’s
capabilities
to
accomplish the networks goals and
objective
COORDINATION
●
Modifying
the
organizations
activities responsive to the needs of
the community
COOPERATION
●
Sharing information and resources
to accommodate the organization’s
agenda
COLLABORATION
●
Assisting organization to enhance
their capacities in performing their
tasks and quality of services
COALITION
●
Forming partnership between the
organization and the members of
the community
PHASE OUT/EXIT
Documentation
Document of all activities done
Basis evaluation overall organizing program
Follow- up expansion
Is the program sustainable?
NOTE: All members must be involved in the
preparation/identification,
implementation
and
evaluation of the programs
● Terminal Goal: We want them to develop
self-reliant
● Principles: Change, self-reliance, benefit the poor
sectors of the society
CRUZ, DCR | BATCH 2022 | 43
IMCI STRATEGY
SICK CHILD AGE 2 MONTHS TO 5 YEARS OLD
ASSESS
CLASSIFY
IDENTIFY TREATMENT
GENERAL DANGER SIGNS
Check for General Danger Signs
● A child with any general danger
sign needs URGENT attention;
● Complete the assessment and any
pre-referral treatment immediately
so referral is not delayed.
Ask:
● Is the child able to drink or
breastfeed?
● Does the child vomit everything?
● Has the child had convulsions?
●
Any general danger sign
VERY SEVERE DISEASE
●
●
●
●
●
●
Give diazepam if convulsing now
Quickly complete the assessment
Give any pre-referral treatment
immediately
Treat to prevent low blood sugar
Keep the child warm
Refer URGENTLY
Look
● See if the child is lethargic or
unconscious.
● Is the child convulsing now?
PNEUMONIA
Ask
● Does the child have cough or
difficulty of breathing
● If yes, how long
Look, listen and feel:
● Count the breaths in one minute.
● Look for chest CHILD indrawing
● Listen for stridor: child must be
calm
Look and listen for wheezing.
●
●
●
Any general danger sign or
Stridor in calm child.
SEVERE PNEUMONIA OR VERY
SEVERE DISEASE
●
●
●
●
Chest indrawing or
Fast breathing.
PNEUMONIA
●
●
CRUZ, DCR | BATCH 2022 | 44
Give first dose of an appropriate
antibiotic
Refer URGENTLY to hospital
Give oral Amoxicillin for 5 days*** If
wheezing (or disappeared after
rapidly acting bronchodilator) give
an inhaled bronchodilator for 5 days
If chest indrawing in an HIV
exposed/infected child, give the first
dose of amoxicillin and refer.
●
●
If wheezing with either fast
breathing or chest indrawing: Give a
trial
of rapid acting inhaled
bronchodilator for up to three times
15-20 minutes apart.
Count the breaths and look for
chest indrawing again, and then
classify.
2 months to 12months: Fast
breathing is: 50 breaths per
minute or more
12 months to 5 years: 40
breaths per minute or more
●
●
●
●
●
No signs of pneumonia or very
severe disease
COUGH OR COLD
●
●
●
●
●
Soothe the throat and relieve the
cough with a safe remedy
If coughing for more than 14 days or
recurrent wheeze, refer for possible
TB or asthma assessment
Advise mother when to return
immediately
Follow-up in 3 days
If wheezing (or disappeared after
rapidly acting bronchodilator) give
an inhaled bronchodilator for 5 days
Soothe the throat and relieve the
cough with a safe remedy
If coughing for more than 14 days or
recurrent
wheezing,
refer
for
possible TB or asthma assessment
Advise mother when to return
immediately
Follow-up in 5 days if not improving
DEHYDRATION
Ask
● Does the child have diarrhea?
● If yes, ask for how long? Is there
blood in the stool
Look and feel
at
the
child's
general
● Look
condition.
Is the child: Lethargic or
unconscious?
Restless and irritable?
● Look for sunken eyes. Offer the child
fluid.
Is the child: Not able to drink or
drinking poorly?
Drinking eagerly, thirsty?
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
SOME DEHYDRATION
CRUZ, DCR | BATCH 2022 | 45
●
If child has no other severe
classification: Give fluid for severe
dehydration (Plan C) OR
If child also has another severe
classification: Refer URGENTLY to
hospital
with
mother
giving
frequent sips of ORS on the way
Advise the mother to continue
breastfeeding
If child is 2 years or older and there
is cholera in your area, give
antibiotic for cholera
Give fluid, zinc supplements, and
food for some dehydration (Plan B)
●
Pinch the skin of the abdomen.
Does it go back: Very slowly
(longer than 2 seconds)?
●
Skin pinch goes back slowly.
●
●
●
●
●
Not enough signs to classify as
some or severe dehydration
NO DEHYDRATION
●
●
●
●
If diarrhea is 14 days or more
●
Dehydration present
SEVERE PERSISTENT DIARRHEA
●
●
●
No dehydration present
PERSISTENT DIARRHEA
If blood in the stool
●
Give fluid, zinc supplements, and
food to treat diarrhea at home (Plan
A)
Advise mother when to return
immediately
Follow-up in 5 days if not improving
Treat dehydration before referral
unless the child has another severe
classification
Refer to hospital
●
Advise the mother on feeding a
child
who
has
PERSISTENT
DIARRHEA
Give multivitamins and minerals
(including zinc) for 14 days
Follow-up in 5 days
DYSENTERY
●
●
Give ciprofloxacin for 3 days
Follow-up in 3 days
VERY SEVERE FEBRILE DISEASE
●
Give first dose of artesunate or
quinine for severe malaria
Give first dose of an appropriate
antibiotic
●
●
●
If
child
also
has
a
severe
classification: Refer URGENTLY to
hospital
with
mother
giving
frequent sips of ORS on the way
Advise the mother to continue
breastfeeding
Advise mother when to return
immediately
Follow-up in 5 days if not improving
Blood in stool
MALARIA
Ask
● Does the child have a fever?
● If yes: Decide Malaria Risk: high or
low
● Then ask: For how long?
●
Any general danger sign or \Stiff
neck.
●
CRUZ, DCR | BATCH 2022 | 46
-
If more than 7 days, has fever
been present every day?
Has the child had measles
within the last 3 months?
●
●
●
Malaria test POSITIVE
MALARIA
Look and feel
● Look or feel for a stiff neck.
● Look for a runny nose.
● Look for any bacterial cause of fever
● Look for signs of MEASLES.
● Generalized rash and
● One of these: cough, runny nose, or
red eyes.
Do a malaria test:
● In all fever cases if High malaria risk.
● Low malaria risk if no obvious cause
of fever present.
●
●
●
●
●
●
●
Malaria test NEGATIVE
Other cases of fever PRESENT
FEVER
NO MALARIA
●
●
●
●
●
No Malaria Risk and No Travel to
Malaria Risk Area
●
●
Any general danger sign
Stiff neck.
VERY SEVERE FEBRILE DISEASE
●
●
●
●
●
No general danger signs
No stiff neck.
FEVER
●
●
●
●
CRUZ, DCR | BATCH 2022 | 47
Treat the child to prevent low blood
sugar
Refer URGENTLY to hospital
Give recommended first line oral
antimalarial
Give
appropriate
antibiotic
treatment for an identified bacterial
cause of fever
Advise mother when to return
immediately
Follow-up in 3 days if fever persists
If fever is present every day for more
than 7 days, refer for assessment
Give
appropriate
antibiotic
treatment for an identified bacterial
cause of fever
Advise mother when to return
immediately
Follow-up in 3 days if fever persists
If fever is present every day for more
than 7 days, refer for assessment
Give the first dose of an appropriate
antibiotic.
Treat the child to prevent low blood
sugar.
Refer URGENTLY to the hospital.
Give
appropriate
antibiotic
treatment
for
any
identified
bacterial cause of fever
Advise mother when to return
immediately
Follow-up in 2 days if fever persists
If fever is present every day for more
than 7 days, refer for assessment
●
There is presence of measles now or
last 3 months
●
●
●
Any general danger sign or
Clouding of cornea or
Deep or extensive mouth ulcers.
SEVERE COMPLICATED MEASLES
●
●
●
●
●
●
Pus draining from the eye or
Mouth ulcers.
MEASLES WITH EYE OR MOUTH
COMPLICATIONS
●
Give Vitamin A treatment
If pus draining from the eye, treat
eye infection with tetracycline eye
ointment
If mouth ulcers, treat with gentian
violet
Follow-up in 3 days
MEASLES
●
Give Vitamin A treatment
MASTOIDITIS
●
Give first dose of an appropriate
antibiotic
Give first dose of paracetamol for
pain
Refer URGENTLY to hospital
●
●
●
●
Measles now or within the last 3
months.
Give Vitamin A treatment
Give first dose of an appropriate
antibiotic
If clouding of the cornea or pus
draining from the eye, apply
tetracycline eye ointment
Refer URGENTLY to hospital
EAR PROBLEM
Ask
● Does the child have an ear
problem?
● If yes, ask: Is there ear pain? Is there
ear discharge?
● If yes, for how long?
●
●
●
●
Look and feel:
● Look for pus draining from the ear.
● Feel for tender swelling behind the
ear.
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.
ACUTE/ CHRONIC EAR INFECTION
No ear pain and No pus seen
draining from the ear.
CRUZ, DCR | BATCH 2022 | 48
●
Give an antibiotic for 5 days Give
paracetamol for pain
Dry the ear by wicking Follow-up in
5 days
Dry the ear by wicking Treat with
topical quinolone ear drops for 14
days
Follow-up in 5 days
●
No treatment
●
●
●
NO EAR INFECTION
MALNUTRITION
●
●
●
●
●
●
●
Look for signs of acute malnutrition
Look for edema of both feet
Determine WFH/L __ z-score
Measure MUAC __ min in a child 6
months or older
If WFH/L less than -3 z-scores or
MUAC less than 115mm then:
Check for any medical complication
present:
Any general danger signs
Any severe classification
Pneumonia
with
chest
indrawing
If no medical complications present:
Child is 5 month or older, offer
RUTF to eat
o Is the child not able to
finish the RUTF portion?
o Able to finish RUTF potion
Child is less than 6 months,
assess breastfeeding
●
●
●
●
●
Edema of both feet or
WFH/L less than -3 z-scores or
MUAC less than 115mm and any one
of the following:
Medical complication present
Not able to finish RUTF
Breastfeeding problem
WFH/L less than -3 z-scores or
MUAC less than 115mm and
Able to finish RUTF
COMPLICATED SEVERE ACUTE
MALNUTRITION
●
●
●
●
UNCOMPLICATED SEVERE ACUTE
MALNUTRITION
●
●
●
●
●
●
●
●
WFH/L between -3 z-scores and -2
z-scores or
MUAC 115mm to 125mm
MODERATE ACUTE MALNUTRITION
●
●
●
●
●
●
●
WFH/L-2 z-scores or more or
MUAC 125 mm or more
NO ACUTE MALNUTRITION
●
●
CRUZ, DCR | BATCH 2022 | 49
Give first dose appropriate antibiotic
Treat the child to prevent low blood
sugar
Keep the child warm
Refer urgently to the hospital
Give oral antibiotic for 5 days
Give ready to use therapeutic food
for a child aged 6 months and
above
Counsel the mother on how to feed
the child
Assess for possible TB infection
Advise mother when to return
immediately
Follow up in 7 days
Assess the child’s feeding and
counsel the mother on feeding
recommendations
If feeding problem, follow up in 7
days
Assess for possible TB infection
Advise mother when to return
immediately
Follow up in 30 days
If child is less than 2 years old, assess
the child’s feeding and counsel the
mother on feeding according to the
feeding recommendations
If feeding problem, follow up in 7
days
ANEMIA
Look
● Look for palmar pallor.
Is it: Severe palmar pallor?
Some palmar pallor?
●
Severe palmar pallor
●
Some pallor
SEVERE ANEMIA
●
●
Refer URGENTLY to hospital
If a child has severe acute
malnutrition and is receiving RUTF,
DO NOT give iron because there is
already an adequate amount of iron
in RUTF
ANEMIA
●
●
Give iron
Give mebendazole if child is 1 year or
older and has not had a dose in the
previous 6 months
Advise mother when to return
immediately
Follow-up in 14 days
●
●
●
No anemia
NO ANEMIA
●
●
If child is less than 2 years old, assess
the child's feeding and counsel the
mother according to the feeding
recommendations
If
feeding
problem
Follow-up in 5 days
HIV INFECTION
●
Use this chart if the child is not
enrolled in HIV care
●
●
Positive virological test in child or
Positive serological test in a child 18
months or older
CONFIRMED HIV INFECTION
Ask
● Has the mother or child had an HIV
test
● If yes: decide HIV status
Mother: positive or negative
Child:
o Serological test positive or
negative
●
●
●
●
●
●
]
CRUZ, DCR | BATCH 2022 | 50
Initiate ART treatment and HIV care
Give cotrimoxazole prophylaxis
Assess the child’s feeding and
provide appropriate counseling to
the mother
Advise the mother on home care
Asses or refer for TB assessment and
INH preventive therapy
Follow up regularly as per national
guidelines
Serological test positive or
negative
If the mother is HIV positive and
child is negative or unknown, ask:
Was the child breathing at the
time or 6 weeks before the
test?
Is the child breastfeeding now?
If breastfeeding, ask: is the
mother and child on ARV
prophylaxis
If no, then test:
Mother
and
child
status
unknown: test the mother
Mother HIV positive and child
status unknown: test the child
NOTE: Give cotrimoxazole prophylaxis to
al HIV infected and HIV exposed
children until confirmed negative after
cessation of breastfeeding
o
●
●
●
●
●
●
Mother HIV-positive and negative
virolgovail test in a breastfeeding
child or only stopped less than 6
weeks ago or
Mother HIV-positive, child not yet
tested or
Positive serological test in a child
less than 18 months old
HIV EXPOSED
●
●
●
●
●
●
●
Negative HIV test in mother or child
HIV INFECTION UNLIKELY
CRUZ, DCR | BATCH 2022 | 51
●
Give cotrimoxazole prophylaxis
Start or continue ARV prophylaxis
as recommended
Do virological test to confirm HIV
status
Assess the child’s feeding and
provide appropriate counseling to
the mother
Advise the mother on home care
Follow-up regularly as per national
guidelines
Treat,
counsel
and
existing infections
follow-up