COMMUNITY

HEALTH

NURSING
Community
- a group of people with common
characteristics or interest living together withina
territory or geographical boundary.
Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
 - combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas
4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
 4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health
- is the state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. (World Health Organization)
Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
 9. Health services
10. Gender
New concept in determinants of health
- OLOF (Optimum Level Of
Functioning) Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
 5. Socio-Economic – education, employment, housing 6.
Health Care Delivery System – availability, accessibility
and affordability of services and facilities
Nursing
- an art and science of rendering care to
individual, families and community.

- assisting an individual, sick or well, in the

performance of those activities contributing to
health or its recovery in such a way as to help gain
independence. (OLOF)
Community Health Nursing
- a direct goal oriented and adaptable to the needs
of the individual, the family and community during health
and illness.
- (ANA, 1973)
- an area of human services directed toward
developing and enhancing the health capabilities of
people – either singly, as an individual or collectively as
groups and communities.
- (John Henrich, 1981)
- the utilization of the nursing process in different
level of clientele concerned with the promotion of health,
prevention of disease and disability and rehabilitation.
- (Aracelli Maglaya)

*** a service rendered by a professional nurse

with the community, groups, families and individuals
 at home, in health centers, in clinics, in schools, in
places of work for the promotion of health, prevention
of illness, care of the sick at home and rehabilitation.
PRIMARY GOAL OF CHN:
- Enhance people’s
capability.

ULTIMATE GOAL OF CHN:

- “ To raise the level of
health of the citizenry.”
PHILOSOPHY OF CHN:
- CHN is based on the
worth and dignity of man.
- (Margaret Shetland)
EMPHASIS/FOCUS:
- Health promotion and
Disease prevention.
Important Concepts of CHN:
1. The primary focus of CHN is on health promotion.
2. Recognized needs of individuals, families and
communities provide the basis for CHN.
3. The family is the unit of service.
4. Contact with the client may continue over a long period
of time which include all ages and all types of health care.
5. CH nurses are generalists in terms of their practice
throughout life’s continuum –its full range of health
problems and needs.
6. CHN practice is extended to benefit not only the
individual but the whole family and community
Roles and Functions of CH Nurse:
1. Advocate
- defends the rights of the client for self-determination
- intercedes, supports, pleads or acts as guardian of the
client’s rights to autonomy and free choice for self-care
2. Supervisor
- provides administrative support
- oversees, monitors and evaluates the function of the
subordinates
3. Counselor
- encourages client to verbalize and express feelings and
concerns
 - key task is active listening
4. Educator
- teaches the client to provide skills, knowledge and
attitude
- primary task is to assess readiness to learn
5. Trainer
- provides technical support
- identifies training needs, formulates training program
designs
- arranges and conducts training to provide learning
experiences to subordinates and clients
Levels of Clientele:
1. Individual
- “point entry”
2. Family
- center of delivery of care.
3. Group
- point of specific care.
4. Community
- point of entire care
PLACES IN CHN:
A. Public Health Nursing
- is a special field of nursing that combines the skills of
nursing, public health and some phases of social assistance and
functions as part of the total health program.

Public Health
- the science and art of preventing disease, prolonging
life and promoting life and efficiency. (C. E. Winslow)
- is the art of applying science in the context of politics to
reduce inequalities while ensuring the best health for the
greatest number. (WHO)
B. School Health Nursing
> Home Visitation – effective implementation of total school
program
> RA 124 – it mandates the school to provide clinics for the
minor treatment and attendance to emergency cases >
Assessment:
1. Arms 5. Ears
2. Eyes and Visual Acuity 6. Neck and Chest
3. Nose 7. Hair
4. Mouth and Teeth 8. Lower extremities
> Feeding Program
- Should run for 120 days
 - Deworming with consent
C. Occupational Health Nursing

> RA 1054
– Occupational Health Act

> Business Firm must employ an occupational health nurse

when it has at least _____________?
101 employees
FAMILY – NURSE CONTACT:
I. HOME VISIT
-Home visit or nursing visit is a professional face to
face contact done by a nurse to an individual, family
or a group in a community on behalf of a case to
further relay the special activity of the agency.
-The home visit is a family- nurse contact which
allows the health worker to assess the home and
family situations in order to provide the necessary
nursing care and health related activities.
 - In performing this activity, is essential to prepare a
plan of visit to meet the needs of the client and
achieve the best results of desired outcomes.

Purposes:
1. To give nursing care to the sick, post partum mother &
her newborn with the view to teach a responsible
member of a family to give subsequent care.
2. To assess living condition of client and his family and
their health practices in order to provide an appropriate
health teachings.
3. To Give health teachings regarding the prevention and
control of diseases.
4. To establish relationship with health agency and public
for the promotion of public health.
5. To make use of inter-referral system and to promote the
utilization of community services.

Principles:
1. Must have a purpose and objective.
2. Make use available information about the patient and his
family.
3. Consider and prioritize essential needs of the individual
and family.
4. Should involve the individual and family in planning and
delivery of care.
5. Plan should be flexible.

Preparation:
1. Assemble records of the cases to be visited and
investigated for health supervision and nursing care.
2. List their names and address in duplicate form in order of
visit. Take one list with you for your guide and leave in
 your box the copy to acquaint the supervision of your
whereabouts.
Example;
Name Address Purpose of visit
Pacarasia Duforte Millora, Lucao dst To give nursing care
To ppartum mother
And health teachings
3. Clip the list on cover of bag for your guide.
4. Provide yourself with ballpen with ink or pencil and
eraser, watch with second hand, information about the
 prevailing condition in the district and an umbrella,
raincoat and rubber shoes during the rainy season.

Arrangement of visit:
1. Nursing care to postnatal cases.
2. Health supervisionvisit to prenatals and infants.
3. Visit to patients with communicable diseases.

Important Steps of Home Visit:

1. Greet client and family then introduce yourself.
2. Explain the purpose of the visit.
3. Observe the patient and determine the health needs.
4. Look for a place to put down the bag or a table or chair
six feet away from the bedside. Line the table with
newspaper (as a paperline) before putting down the bag.
See the patient and determine the need.
5. Perform nursing care and give health teachings.
6. Record all important data, observation and care
rendered.
7. Make appointment for a return visit.
Phases:
1. Preparatory Phase
a. review existing records of referral data of the family
b. notifies the family of the intention to make a home
visit
2. Home Visit Phase
a. actual visits of the family
b. makes plans, interventions, evaluation with the family
and set schedule for the next visit
3. Post Visit Phase
a. records data and plans for the next visit and referrals
Priorities During Home Visit:
1. Newborn
2. Post partum
3. Pregnant women
4. Morbid individuals

Factors affecting Frequency of Home Visit:

1. Physical, psychological and educational
2. Acceptance of family
3. Policies given by the agency
4. Consider other health agencies and number of
personnel already involved
5. Depends on a careful evaluation of past services given
to family
6. Ability of the family to recognize their own needs. Their
knowledge to available resources, and ability to utilize
those resources.

Priorities:
a. Expectant mothers who do not have a prenatal
check up.
b. Those who do not visit a clinic for one reason or
another.
c. Those which the clinic Dr. requested for a follow
up home visit

Components of a Home visit:

1. Planning for a visit
2. Approach and introduction
3. Activity during the visit
4. Summary and evaluation
 Bag Technique:
- a tool making use of a public health bag and which
the public health nurse can perform procedures during
home visits.

Rationale :
- Helps render effective nursing care to clients.

Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
3. To systematize the procedure so as to give care and
adeptness for effective performance.
*** Open bag TWICE during home visit.

Special Consideration:

B
- bag and its contents must be free from any
contamination.
A
 - always perform handwashing.
G
- gather necessary equipments to render effective
nursing care.
•
Steps in Performing The Bag Technique Actions:

1. Upon arrival, place the bag on the table lined with a clean
paper. (the clean side must be out and folded part,
touching the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific
care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used
and perform handwashing.
10. Open the bag and return all things that were used in their
proper place
 11. Remove apron, folding it away fro the person, the soiled
side in and the clean side out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.
II. CLINIC VISIT
Advantage:
- it is inexpensive in time and usually in cost both for the
service and for the family.
Standard Procedure in Conducting Clinic Visit:
I. Registration/Admission
 1. Greet the client and establish rapport
2. Prepare records
3. Elicit client’s chief complaint and clinical history
4. Perform PEII. Waiting Time
* Implement the “first come”, “first served” except for
emergency and urgent cases
III. Triaging
* Manage program-based cases
* Refer all non-program based cases
IV. Clinical Evaluation
* Validate clinical history and PE
 * Inform client of the nature of the illness, treatment,
prevention and control measures
V. Laboratory and other diagnostic examinations
* Identify a designated referral laboratory when needed
VI. Referral System
1. Refer if needs further management (BHS to RHU,
RHU to RHU, RHU to Hospital)
2. Accompany patient if it is an emergency
referralVII. Prescription/ Dispensing
* Give proper instructions on drug intakeVIII. Health
Education
1. Conduct one-on-one counseling with the patient
 2. Reinforce health education and counseling messages
3. Give appointments for the next visit
Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
 b. follow-up care
c. referral (if possible)
PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR

Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.
Vision :
Health for All Filipinos

Goal :
Health for All Filipinos and Health in the Hands of the
people by the Year 2020

Mission :
 In partnership with the people, provide equity, access
and quality health care especially to the marginalized
Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5. Partnership between the community and the health
agencies in provision of quality life
6. Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization
RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
 - Devolution Code (Mandate of Devolution)
Local Government Code
Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
 - BHW
- PHW
4 Pillars/Cornerstones:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available

Levels of PHC Workers:

1. Village or Brgy. Health Workers
 - health auxiliary or volunteers
2. Intermediate Level Health Workers
- Physician - Sanitary Inspector
- Nurse - Midwife
Ratios to catchment population:
Public Health Worker = 1:50,000
Public Health Physician = 1:20,000
Public Health Nurse = 1:20,000
Public Health Midwife = 1: 5,000
Dentist = 1:20,000
 LEVELS OF PREVENTION
1.Primary Prevention
- health promotion
- specific protection
Behaviors:
1. Quit smoking
2. Avoid/limit alcohol intake
3. Exercise regularly
4. Eat well-balance diet
5. Reduce fat and increase fiber in the diet
 6. Complete immunization program
7. Wear hazard devices in work site
2. Secondary Prevention
- early
diagnosis/detection/screening
- prompt
treatment Behaviors:
1. Have annual physical examination
2. Regular Pap smear for women
3. Monthly BSE for women who are 20 yrs old and above
 4. Sputum examination for Tuberculosis
5. Annual stool Guaiac test and rectal exam for clients
over age 50 yrs old
3. Tertiary Prevention
- prevention of complication
- optimal health status after a
disease or disability Behaviors:
1. Self-monitoring of blood glucose among diabetics
2. Physical therapy after CVA
3. Attending self-management education for diabetes
 4. Undergoing speech therapy after laryngectomy
Levels of Health Care and Referral System

1. Primary Level of Care

1. Rural Health Units
2. Community Hospitals and Health Center
3. Private Practitioners (Puericulture Centers)
4. Brgy. Health Stations
- is usually the first contact between the community
members and the others levels of health facility.
 - provided by center physicians, public health nurses,
rural health midwives, barangay health workers,
traditional healers
2. Secondary Level of Facilities
1. Provincial/City Health Services and Hospitals
2. Emergency and District Hospitals
- serves as a referral center for the primary health
facilities
- are capable of performing minor surgeries and perform
some simple laboratory examinations
3. Tertiary Level of Facilities
1. National and Regional Health Services
2. Teaching and Training Hospitals
- serves complicated cases and intensive care
ALTERNATIVE HEALTH CARE

Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act

* created the Philippine Institute of Traditional and

Alternative Health Care
 ** S A N T A L U B B Y **
S - Sambong
* anti-edema, diuretic,
anti-urolithiasis A - Ampalaya
* DM
N - Niyog-niyogan
* anti-helmintic T- Tsaang Gubat
* diarrhea, stomachache, mouth
washA - Akapulko (Bayabas-bayabasan)
* anti-fungal
L - Lagundi
* asthma, cough, fever, dysentery, skin
diseasesU - Ulasimang Bato (Pansit-pansitan)
* lowers uric acidB - Bawang
* lowers cholesterol levels, hypertension,
toothache
B - Bayabas
* washing of wounds, diarrhea, gargle for toothache
Y - Yerba Buena
 * pain, rheumatism, arthritis, headache, cough and
colds, swollen gums, toothache, menstrual and gas
pain, nausea, fainting, insects bites and pruritus
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
 7. If signs and symptoms are not relieved after 2 or 3
doses, consult a doctor.
DOH
(Department of Health)
Vision:
- A leader, staunch advocate and model in
promoting health for all in the Philippines.

Mission:
 - Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor and shall
lead the quest for excellence in health.
3 Roles and Functions of DOH:
- Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health
policies, plans and programs to address national and sectoral
concerns.
2. Administrator of Specific Service
 - administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.
Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA) Framework
for its Implementation:
- FOURmula One for Health --- *Arroyo
- Universal HealthCare (Kalusugan Pangkalahatan)
---*Aquino ( Executive Order 36)
 ---Phil. Health Agenda (Pres. Duterte)
ALL FOR HEALTH TOWARDS HEALTH FOR ALL

Goals:
1. Financial Protection
2. Better Health Outcomes
3. Responsiveness
Values:
1. Equitable and inclusive to all
2. Transparent and accountable
3. Uses resources efficiently
 4. Provides high quality servicesStrategies:
1. Advance quality, health promotion and primary care.
2. Cover all Filipinos against health-related financial risk.
3. Harness the power of strategic HRH development.
4. Invest in eHealth and data for decision-making.
5. Enforce standards, accountability and transparency.
6. Value all clients and patients, especially the poor, marginalized
and vulnerable.
7. Elicit multi-sectoral and multi-stakeholder support for health.
8 MILLENIUM DEVELOPMENT GOALS
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

- based on the fundamental values of freedom, equality,

solidarity, tolerance, health, respect for nature and shared
responsibility.
PHILIPPINE REPRODUCTIVE HEALTH

Goal:
- To achieve “Better Quality Life among Filipinos”

*Responsible Parenthood and Reproductive Health Act of 2012

- RA 10354

Local Framework Focuses on:

 - Health needs of women, men, adolescents, children
and underserved groups.
Main objectives:

1. Reducing maternal mortality rate.

2. Reducing child mortality.
3. Halting and reversing spread of HIV/AIDS.
4. Increasing access to reproductive health information and
services.
10 Elements:
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention and Management of Reproductive Tract Infections
including STIs and HIV/AIDS
5. Prevention and Management of Abortion and its Complication
6. Education and Counseling on Sexuality and Sexual Health
7. Prevention and Management of Breast and Reproductive Tract
Cancers and other Gynecological Conditions.
8. Men’s Reproductive Health
9. Violence Against Women and Children
10. Prevention and Management of Infertility and Sexual
Dysfunctions
t
PHILIPPINE FAMILY PLANNING PROGRAM

*** Principal recipients of information, education,

communication and motivation in family planning:
- married couples of reproductive age
*** It requires all couples who want to receive a marriage license
to first undergo a seminar in family planning and responsible
parenthood
- PD 965
Advantages:
1. FP helps families improve their standard of living
2. FP reduces/eliminates fears of unwanted pregnancy
t
3. FP affords family members time to study or pursue
occupational interest
Major target (High Risk Women):
1. Women under 20 years old
2. Women over 35 years old
3. Women suffering from certain medical conditions that
contradict pregnancy
4. Women who have had at least 4 deliveries

*** The Family Code of the Philippines?

- Executive Order No. 209
The Family Planning Methods:
t
1. Female Sterilization
- safe and simple surgical procedure which provides
permanent contraception for women who do not want more
children. Also known as BTL that involves cutting or blocking the
two fallopian tubes.
- performed during first 2 weeks of her menstrual cycle or
within the first 3 days after delivery.
2. Male Sterilization
- permanent method wherein the vas deferens (passage
of sperm) is tied and cut or block through a small opening on the
scrotal skin. It is also known as Vasectomy.
3. Pill
t
- contains hormones estrogen and progesteron taken
daily to prevent contraceptions. Advised for women who are
anemic because of the reduced menstrual flow.
- taken some time everyday preferably at night.
Common side effects:
- dizziness, headache, nausea, spotting, weight gain,
breast fullness.
Adverse effects: Contraindications:
1. Abdominal pain 1. pregnancy or suspected
2. Chest pain 2. history of diabetes
3. Headache 3. high blood pressure
4. Eyes blurred 4. weak heart
5. Severe leg pain 5. CA of the breast
t
6. over 50 years old
Important facts to remember about a Pill
1. Pill are advised for women who are anemic because of the
reduced menstrual flow
2. Take pill same time everyday
3. A packet of pills contain 28 tablets; 21 pills are “active pills”, 7
contain no hormones, only iron
4. Follow the direction of the arrows of the pill. When empty, start
a new pack on the next day without missing a day
5. For 1 missed pill: take the pill as soon as possible; take regular
pill at night
6. For 2 missed pill: take 2 pills next day, then take 2 pills the next
day again
t
7. For 3 missed pill: discard and substitute method, start on next
pack on next menstrual period.
4. Male Condom
- thin sheath of latex rubber made to fit on a man’s erect
penis to prevent the passage of sperm cell and sexually
transmitted disease organism into the vagina.
- the shelf life is 3 years in the Phils., if stored in a cool dry
place.
5. Injectables
- contain synthetic hormones, progestin which
suppresses ovulation, thickens cervical mucus, making it difficult
for sperm to pass through and changes uterine lining.
6. Basal Body Temperature
t
- used to measure changes of temperature during
ovulation. Temp. slightly decreases before ovulation and
increases during ovulation day. It must be measured on the same
time of the day, before rising, with the same thermometer.
7. Lactating Amenorhea Method or LAM
- temporary introductory postpartum method of
postponing pregnancy based on physiological infertility
experienced by Breast Feeding women.
Criteria:
1. Amenorrhea
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 months
8. Mucus/Billings/Ovulation
t
- abstaining from sexual intercourse during fertile (wet)
days prevent s pregnancy.
9. Abstinence
- best way to prevent pregnancy and STI’s
10. Sympto-Thermal Method
- method in identifying the fertile and infertile days of the
menstrual cycle as determined through a combination of
observations made on the cervical mucus, basal body temp
recording and other sign of ovulation.
11. IUD
- changes the nature of internal secretions of woman’s
body., disturbs transport and decreases number of viable sperms
Contraindications:
t
1. PID
2. Septic Abortion
3. Endometritis
4. Anemia
5. Suspected pregnancy
Adverse effects:
1. Period that is late
2. Abdominal pain
3. Increase in temperature
4. Noticeable discharge – foul smelling
5. Severe bleeding
> an outpatient procedure; examined 1 month after insertion,
then after 6 months then after 1 year.
t
12. Standard Days Method
- A new method of natural family planning in which all
users with menstrual cycles between 26 and 32 days are
counseled to abstain from sexual intercourse on days 8-19 to
avoid pregnancy.
-The couples use color coded cycle beads to mark the fertile
and infertile days of the menstrual cycle.
NUTRITION PROGRAMS

Goal:
-To improve the quality life of Filipinos through
better nutrition, increased productivity and improved
health.

3 Most Common Deficiencies:

1. Iron
2. Vitamin A
3. Iodine
Programs and Projects:
1. Micronutrient Supplementation
- is one of the interventions to address the health and nutritional
needs of infants and children and improve their growth and
survival.
* Araw ng Sangkap Pinoy (ASAP), Garantisadong Pambata
- addresses health and nutritional needs of 6-71 months old
2. Food Fortification
- to improve the nutritional status of the populace including
children.
- legal basis: RA 8976
4 Food Staples that require Mandatory Fortification:
 1. Rice with Iron 3. Oil with Vitamin A
2. Sugar with Vitamin A 4. Flour with Iron and Vitamin A
3. Essential Maternal and Child Health Services
- this ensures the right of the child to survival, development,
protection and participation.
4. Nutrition, information, communication and education
- promotion of 10 Nutritional Guidelines for Filipinos.

1. Eat variety of foods everyday.

2. Promoting exclusive breastfeeding from birth up to 4-6 months.
3. Giving proper advice on proper feeding of children.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calcium-rich foods.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe foods to prevent food-borne diseases.
10. Promoting healthy lifestyles.
5. Home, School and Community Food Production
- establishment of kitchens, gardens in home, schools and in
communities in urban and rural areas.
6. Food Assistance
- it involves complementary feeding for wasted/stunted children
and pregnant women with delivering low birthweight.
7. Livelihood Assistance
- provision of credit and livelihood opportunities to poor
households especially those with malnourished children through
linkage with lending and financial institutions.
Control of Acute Respiratory Infection (CARI)
Objective:
Reduce mortality through early detection.

Contributing Factors to Pneumonia:

1. Mothers failure to recognize signs and symptoms of
Pneumonia.
2. Indiscriminate use of antibiotics.
3. Not standardized management to Pneumonia Sign of Severe
Pneumonia:
- Chest Indrawing
Important Responsibility of the Nurse in preventing unnecessary
death from Pneumonia:
- Provision of careful assessment
National Cancer Control Program
9 Warning Signs:
C – change in blood, bowel/bladder habits
A – a sore that does not heal
U – unusual bleeding/discharge
 T – thickening or lump in breast
I – indigestion or difficulty in swallowing
O – obvious change in wart or mole
N – nagging cough or hoarseness

U – unexplained anemia
S – sudden unexplained weight loss
Specific Guidelines for Early Detection of Common Cancers
1. Breast Cancer
A. BSE - cheapest and most affordable
 - done 1 week after menstrual period while
taking a shower
B. Mammography
- if a mass detected and confirmed
2. Cervical CancerA. Pap Smear
- primary screening tool for women over age 18
3. Colon Rectal Cancer
A. Annual digital rectal exam starting at age 40
B. Annual stool blood test starting at age 50
C. Annual inspection of colon
4. Prostate Cancer
A. Digital rectal exam
B. PSA (prostate Specific Antigen) – confirms
diagnosis
5. Lung CancerA. Chest X-ray
B. Sputum Cytology
LEVELS OF PREVENTION:

Primary Prevention:
 - elimination of conditions causing cancer
Secondary Prevention:
- Definitive Treatment and Management
(a.) Chemotherapy, (b.) Radiation, (c. )Surgery
Tertiary Prevention:
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
National Voluntary Blood Services Program
 - promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood
banks.
Legal basis:
RA 7719 “Blood Services Act of 1994”
Criteria for Eligible donor:
B = BP 90/60 – 160/100mmHg
A. = 16 – 65 years old
W = 45 – 50 kgs minimum
A = At least 12.5 hemoglobin
S = Status in good condition
Main Objectives:
1. to promote and encourage voluntary blood donation
by the citizenry and to instill public consciousness of the
principle that blood donation is a humanitarian act

2. to provide adequate, safe, affordable and equitable

distribution of supply of blood and blood products

3. to mobilize all sectors of the community to participate

in mechanisms for voluntary and non-profit collection of
blood
Steps to donate:
1. Go to the nearest center
2. Register a s a donor
3. History taking
4. Vital signs, PE taking
5. Blood test with blood typeMust do after
donated blood:
1. Eye on dressing at least 8 hours but not more than 12
hours
2. No lifting heavy objects
3. No smoke for 2 hours, no alcohol for 12 hours
 4. Eat regular meals and increase fluids
National TB Control Program
Vision:
- A country where TB is no longer a public health problems.

Mission:
- Ensure that TB DOTS services are available, accessible and
affordable to the communities.

Treatment:
- Quality of SDF (Single Dose Formulation) & FDC (Fixed
 Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1st specimen – SPOT specimen collected on the day of
consultation
2nd specimen – early morning specimen on the next day
3rd specimen – SPOT specimen collected on the 2nd day after
submission of early morning specimen
2. Chest X-ray
- to identify the extent of the disease
3. Tuberculin Testing/Mantoux Test/PPD Testing
TB Treatment:
TB Abbreviation
SDF OLD NEW
Rifampicin R R
Isoniazid INH H
Pyrazinamide PZA Z
Ethambutol E E
Streptomycin S S
# of Tablets of FDC of Patient per Body Weight
 Body Weight (kg) # of Tablets
30-37 2
38-54 3
55-70 4
>70 5
Category I: Newly Diagnosed TB Patient
- - - ( + ) DSSM, ( + ) CXR
Intensive Phase 2 months

HRZE
 Maintenance Phase 4 months

HR

Category II: Previously treated patient

with relapses or failure
Intensive Phase 2 months HRZES
Intensive Phase 1 month HRZE
Maintenance Phase 5 months HRE
Category III: Newly TB patient
- - - ( - ) DSSM, ( + ) CXR
 Intensive Phase 2 months HRZ
Maintenance Phase 4 months HR
Category IV: - CHRONIC
Still ( + ) smear after supervised re-treatment
- refer to specialized facility
- Provincial NTP Coordinator
DOTS
- Direct Observed Treatment Short course
- Main strategy which primary health services around the
world are using to detect and cure TB patients.
Treatment partner:
-watching the TB patient take medicines everyday
during the whole course of treatment.
a. Staff of the Health Care facilities
b. LGU officials
c. Family members of the patient
5 ELEMENTS OF DOTS:

1. Political will
2. Sputum microscopy service
 3. Regular drug supply
4. Record of patient’s progress
5. Supervision of drug intake
Leprosy Control Program
Leprosy
- known as Hansen’s Disease
- cause: Mycobacterium leprae
- MOT: prolonged intimate skin to skin
contact; droplet infection Diagnostic procedure:
 = Slit Skin Smear
Preventive Measures:
- BCG immunization
- Health education on the MOT
DOMICILLARY TREATMENT:
(Republic Act 4073)
PAUCIBACILLARY : 6-9 months
A. Intermediate type
- flat, with not well defined patches, with slight to no
sensory loss and pale in color.
 B. Tuberculoid type
- flat, with some raised patches, definite sensory loss
and rough to touch.
Treatment:
Day 1: Rifampicin and Dapsone
Succeeding days (2-28 days): Dapsone
MULTIBACILLARY: : 24-30 months
A. Borderline type
- many raised patches at different sizes and shapes,
usually enlarged nerves and occasionally with
deformities.
 B. Lepromatous type
- thickened skin and earlobes and with hair loss in
eyebrows.

Treatment:
Day 1: Rifampicin, Dapsone, Clofaximine or Lamprene
Day 2-28: Dapsone, Clofaximine or Lamprene
THE MATERNAL and CHILD HEALTH PROGRAM
Overall Goal:
- To improve the survival, health and well being of
mothers and unborn through a package of services
 for the pre pregnancy, prenatal, natal and post natal
stages.

Essential Health Service Packages:

A. Prenatal Registration
1St visit – as early in pregnancy as possible before four months
or during the first trimester
2nd visit – during the 2nd trimester
3rd visit – during the 3rd visit
Every 2 weeks – after 8th month of pregnancy until delivery
B. Deliver Tetanus Toxoid
Immunization OLD TT Immunization
Schedule: TT1
= given anytime during pregnancy
TT2
= 1 month after the first dose
TT3
= 1st booster dose; 6 months interval from TT2
TT4
= 1 year interval from TT3
TT5
 = booster dose 1 year interval from TT4
NEW TT Immunization Schedule:
TT1
= 5th or 6th month of pregnancy
TT2
= after 1 month of TT1
TT3
= succeeding pregnancy (5th or 6th month pregnant)
TT4
= succeeding pregnancy (5th or 6th month pregnant)
TT5
 = succeeding pregnancy (5th or 6th month pregnant)
Lifespan of TT Vaccines:
TT1
= 0; 0
TT2
= 80% protection; 3 yrs protection TT3
= 95% protection; 5 yrs protection
TT4
= 99% protection; 10 yrs protection
TT5
= 99% protection; lifetime protection
C. Micronutrient Supplementation
1. Vitamin A
10,000 IU 2X a week starting on
the 4th month of pregnancy
10,000 IU once a day for 4
weeks if with Xeropthalmia
200,000 IU post-partum; one
dose within 4 weeks
2. Iron
60 mg/day 1st trimester
120 mg/day 2nd/3rd trimester
 60 mg/day X 3 mos. Post-partum
D. Treatment of Diseases and Other Conditions
- Unconscious
- Difficulty of breathing
- Post partum bleeding
- Parasitism
E. Clean and Safe Delivery
- ensure hygiene during labor and delivery
Qualifications for Home Care Delivery:
1. Full Term 7. No history of previous infection
2. G1-G4 8. No PROM
3. Cephalic Presentation 9. Adequate pelvis
4. No history of previous CS 10. No history of prolonged labor
5. No history of previous Complications
6. Enlargement of abdomen is equal to AOG
3 Priorities for a Safe Home Care Delivery:
1. Clean Hands 2. Clean Surface 3. Clean Cord

Post Partum Visits:

1st visit
– within a week (3-5 days)
2nd visit
 – 6th week post delivery

3 Cardinal Signs of Post Partum Infection:

1. Board-like abdomen
2. Fever
3. Foul-smelling vaginal discharges
F. Support Breastfeeding

Breastfeeding and Rooming –in ACT : RA 7600

Benefits of BF to Infants:
 1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ pointsBenefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
New Breastfeeding Act….
REPUBLIC ACT 10028
Storage Full-term Pre-term
Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
G. Family Planning Counseling-
right choice of FP methods -
birth spacing is …..
3-5 years
Expanded Program on Immunization
(EPI)
Legal Basis: PD No. 996
– providing for compulsory basic immunization for
infants and children below 8 yrs old. ( September 16, 1976)
 > launched in July 1976
> free vaccines: BCG, DPT, OPV, Measles

Mandatory Infants and Children Health Immunization of 2011

--- RA 10152
Objective:
To reduce morbidity and mortality among infants and
children caused by the 6 childhood immunizable diseases
Target for Immunization Program
a. Infant : 12 months old
b. School Entrants : 6-7 years old
 c. Pregnant MotherInfants:
- 1 BCG
- EO 663
- 3 Hepa B
- RA 7846
- 3 DPT
- 1 Measles
- Proc. 4
- 3 OPV
School entrants:
 - 1 booster dose of BCG

Pregnant mothers:
- 5 Tetanus Toxoid
- RA 1066 (tetanus elimination)
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health serviceElements of
EPI: Target setting: calculation of eligible population
 Formula: EP = total population x constant percentage
Constant percentage:
Infants = 3% or .03
School Entrants = 3% or .03
Pregnant Mothers = 3.5% or .035
Cold Chain System
- to maintain potency of the vaccine

Refrigerator:
Freezer:
 (-15° to -25 °C) – OPV, Measles
Body:
(2° to 8°C) - DPT, Hepa B, BCG, TT

2 most sensitive to heat vaccine:

OPV & MEASLES
2 least sensitive to heat vaccine:
BCG & TT
HOW LONG CAN VACCINE BE STORED?
DOH
 REGIONAL HEALTH OFFICE

DISTRICT/ PROVINCIAL HEALTH OFFICE

HEALTH CENTER
* Health centers using cold box or transport boxes
- 5 days
* Check temperature 2x a day: first and last hour of the
clinic
Vaccine Age Doses Interval ROUTE Dosage

BCG At birth 1 ID(RIGHT deltoid ) 0.05 ml

School ID(LEFT deltoid ) 0.5 ml

Entrants

DPT 6 wks. 3 4 wks. IM (VASTUS 0.5 ml

(Triple) LATERALIS)

OPV 6 wks. 3 4 wks. ORAL 2-3 gtts

(Sabin)
HEPA B At birth 3 4 wks. 0.5 ml
IM (VASTUS
LATERALIS)

MEASLES 9 mos. 1 SUBCUTANEOUS 0.5 ml

Pentavalent – Hib
(Penta – hib)

1. Diptheria
2. Pertussis or whooping cough
3. Tetanus
 4. Hepatitis – B
5. Hemaphilus influenza type B
- to prevent
pneumonia and
meningitis to babies
- injected
intramuscularly
- given at age 6
weeks up to 11 months
CONTENT OF VACCINES:
BCG:
 - live attenuated
bacteria OPV and
MEASLES:
- live attenuated
virus DIPTHERIA & TT:
- weakened
bacterial toxins
PERTUSSIS:
- killed bacteria
HEPA B:
 - derived from
plasma (plasma
derivatives)
RNA recombinants
PRINCIPLES OF VACCINATION…

1. No BCG to a child born positive with HIV or AIDS

2. DPT is not given to a child who has recurrent
convulsions or active neurologic disease
3. DPT2 or DPT3 is not given to a child who has had
convulsions or shock w/in 3 days the previous dose but
you can give DT.
4. Don’t immunize children before referral
5. Moderate fever, malnutrition, mild resp. infection,
cough, diarrhea & mild vomiting aren’t contraindication
to vaccination.
6. Safe to administer all EPI vaccines on the same day at
different sites of the body.
7. No food 30 minutes after giving OPV.
8. Assess the child for allergy to egg before giving measles
vaccine.
9. Measles vaccine should be given as soon as the child is
9 months old regardless of whether other vaccines will
be given on that day.
10. Vaccination schedule should not be restarted from the
beginning even if the interval between doses exceeded.
11. It is safe and effective with mild side effects after
vaccination.
12. Do not repeat BCG vaccination if the child does not
develop a scar after the first injection.
13. Strictly follow the principle of never, ever reconstitute
the freeze dried vaccines to any diluents.
14. Use one syringe, one needle per child during
vaccination.
15. During vaccination, clean the skin with cotton ball,
moistened with water only (boiled H20).
Opened vaccines should be discarded after:
> BCG & Measles
: 4-6 hours
> DPT, OPV, Hepa B & TT
: 8 hours
 Open OPV vials can be used for the next immunization if:
a. Expiry date has not passed
b. Vaccines stored at 0°C to 8°C
c. Not taken out at the health center for outreach
activities
ENVIRONMENTAL HEALTH AND SANITATION
- the study of all factors in man’s physical environment, which
may exercise a deleterious effect on his well-being and survival.
FACTORS:
1. water sanitation 7. steam pollution
2. food sanitation 8. air pollution
3. refuse and garbage disposal 9. noise
4. excreta disposal 10. radiological protection
5. housing 11. institutional sanitation
6. insect vector and rodent controlLegal basis:
PD 856, 1978
Different Laws relating to Environmental Sanitation:
1. Garbage Disposal Law
- PD 825
2. Ecological Solid Waste Management Act
- RA 9003
3. Clean Air Act
 - RA 8749
4. Clean Water Act
- RA 9275
5. Toxic Substances and Hazardous and Nuclear Waste Control
Act
- RA 6969
WATER SUPPLY SANITATION PROGRAM
Approved type of water supply facilities:
LEVEL I
(Point Source)
- a protected well or a developed spring with an outlet but
without a distribution system.
 - serves 15 to 25 households
- outreach must not be more than 250 meters from the
farthest user
LEVEL II
(Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped
distribution network and communal faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest
house
LEVEL III
(Waterworks System or Individual House Connections)
 - a system with a source, a reservoir, a piped distributor
network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
Approved types of toilet facilities:
LEVEL I
Non-water carriage toilet facility – no water is necessary to
wash the waste into the receiving space.
Ex. Pit latrines, Reed odorless earth closet
Toilet facility requiring small amount of water to wash the waste
into the receiving space.
 Ex. Pour flush toilet, Aqua privies
LEVEL II on site toilet facilities of the carriage type with water-
sealed and flushed type with septic tank/vault disposal facilities
LEVEL III
- water carriage types of toilet facilities connected to septic
and/or to sewerage system to treatment plant
FOOD SANITATION PROGRAM

FOUR RIGHTS IN FOOD SAFETY:

1. Right source
- always buy fresh meat, fish, fruits and vegetables
- check for expiry dates of processed foods
 - avoid buying canned foods with dents, bulges, deformation,
broken seals and improper seams
- use clean and safe water
- if doubt of water source – boil water for at least 2 minutes
2. Right preparation
- avoid contact between raw and cooked foods
- always buy pasteurized milk and fruit juices
- wash vegetables well if eaten raw
- wash hands and kitchen utensils before and after preparing food
- sweep kitchen floors to remove food droppings
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts
of the food should reach 70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT
more than 2 hours
- store foods carefully: 4 -5 hours hot conditions : at least or
above 60 degrees centigrade cold conditions: below or equal to
10 degrees centigrade
 - do not overburden the refrigerator - reheat stored food before
eating
--at least 70 degrees centigrade

Rule in Food Safety:

“WHEN IN DOUBT, THROW IT OUT”
HEALTH EMERGENCY PREPARENESS AND RESPONSE PROGRAM

Legal Mandate:
1. PD 1566 (1978)
- creation of the National Disaster Coordinating Council
 - creation of the Multi-level Organization
- funding for a 2% reserve for calamities
2. RA 7160
- transfer of responsibilities from the national to local
government units giving more power, authority and
resources
- allocation of 5% calamity fund for emergency operations
Terms:
1. Disaster
- is a serious disruption of the functioning of a society,
causing wide spread human, material or environmental
losses
2. Emergency
- as any occurrence, which requires an immediate response
3. Hazards
- any phenomenon, which has the potential to cause
disruption or damage to humans and their environment
4. Risk
- the level of loss or damage that can be predicted from
a particular hazard affecting particular place at a
particular time from the point of view of the community.
2 components:
A. Susceptibility
- the factors which allows a hazard to cause an emergency
 B. Vulnerability
- the factors which allows a hazard to cause a disaster
Classification of disaster
A. According to its Cause
1. Natural disaster – force of nature
2. Human generated/Manmade –
transportation/technological disasters
B. According to Onset
1. Acute or sudden impact events
2. Slow or chronic genesis (Creeping disaster)
Contributing factors to Disaster:
 1. human vulnerability resulting from poverty and social
inequality
2. environmental degradation resulting from poor land use
3. rapid population growth especially among the poor
General Principles of Disaster Management:
1. The first priority is the protection of people who are at risk.
2. The second priority is the protection of critical resources and
systems on which communities depend.
3. Disasters management must be an integral function of national
development plans and objectives.
4. Disaster management relies upon an understanding of hazard
risks.
5. Capabilities must be developed prior to the impact on a hazard.
6. Disaster management must be based upon interdisciplinary
collaboration.
7. Disaster management will only be as effective as the extent to
which commitment, knowledge and capabilities ca be applied.
The Disaster Spectrum Cycle

1. Disaster Impact
2. Relief
3. Rehabilitation
4. Prevention
5. Mitigation
 6. Readiness
More Specific within Preparedness includes:
1. vulnerability assessment and dissemination of information
related to particular hazards and emergencies.
2. emergency planning
3. training and education
4. warning system
5. specialized communication system
6. resources and information databases and management
systems and resource stocks
7. emergency exercises/drills
Principles of Emergency Preparedness:
1. It is the responsibility of all.
2. Should be woven into the community and administrative levels
of both government and government organizations.
3. It is an important aspect of emergency management.
4. It is connected to other aspects of emergency management.
5. Should concentrate on process and people rather than
documentation.
6. Should not be done in isolation.
7. Should not concentrate only on disasters but integrate
prevention and response strategies for any scale of emergency.
8. Hospital plays a very vital role in the management of disaster.
9. The main objective is to decrease mortality, morbidity and to
prevent disaster.
10. Every hospital should have a regular updated disaster plan.
PURPOSE OF THE DISASTER PLAN:
1. To provide policy for effective response to both internal and
external disaster situations that can create impact to the
operation of the hospital and may affect hospital staff, patients,
visitors and the community.
2. Identify hospital capability to handle mass casualty.
3. Identify responsibilities of individuals and departments in the
event of a disaster situation.
4. Identify standard operating guidelines for emergency activities
and responses.
VITAL STATISTICS
- refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.

Use of Vital Statistics:

1. indices of the health and illness status of a community.
2. serves as bases for planning, implementing, monitoring and
evaluating community health nursing programs and services.
Sources of Data:
1. population census
 2. registration of vital data
3. health survey
4. studies and researches
* statistic on population and the characteristics such as age, sex
- Philippine Statistic Authority * Birth Certificate
form
- Form 102; Signatory: Birth Attendant
1. Physician
2. Nurse
3. Midwife
* requires registration of birth within 30 days
 - PD 651
* requires registration of births and deaths to the Office of the
Civil Registrar
- RA 3753
A. Cities – City Health officer
B. Municipalities – Municipal Treasurer
* Death Certificate form
- Form 103; Signatory: Either of the following:
1. Health Officer (Physician)
2. Local Chief Executive (City or Municipal
Mayor)
3. Licensed Embalmer and Undertaker (LEU)
 * reporting should be done within 2 days
COMMON VITAL STATISTICAL INDICATORS

1. Crude Birth Rate (CBR)

- a measure of one characteristic of the natural growth or
increase of a population.
total number of live births registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year

2. Crude Death Rate (CDR)

 - a measure of one mortality from all causes which may
result in a decrease of population.
total number of deaths registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year
3. Infant Mortality Rate (IMR)
- measures the risk of dying during the 1st year of life. It is
a good index of the general health of a community.
total number of death under 1 year of age registered
in a given calendar
_____________________________________________ X 1000
total number of registered live births of same calendar year
4. Maternal Mortality Rate (MMR)
- measures the risk of dying from causes related to
pregnancy, childbirth and puerperium.
total number of deaths from maternal causes registered
for a given year
_____________________________________________ X 1000
total number of live births registered of same year
5. Fetal Death Rate (FDR)
- measures pregnancy wastage. Death of the product of
conception occurs prior to its complete expulsion.
total number of fetal deaths registered in a given calendar
 _____________________________________________ X 1000
total number of live births registered on same year

6. Neonatal Death Rate (NDR)

- measures the risk of dying the 1st month of life. It serves
as an index of the effects of prenatal care and OB management.
number of deaths under 28 days of age registered
in a given calendar year
_____________________________________________ X 1000
number of live births registered of same year
7. Incidence Rate (IR)
 - measures the frequency of occurrence of the
phenomenon during a given period of time.
number of new cases of a particular disease registered
during a specified period of time
_____________________________________________ X 1000
estimated population as of July of same year

8. Prevalence Rate (PR)

- measures the proportion of the population which
exhibits a particular disease at a particular time.
number of new and old of a certain disease
registered at a given time
 _____________________________________________ X 1000
total number of persons examined at same given time
9. Attack Rate (AR)
- a more accurate measure of the risk of exposure.
number of persons acquiring a disease registered in a given year
_____________________________________________ X 100
number of exposed to same disease in the same year

10. Case Fatality Ratio (CFR)

- index of a killing power of a disease and is influenced by
incomplete reporting and poor morbidity data.
 number of registered deaths from a specific disease
for a given year
_____________________________________________ X 100
number of registered cases from same specific disease
in same year
C O P A R
COMMUNITY ORGANIZING PARTICIPATORY ACTION
RESEARCH
DEFINITIONS:
- A social development approach that aims to
TRANSFORM the APATHETIC, INDIVIDUALISTIC, and
 VOICELESS POOR into DYNAMIC, PARTICIPATORY
and POLITICALLY responsive community.

- A process, by which a community identifies its

needs and objectives, develops confidence to take action
in respect to them and in doing so, extends and develops
cooperative and collaborative attitude and practices in the
community.
IMPORTANCE OF COPAR:
> COPAR is an important tool for community
development and people empowerment as this:
 helps the community workers generate community
participation in development activities.

 maximizes community participation and involvement.

 prepares people/clients to eventually take over the

management of development programs in the future
PRINCIPLES OF COPAR:

1.People, especially he most OPPRESSED,

EXPLOITED, AND DEPRIVED ( women sectors,
 children, handicapped, elderly, youth ) open to
change, have the capacity to change, and are able to
bring about change.
2.COPAR should be based on the interest of the
POOREST SECTORS of society.
3.COPAR should LEAD TO SELF-RELIANT
COMMUNITY AND SOCIETY.
PROCESS USED:
 A PROGRESSIVE CYCLE OF ACTION-
REFLECTION-ACTION which begins with small, local
and concrete issues identified by the people and the
 evaluation and reflection of and on the action taken by
them.

 CONSCIOUSNESS-RAISING through experiential

learning is central to the COPAR process because it
places emphasis on learning that emerges from concrete
action and which enriches succeeding action.
 COPAR is PARTICIPATORY AND MASS-BASED
because it is primarily directed towards and biased in
favour of the poor, the powerless and the oppressed.

 COPAR is GROUP-CENTERED AND NOT LEADER

ORIENTED. Leaders are identified, emerged and tested
through action rather than appointed or selected by some
external force or entity.
COMMUNITY ORGANIZING

- the process whereby the community members

develop the capability to assess their health needs and
problems, plan and implement actions to solve these
problems.

- carried out by the nurse with the goal of motivating,

enhancing and seeking wider community participation in
 decision-making in activities that have the potential to
impact positively on community health.
STAGES

Stage 1. Community Analysis

- the process of assessing and defining needs,
opportunities and resources involved in initiating
community health action program.

5 Components:
1. demographic, social and economic profile
2. health risk profile
3. health/wellness outcome profile
4. survey of current health promotion programs
5. studies conducted in certain target groups
Steps:
1. Define the community.
2. Collect data.
3. Assess community capacity.
4. Assess community barriers.
5. Assess readiness for change.
6. Synthesis data and set priorities
Stage 2. Design and Initiation

1. Establish a core planning group and select a local

organizer.
2. Choose an organizational structure.
a. Leadership board or council – existing local leaders
working for a common cause
b. Coalition – linking organization and groups to work on
community issues
c. Lead or official agency – a single agency takes the
primary responsibility of a liaison for health promotion
activities in the community.
 d. Grass-roots – informal structure in the community like
the neighborhood residents
e. Citizen panels – a group of citizens (5-10) emerge to
form a partnership with a government agency.
f. Networks and consortia – network develop because
of certain concerns.

3. Identify, select and recruit organizational members.

4. Define the organization mission and goals.
5. Clarify roles and responsibilities of people involved in the
organization.
6. Provide training and recognition.
Stage 3. Implementation
– put design into action.

1. Generate broad citizen participation.

2. Develop a sequential work plan.
3. Use comprehensive, integrated strategies.
4. Integrate community values into the programs, materials
and messages.
Stage 4. Program Maintenance
– at this point the program has experienced some
degree of success and has weathered through
implementation programs.
To maintain and consolidate gains of the program, the
following are essential:
1. Integrate intervention activities into community networks.
2. Establish a positive organizational culture.
3. Establish an ongoing recruitment plan.
4. Disseminate results.
Stage 5. Dissemination - Reassessment

* continuous assessment is a part of the monitoring

aspect in the management of the program. Formative
evaluation is done to provide timely modification of
strategies and activities.
1. Update the community analysis. Is there a change in
leadership, resources and participation?
2. Assess effectiveness of interventions/programs.
3. Chart future directories and modifications.
4. Summarize and disseminate results.

PHASES OF COPAR
A. Pre-Entry Phase
> Community consultation/dialogues
> Setting of issues/considerations related to site location
> Development of criteria for site selection
1. high percentage of the family income is below the
national poverty threshold
2. high malnutrition rate
3. lack of primary or secondary hospital within a 30minute
ride from the area
4. area must not have relative peace and order problem
5. acceptance of the community > Site selection
> Preliminary social investigation
 >Networking with LGU’s, NGO’s and other departments
B. Entry Phase
> Integration with the community
> Sensitization of the community; information campaign
> Continuing/Deepening social investigation
> Core group formation
1. belongs to the poor sector of the society
2. responsible and committed
3. able to communicate
> Coordination with other community organization
> Self-Awareness and Leadership Training (SALT)/
Action Planning
Best technique to identify potential leaders:
- observe people who are active in small
mobilization activities that motivate residents to start
working.
C. Community Study/Diagnosis Phase

> Selection of the research team

> Training on data collection methods and techniques
> Planning for the actual gathering of data
> Data gathering
> Training on data validation
> Community validation
> Presentation of the community study/ diagnosis and
recommendations.
> Prioritization of community needs/problems for action
TYPES OF COMMUNITY DIAGNOSIS
1. Comprehensive Community Diagnosis
> aims to obtain a general information about the
community.
Elements:
A. Demographic variables
B. Socio-economic and cultural variables
C. Health and illness patterns
D. Health resources
 E. Political/Leadership patterns

2. Problem-Oriented Community Diagnosis

> type of assessment that responds to a particular
need.
D. Community Organization and Capability
Building
Phase
> Community meetings to draw up guidelines for the
organization
> Election of officers
> Delineation of the roles, functions and task of officers and
members
> Action-Reflection-Action session
- tool used to develop team-building and to promote an
avenue to verbalize feelings, opinions and suggestions and
enable them to participate in decision-making
> Team building exercises
> Working out legal requirements for the establishment of
the CHO
> Training of the CHO officers/ community leaders
E. Community Action Phase > Organization and training
of CHW’s
 > Setting-up of linkages/network referral system
> Project Implementation Monitoring Evaluation (PIME) of
health services
> Initial identification and implementation of resource
mobilization schemes
F. Sustenance and Strengthening Phase
- begins when the community organization has already
established community members who are actively
participating in community wide undertakings activities. >
Formulation and ratification of constitution and by-laws
> Identification and development of “Secondary” leaders
 > Setting up and institutionalization of a financing scheme
for the community health activities
> Formalizing and institutionalization of linkages, networks
and referral systems
> Continuing education and upgrading of community
leaders, CHW’s and CHO members
> Development of medium/ long term community health
and development plans
CRITICAL STEPS (ACTIVITIES) IN BUILDING PEOPLE
AND ORGANIZATION
1. INTEGRATION
***A community becoming one with the people in order to:
A. Immerse himself in the poor community
B. Understand deeply the culture, economy leaders, history
rhythms and life style in the community.
2. SOCIAL INVESTIGATION
- a systematic process of collecting and analyzing data to
draw a clear picture of the community.
- a process of systematically learning and analyzing the
various structures and forces in the community
> Also known as the “Community Study”
3. TENTATIVE PROGRAM PLANNING
- CO to choose one issue to work on in order to begin
organizing the people.
4. GROUNDWORK
- going around and motivating the person on a one on
one basis to do something on the issue that has been
chosen.
5. THE MEETING
- people collectively ratifying what have already
decided individually. The meeting gives the people the
collective power and confidence .Problems and issues are
discussed.
5. ROLE PLAYING
- means to act out meeting that will take place
between the leaders of the people and the government
representative’s .It is the way of training the people to
 anticipate what will happen and prepare themselves for
such eventually.
6. MOBILIZATION OF ACTION
- actual experience of the people in confronting the
powerful and the actual exercise of the people power.
7. EVALUATION
- the people reviewing the steps 1-6 so as to
determine whether they were successfully or not on their
objectives.
8. REFLECTION
- dealing with deeper, on going concerns to look at the
positive values CO is trying to build in the
 organization. It gives as the people time to reflect on the
starch reality of the life compared in the ideal.
9. ORGANIZATION
- the people organization is the result of many
successive and similar actions of the people .A final
organizational structure is set up with elected officers and
supporting members.
 What is IMCI?

Integrated Management of Childhood Illness (IMCI)

is a strategy for reducing the mortality and morbidity
associated with the major causes of childhood illness.

IMCI is an integrated approach to child health that

focuses on the well-being of the whole child.
The IMCI strategy :
• promotes the accurate identification of childhood
illnesses;
• ensures appropriate integrated treatment of all major
illnesses;
 • strengthens the counseling of caregivers;
• identifies the need of and speeds up the referral of severely
ill children.

In the home setting:

• it promotes appropriate care-seeking behaviors;
• improved nutrition and preventative care;
• and the correct implementation of prescribed care.
2 Age Categories in IMCI:

1. Young Infant
– up to less than 1 week up to 2 months
 (1 week up to 1 month and 29 days)

2. Young Child
– 2 months up to 5 years
(2 months up to 4 years and 11 months)
Principles in IMCI:
1. All sick children must be examined for
GENERAL DANGER SIGNS:
C
> convulsions (fits, jerky movement, spasm)
U
 > unable to drink or breastfeed (not eat)
V
> vomiting
A
> abnormally sleepy (difficult to awaken)
2. Assess for MAIN SYMPTOMS:
For Older children For Young infants:
a. Cough/DOB a. Local bacterial infection
b. Diarrhea b. Diarrhea
c. Fever c. Jaundice
d. Ear problems
3. Assess for nutritional status, immunization status, vitamin
A status, feeding problems and other potential problems.

4. Only a limited number of carefully-selected clinical signs

are used.
5. A combination of individual signs leads to a child’s
classification(s) rather than a diagnosis.
× identify illness = Dx
√ classify illness = classification

6. The guidelines do not describe the management of trauma

or other acute emergencies d/t accidents or injuries.
7. IMCI management procedures use a limited number of
essential drugs and encourage active participation of
caretakers.

8. An essential component of the IMCI guidelines is the

counseling of caretakers.
THE IMCI STRATEGY
ASSESS THE CHILD

Check the child for Danger Signs

Then Ask: For any “yes” answer

Does the child have cough or • Ask further
difficult breathing? questions
Does the child have diarrhea? • LOOK,LISTEN, FEEL
Does the child have Fever? • Based on this
Does the child have ear problem classify illness

Then Check the child for malnutrition and anemia

Then check the child’s immunization status
Classify Illness
Pink classification
Yellow classification
Green classification

Identify Treatment
urgent pre-referral treatment and referral,
or
specific medical treatment and advice, or
simple advice on home management
Treat the Child

Teach the mother to give oral drugs at home

Teach the mother to treat local infections at home
Give intramuscular drugs in clinic
Counsel the mother
Using the process: ASK, PRAISE, ADVISE, CHECK
Food and feeding problem
Fluid intake during illness
When to return
Care for Development
Her own health

Follow - up
health-care provider gives appropriate follow-
up
 care, as indicated in IMCI guidelines
If necessary, reassess the child for any new

problems.
Assess and Classify A Sick Child
Aged 2 months to 5 years
1. Ask the mother what the child’s problems
are?greet the mother appropriately
use good communication skills
listen carefully to what the mother tells you
use words that the mother will understand
give the mother time to answer questions ask
additional questions if the mother is not
sure about her answer
2. Determine if it is an initial visit
 For ALL sick children ask the mother about the child’s problem, check for general danger signs
and then
ASK: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?

If YES

If NO

IF YES, ASK: LOOK, LISTEN, FEEL:

For how long? Count the breaths in one

minute.
The child
Look for chest indrawing must be
Look and listen for stridor calm
Look and Listen for wheeze
Fast breathing is: If wheezing and weather fast
2 mos – 12 mos. 50 breaths breathing, give a trial of rapid
per minute or more acting bronchodilator up to 3
12 mos – 5 yrs. 40 breaths times 15 – 20 mins. apart.
per minute or more Reassess

CLASSIFY the child's illness using the colour-coded classification table

for cough or difficult breathing.

Then ASK about the next main symptoms: diarrhoea, fever, ear problems. CHECK for malnutrition and anaemia,
immunization status and for other problems
Classify Cough
SEVERE
• Any general danger sign or PNEUMONIA
• Lower chest indrawing or OR
• Stridor in calm child VERY SEVERE
DISEASE
PNEUMONIA
Fast Breathing (if wheezing,
go directly to treat
wheezing)
 No signs of pneumonia or NO PNEUMONIA:
very severe disease COUGH OR COLD

Treatment

Safe remedies: NO PNEUMONIA:

- Instruct COUGH OR COLD
- Follow –up care after
5 days
1. Give 3 days antibiotic. PNEUMONIA
1st line of drugs:
Amoxicillin 2 times daily for 3 days 2nd
line of drugs:
Cotrimoxazole 2times daily for 3 days
2. Soothe the throat & relieve the cough using safe
remedies:
- B, T, L, C
Breastmilk, Tamarind, Luya, Calamansi)
•Never give cough syrup, antitussive, decongestant,
mucolytics.
3. Instruct the mother when too return the baby
immediately.
4. Follow up after 2 days.
Pre-referral Treatment: SEVERE
1. Give 1st dose antibiotic PNEUMONIA
OR
2. Give Vitamin A VERY SEVERE
- 2 months to 12 months: DISEASE
100,000 IU (blue) -
12 months to 5 y/o :
200,000 IU (red)

3. Treat the child to prevent lowering of the

blood sugar (hypoglycemia)
How to prevent lowering of blood sugar level:

*If the child is able to breastfeed:

*If the child is not able to breastfeed but is able to swallow
- give 30-50 ml milk or sugar H2O p.o.
(sugar H2O: 4 tsp. sugar+200 ml H2O) *Not
able to swallow but conscious:
- Insert NGT
*If the child is unconscious:
- (IVF) D10W 5 ml/kg body weight for a few
minutes
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing and then
ASK: DOES THE CHILD HAVE DIARRHEA?
If NO

Does the child have diarrhea

IF YES, ASK: LOOK, LISTEN, FEEL:

• For how long? • Look at the child's general condition.

• Is there blood in the stool Is the child:
Abnormallysleepy or difficult to awaken?
Restless or irritable?
• Look for sunken eyes.
• Offer the child fluid. Is the child:
Not able to drink or drinking poorly? Drinking
eagerly, thirsty?
• Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?

CLASSIFY the child's illness using the color-coded classification tables for
diarrhea.
 Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.

Classify Diarrhea
SIGNS CLASSIFY AS
Two of the following signs: SEVERE DEHYDRATION
• Lethargic or unconscious
• Sunken eyes
• Not able to drink or drinking poorly
• Skin pinch goes back very slowly

Two of the following signs: SOME DEHYDRATION

• Restless, irritable
• Sunken eyes
• Drinks eagerly, thirsty
• Skin pinch goes back slowly
Not enough signs to classify as some or severe
dehydration. NO DEHYDRATION

SIGNS CLASSIFY AS
Dehydration present SEVERE PERSISTENT DIARRHEA

No dehydration PERSISTENT DIARRHEA

• Blood in the stool DYSENTERY

Treatment:
Severe Dehydration

PINK

PLAN C
 Give IVF : D5LR
< 12 mos. old : 100ml/kg within 6 hrs
12 mos. up to 5 y.o. : 100ml/kg within 3 hrs
Some Dehydration

YELLOW

PLAN B

Give ORS for the 1st 4hrs

 Amount of ORS = weight (kg) x 75 = ml/cc
> after 4 hours, re-assess child for signs of dehydration
> if still some dehydration, continue ORS for 4 hours
Age Amount of ORS

1 week up to 4 mos. old 200-400 ml 400-

4 mos. up to 12 mos. 700 ml 700-900 ml
12 mos. up to 2 years old 900-1400 ml
2 years old up to 5 years old

Mild vomiting during ORT

 = stop ORS in 10 mins, after 10 mins continue ORS but
give it in a slow manner
Severe Vomiting during ORT
= stop ORS → IVF or refer!
No Signs of Dehydration

Green

PLAN A

Give ORS if with watery or loose stool

 1 week up to 2 y/o = 50-100 ml ORS
2 y/o up to 5 y/o = 100-200 ml ORS
If there’s no watery/loose stool (4 Home Rule Management):
1. Continue feeding (BRAT diet)
2. Give extra fluids; soups, milk, plain water, juice, rice water3.
Give Zinc supplement for 10-14 days to increase immune
system
4. Advise mother when to return baby immediately.
PERSISTENT DIARRHEA (Young child)

Yellow
 1. Give Vit. A
2. Advise mother recommended feeding
3. Follow-up after 5 days → if still breastfeeding:
= breastfeed day and night
→ if taking milk supplements:
= replace milk supplements with increased breastfeeding
= replace half of the milk & nutrient rich, semi-solid foods
* Do not use condensed or evaporated milk
= because it is high in CASEINE
SEVERE PERSISTENT DIARRHEA

Pink
 1. Give Vitamin A
2. Give IVF = Plan C

DYSENTERY (Young Infant) DYSENTERY (Child)

Pink Yellow

Referral Ciprofloxacin 2 times daily

for 3 days
Cholera:
First Line Antibiotic:
> Tetracycline

Second Line Antibiotic :

> Erythromycin
FEVER
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing, diarrhea and then
ASK: DOES THE CHILD HAVE FEVER?

Does the child have fever?

(by history or feels hot or temperature 37.5 C** or above)

IF YES:
If No Decide the Malaria Risk: Yes or No
THEN ASK: LOOK AND FEEL:

Look or feel for stiff neck.

Look for runny nose.
For how long?
If more than 7 days, has fever been present every day? Look for signs of MEASLES
Has the child had measles within the last 3 months? Generalized rash and
One of these: cough, runny nose, or red eyes.

If the child has measles now or within the last 3 months: Look for mouth ulcers.
Are they deep and extensive?
Look for pus draining from the eye.
Look for clouding of the cornea.
Decide Dengue Risk : Yes or No
Ask: Look and Feel:
o Has the child had any bleeding from the nose or gums, or •Look for bleeding from the nose or gums?
in the vomitus or stool? •Look for skin petechiae
o Has the child had black vomitus ? •Feel for cold and clammy?
o Has the child evacuated black stool? •Check for slow capillary refill .
o Has the child had persistent abdominal pain? •If none of the above ask , look and feel signs are
o Has the child been persistent vomiting? present and the child is 6 months and older and fever
has been present for more than 3 days, perform
tourniquet test.
 Malaria Risk
Signs Classification
Signs Classification
Any general danger signs Stiff Very Severe Febrile Disease/Malaria
neck
Blood Smear (+)
If Blood smear is not done; Malaria
No runny nose, and
No measles, and
No other cause of fever
Blood Smear (-) or
Runny nose, or Fever: Malaria Unlikely
Measles, or
Other cause of fever

No Malaria Risk
Signs Classification

Signs Classification
Any general danger sign Stiff Very Severe Febrile Disease
Neck
 No signs of very febrile disease Fever: No Malaria

Malaria Risk Treatment

> Give paracetamol for fever
Fever: Malaria
> Advise mother when to return immediately
Unlikely
> Follow-up after 2 days
> Give paracetamol for fever Malaria
> Bring the child if there’s CUVAS
> Follow-up after 2 days
> Give antimalarial drugs
First Line Antibiotic: Arthemeter + Lumefantrine
Second Line Antibiotic: Chloroquine, Primaquine,
Sulfadoxine and Pyremethamine
 Pre-referral Treatment:
1. Give first dose antibiotic
2. IM Quinine
3. Give paracetamol Very Severe Febrile
Disease/Malaria
4. Treat lowering of blood sugar5. REFER!

No Malaria Risk Treatment

> Give Paracetamol for fever Fever: No Malaria
> Advise mother when to return
immediately
> Follow-up after 2 days
 Pre-referral Treatment: Very Severe
Febrile Disease
> Give Paracetamol for fever
> Treat lowering of blood
sugar > Refer!

Measles
Signs Classification

Any general danger signs or

Clouding of the cornea, or Severe Complicated Measles
Deep and extensive mouth ulcers
• Pus draining from the eyes, or Measles with Eye or Mouth
• Mouth Ulcers Complications
 Measles now or within the last three Measles
months
Dengue Hemorrhagic Fever
Signs Classification
Bleeding from the nose or gums, or
Bleeding in stools or vomitus, or
• Skin petechiae, or Severe Dengue Hemorrhagic
Cold and clammy extremities, or Fever
• Persistent abdominal pain, or
Persistent vomiting, or
Torniquet test positive
No signs of severe dengue hemorrhagic Fever: Dengue Hemorrhagic
fever Fever
Unlikely
Measles Treatment
*Pre-referral Tx:
> Give Vitamin A
> Apply tetracycline on eyes if with eye
complication Severe
Complicated
> Give 1st dose of antibiotic > Measles
Refer!
Don’t give/apply gentian violet on mouth ulcers

> Give Vitamin A

> Apply tetracycline on eyes QID
> Apply Gentian Violet (half strength)
on mouth BID Measles with Eye
> Follow-up after 2 days or Mouth
Complications
 Give Vitamin A Measles

Dengue Hemorrhagic Fever Treatment

Severe Dengue
Hemorrhagic Fever
Pre-referral treatment:

1. Rapid fluid replacement

2. Paracetamol for fever of 38.5 ˚C without
ASA
3. Treat child to prevent lowering of blood
sugar
4. REFER!
1. Give Paracetamol for fever of 38.5 ˚C w/o
ASA
2. Advise to bring if signs of severe dengue
fever occurs
Fever: Dengue
3. Follow up after 2 days Hemorrhagic Fever
Unlikely
Ear Problem
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing, diarrhoea, fever and then
ASK: DOES THE CHILD HAVE AN EAR PROBLEM?

If No If Yes
 IF YES, ASK: LOOK AND FEEL:

If yes, for how long?

• Is there ear pain? • Look for pus draining from the ear.
• Is there ear discharge? • Feel for tender swelling behind the
ear.

CLASSIFY the child's illness using the color-coded classification table for
ear problem.

Then CHECK for malnutrition and anemia, immunization status and for other problems.
Classify Ear Problem
SIGNS CLASSIFICATION

Tender swelling behind the ear. MASTOIDITIS

 • Pus is seen draining from the ear
and discharge is reported for Less ACUTE EAR
than 14 days, or INFECTION
• Ear pain.

Pus is seen draining from the ear and CHRONIC EAR

discharge is reported for 14 days or INFECTION
more.

No ear pain and NO EAR INFECTION

No pus seen draining from the ear.
Ear Problem Treatment
Pre-referral treatment:
* Give 1st dose antibiotic * Give
Paracetamol for ear pain * Refer! MASTOIDITIS
* give 3 days antibiotic ACUTE EAR
* dry the ear by wicking (roll soft cloth in a wick) INFECTION
* give Paracetamol for ear pain
* follow-up after 5 days
* dry ear by wicking CHRONIC EAR
* follow-up after 5 days INFECTION

* No treatment needed NO EAR INFECTION

Malnutrition and Anemia
For ALL sick children ask the mother about the child’s problem, check for general danger
signs, ask about cough or difficult breathing, diarrhoea, fever, ear problem and then
CHECKFOR MALNUTRITION AND ANEMIA
CHECK FOR MALNUTRITION AND ANEMIA.

If Yes
If No Check for Malnutrition

LOOK AND FEEL:

For All Children

Determine the weight for age
Look for visible severe wasting.
Look for edema of both feet.
For children aged 6 mos. or more determine if MUAC I is less than
11 cm.
Check for Anemia
LOOK AND FEEL:
Look for palmar pallor. Is it:
Severe palmar pallor?
Some palmar pallor?
Classify Malnutrition
SIGNS CLASSIFICATION
If age up to 6 mos. SEVERE
- Visible severe wasting or Edema of both feet. MALNUTRITION
• If age 6 months and above and MUAC less than
11 mm or
- edema of both feet, Visible severe wasting

Very low weight for age. LOW WEIGHT

Not very low weight for age and no other signs NOT VERY LOW WEIGHT
or malnutrition.

Classify Anemia
Severe palmar pallor SEVERE ANEMIA
Some palmar pallor ANEMIA

No palmar pallor NO ANEMIA

 Severe Anemia/ Anemia Low Weight No Anemia, Not
Severe Very Low
Malnutrition * Give 30 days * Counsel Weight
of 10 ml or mother
* Give Vitamin A 2 tsp Iron * Follow up after * Assess the
* Refer! * Deworm: 5 days child’s feeding
Mebendazole
Albendazole No feeding * Counsel the
* Follow up problem: mother
after 14 days * Give Vit. A
* Follow-up after
30 days
Check Immunization Status, Vitamin A and Deworming Status

For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing, diarrhoea, fever, ear problem, and then check for
malnutrition and anaemia and
CHECK IMMUNIZATION STATUS.

AGE VACCINES
IMMUNIZATION Birth BCG OPV- Hep B 1
SCHEDULE: 6 weeks DPT-1 1 Hep B 2
10 weeks DPT-2 OPV-
14 weeks DPT-3 2 Hep B 3
9 months Measles OPV-
3
 DECIDE if the child needs an immunization today, or if the mother should be told to
come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child if the
child is well enough to go home.

Then CHECK for other problems.

Vitamin A Prophylaxis Routine Worm Treatment

The first dose at 6 mos. Or Give every child mebendazole every
above and subsequent dose 6 mos. From age 1 year and record in
every 6 mos. the child’s card

Assess and Classify Sick Young Infant Aged up to 2 Mos.

 For ALL sick young infants check for signs of POSSIBLE BACTERIAL INFECTION.

ASK: LOOK, LISTEN, FEEL :

Is the infant having difficulty in
feeding?
Has the infant had convulsions ?
Count the breaths in one minute.
Repeat the count if elevated.
Look for severe chest indrawing .
Look at the umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
Measure axillary temperature
Look for skin pustules. Are there many or severe
pustules?
Look at the young infant's movements.
Does the infant move on his own?
Does the infant move only when stimulated?
Does the infant not moving at all

CLASSIFY the infant's illness using the colour-coded classification table for possible
bacterial infection.
 Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status
and for other problems.

Classify Sick Young Infant

Signs Classification

• Not Feeding well or VERY SEVERE

• Convulsions or DISEASE
• Fast breathing (60 breaths per minute or
more) or
• Severe chest indrawing or
• Fever (37.5° C* or above or feels hot) or
• low body temperature (less than
35.5°C* or feels cold)
• Movement only when stimulated or no
movement at all
• Umbilical red or draining pus or LOCAL BACTERIAL
• Skin pustules INFECTION
• No signs of very severe disease or local SEVERE DISEASE OR
bacterial infection LOCAL BACTERIAL
DISEASE UNLIKELY

TREATMENT
Pre-referral treatment: VERY SEVERE
1. Give first dose antibiotic: DISEASE
Gentamycin - (IM) Right
Vastus lateralis
Benzyl penicillin: Left
Vastus lateralis
2. Keep warm
3. Treat child to prevent hypoglycemia
4. Refer.

1.Give 3 days antibiotics P.O.

2.Apply gentian violet on affected area LOCAL BACTERIAL
(FULL STRENGHT) INFECTION
3.Follw-up after 2 days.
 SEVERE DISEASE OR
LOCAL BACTERIAL
DISEASE UNLIKELY
Assess Jaundice
Look:
Look for jaundice (yellow eyes and skin)
Look at young infant’s palms. Are they yellow

Classify Jaundice
Signs Classification
Any jaundice if age less than 24 hours or
Yellow palms and soles at any age SEVERE JAUNDICE
 Jaundice appearing after 24 hours of age JAUNDICE
and
Palms and soles are not yellow

No Jaundice NO JAUNCICE

Check for Low Weight Infants for Age in Breastfed Infants

ASK:
Is the infant breastfed? If yes,
How many times in 24 hours?
Does the infant usually receive
any
other foods or drinks?
If yes, how often?
What do you use to feed the
infant?
ASSESS BREASTFEEDING:
Has the infant breastfed in the
previous hour?
Look, Listen and Feel
•Determine the weight
for age
•Look for white ulcers
or white patches in the
mouth
If the infant has not fed in the previous hour, ask the mother to put her infant to
the breast. Observe the breastfeed for 4 minutes.
(If the infant was fed during the last hour, ask the mother if she can wait and tell
you when the infant is willing to feed again.)
Is the infant able to attach?
no attachment at all not well attached good attachment
TO CHECK ATTACHMENT, LOOK FOR:
Chin touching breast
Mouth wide open
Lower lip turned outward
More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)
Is the infant suckling effectively (that is, slow deep sucks, sometimes
pausing)?
Classify the Feeding Problem
Signs Classification

Not well attached to breast, or

• Not sucking effectively, or Less
than 8 breastfeeds in 24 hours,
or FEEDING
• Receives other foods or drinks, or PROBLEM OR LOW
• Low weight for are age, or WEIGHT FOR AGE
• Thrush (ulcers or white patches in
mouth).
 Not low weight for age and no other NO FEEDING
signs of inadequate feeding. PROBLEM
RECOMMENDED FEEDING
At birth up to 6 months
> exclusively breastfeed
> 8 times or more than 8 times within 24 hours.

SIGNS OF HUNGER:
 1. Beginning to fuss.
2. Sucking fingers and fist
3. Sucking movements with their lips.
>6 months up to 12 months:
breastfeeding + 3 times a day complementary food.
If not on breastfeeding:
5 times a day complementary food.

>12 months up to 2 years old: breastfeeding + 5 times

a day of complementary food.
>At birth up to 4 months: exclusive
breastfeeding 8 times in 24 hrs.

>4 months up to 6 months:

breastfeeding with complementary food 1-2 times a day
Gentian Violet:

Half strength: for mouth ulcers

=15 ml GV+30-45 DW = .25% concentration
Full strength: skin pustules &
umbilical redness or pus
=15 ml GV+15 ml DW = .5% concentration
 Mouth ulcers Skin pustules Umbilical Redness/Pus

1. Wash hands 1. Wash hands 1. Wash hands

2. Clean affected area 2. Clean 2. Clean affected

using soft cloth affectedarea using areausing 70% alcohol
dipped in salt water soft cloth soaked
with soap & water
3. Paint GV 3. Paint GV 3. Paint GV

4. Wash hands 4. Wash hands 4. Wash hands

Preparation and Application of Gentian Violet

.