Beruflich Dokumente
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DOH PROGRAM
STANDARDS AND
PROTOCOLS
COMPILED BY:
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Mandate: Executive Order No.102
Vision:
The Leader, Staunch Advocate and Model for promoting Health for all
in the Philippines.
Mission:
To guarantee equitable, sustainable and quality health for all Filipinos,
especially the poor, and to lead the quest for excellence in health.
Focus:
A. Public Health Programs:
> Prevention and Control of Infectious Diseases
> Prevention and Control of Degenerative Diseases and Lifestyle-Related
Diseases
Management of Health Risk and Promotion of Healthy Lifestyle
Protection and promotion of Family Health and Health of Special
Population
2. Management System
Procurement
Knowledge management
Human resource
Critical Infrastructure
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“Speed, precision, and effective coordination towards improving
the efficiency, effectiveness & equity of health care delivery.”
Four Thrusts
– Financing (increased, better and sustained)
– Regulation (assured quality and affordability)
– Service Delivery (ensured access and availability)
– Governance (improved performance)
Strategic Guideposts
– Building upon gains and lessons from major reform initiatives
– Focus on critical interventions to be implemented as a single
package
– Sector wide management of FOURMULA ONE implementation
– NHIP as the primary instrument
FINANCING
Goal:
Secure increased better and sustained investments in health to improve
health outcomes especially of the poor.
Out-of-Pocket
– Shift of OOP to outpatient care (e.g. check-up, consultation, etc)
Local Government
– Focus subsidy on preventive and promotive health services
National Government
– Shift resources on regulation, governance and to
teaching/training tertiary hospitals
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Social Health Insurance
– Focus on in-patient care
REGULATION
Goal:
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Assure access to quality and affordable health products, devices, facilities
and services especially those used by the poor.
Strategies
Harmonizing & streamlining of systems, processes for licensing &
accreditation & certification
Developing a seal of approval system
Pursuing cost recovery with income retention for health regulatory
agencies & other revenue generating mechanisms
Ensuring access of the poor to essential health products
One-stop shop
PhilHealth-Sentrong Sigla seal
Unified seal of approval
Botika ng Barangay/Pharma 50
SERVICE DELIVERY
Goal:
Improve accessibility and availability of basic and essential health care for
all, especially the poor.
Strategies
Making available basic and essential health service packages by
designated providers in strategic locations
Assuring the quality of both basic and specialized health services
Intensifying current efforts to reduce public health threats
Components
Public health development plan
a) Disease-free zones – “mopping up” leprosy, schistosomiasis,
filariasis, malaria, rabies
b) Intensified disease programs – TB, HIV/AIDS, and emerging
infections
c) Improving reproductive health outcomes – MMR, IMR, U5MR,
TFR, CPR
d) Intensified promotion of healthy lifestyle – DM, HPN, CVD, breast and
cervical cancer, anti-smoking, safe water, sanitation, among others
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Intensification of health promotion /Establishment of National Health
Promotion Foundation
GOVERNANCE
Goal:
Improved health system performance at the national and local levels
Components
Sectoral Development Approach for Health
Health Human Resource Master plan
Establishment of 4-in1- F1 Sites
Philippine Health Information System
Procurement and Logistics Management System
Public Finance Management System
STATISTICS:
• Refers to the science dealing with the collection, organization, analysis
and interpretation of numerical data.
B. Hospital Statistics
Number of admissions and discharges
Bed Occupancy rate
Average length of stay
B. Inferential Statistics
- The methods involved in order to make generalizations and
conclusions about a target population, based on results from a
sample.
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1. Timeliness- refers o the interval between the date of occurrence of the
different events considered and the time the data is ready to be used
or disseminated.
2. Completeness- two components:
A. completeness of coverage—
“Does the data cover the entire geographic area and target population
within the area of interest?”
B. completeness in accomplishing all the items in every form.
3. Accuracy- refers to how close the measurement or the data is to its
true value.
4. Precision- refers to the extent to which similar situations obtained
when a
measurement is performed or an observation is made more than
once; it therefore
refers to the repeatability or the consistency of the information that
was collected.
5. Relevance- the consistency of the data produces with the needs of the
data users.
6. Adequacy- “Does the collected data provide all the basic information
needed to
meet the requirements of the users?”
MORTALITY RATES:
CRUDE DEATH RATE (CDR) =
Number of deaths in a calendar year X 1000
Midyear population
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CDR of City Z in 2002= 1148 X 1000
155,511
= 7.38/ 1000 population
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MATERNAL MORTALITY RATE (MMR) =
Number of deaths due to pregnancy,
Delivery, puerperium in a calendar yr. X 1000
Number of live births in the same year
INCIDENCE RATE=
Number of new cases of a disease
Over a period of time XF
Population at risk
PREVALENCE RATE=
Number of existing cases (old and new)
At a point in time X 100
Total population
GOAL:
To ensure that the health facility and staff promote public health
programs and prevent and control public health problems through direct
patient/client care and support that are consistent, well planned and well
executed.
SCOPE:
Integrated Women’s Health - Safe Motherhood and Family Planning
Child Care
Prevention and Control of Infectious Diseases
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Integrated Prevention and Control of Lifestyle – Related Diseases and
Environmental Health
Reproductive Health
Is a state of complete physical and social well-being and not merely the
absence of disease or infirmity in all matters relating to reproductive system
and its functions and processes.
ELEMENTS OF REPRODUCTIVE HEALTH
EXISTING:
Family Planning
Maternal and Child Health
Prevention and treatment of Reproductive Tract Infections/ STI,
HIV/AIDS
Breast and Reproductive Tract Cancers and other Gynecological
Conditions
Emerging:
Education and Counseling on Sexuality/ Sexuality Health
Violence Against Women
Adolescent Reproductive Health
Prevention of Abortion & Management of its complications
Prevention and treatment of Infertility & Sexual Disorders
Men’s Reproductive Health
WOMEN’S HEALTH
VISION
“Healthy empowered Filipino mothers able to make decisions for
themselves and their families and to contribute to the socio-economic
development of the Philippines”.
MISSION
1. ANTENATAL.
2. POSTNATAL
3. EMERGENCY OBSTETRIC CARE
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4. FAMILY PLANNING
MATERNAL CARE!
Mid decade Goal: Reduce maternal mortality
rate by ¾ by 2015
MMR ’93 = 209/100,000 live births
Refers to the total number of births that a woman would have at the
end of her reproductive life.
An important indicator in assessing the impact of programs on family
planning and reproductive health.
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Danger Signs of Pregnancy
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TETANUS TOXOID IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN
Vaccine
Minimum Age/Interval Duration of Protection
Benefits to Mothers:
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Exclusive breastfeeding during the first 6 months will delay the next
pregnancy.
It is convenient in terms of not having to prepare a bottle. All she has
to do is to
give her breast and the baby is fed. The mother can also sleep while
feeding.
* Remember that crying after breastfeeding is not a sign that a baby needs
formula or other solutions. It normally means that the baby wants to be held
and cuddled more. Some babies need to suck the breast simply for comfort.
QUALITY STANDARDS:
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maternal nutrition, physical activities, and planning for her labor and
delivery.
8. Conducts community level activities and advocacy campaigns on safe
motherhood to include family planning.
To come for early and regular prenatal care
Proper maternal nutrition
Promotion of healthy lifestyle
TT vaccination
Child spacing
Fertility awareness
Voluntary blood donation
9. Provision of clients information on family planning
10. Provision of clients information on Family Planning.
11. Couples currently using family planning methods are using the method
correctly.
FAMILY PLANNING
Goal
Universal access of Family Planning information and services for men and
women or couples of reproductive age.
Policy Statements
FP as a health intervention
FP prevents high risk pregnancies
FP reduces maternal deaths
FP prevents abortion
FP responds to the unmet needs and demands of women of
reproductive age
FP as a means to attain sustainable development
Principles
Responsible parenthood
Birth spacing
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Informed choice
Respect for Life
Privacy and Confidentiality
Multi-agency participation and partnership
Categories of FP Services
FP Promotion
FP Counseling:
G - Greet clients
A - Ask clients about themselves
T - Tell clients about choices
H - Help clients to make informed and voluntary
choices
E – Explain fully how to use the chosen method
R – Return visits should be welcomed
Provision of FP methods
Benefits for the Mothers:
* It delays pregnancy until the mother is ready to have another
baby.
* It provides a mother who may be suffering from some chronic
illness
(e.g., TB, diabetes, anemia, etc. enough time for treatment and
recovery
* It prevents young mothers (below 18 years old) and old mothers
(above
35 years old) from getting pregnant because it is dangerous at
their age.
Advantages of NFP:
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No health-related side effects
The method increases self-awareness and knowledge of human
reproductive functions
Can promote involvement of male sexual partner
Acceptable to couples regardless of culture, religion, socio-economic
status and education
Disadvantages of NFP:
Not recommended unless couples are willing to follow all the rules.
o Demands commitment, cooperation and communication
between both partners.
o Woman has to keep daily records of her signs and
symptoms of fertility.
o Some couples experience emotional stress due to need to
abstain from intercourse of certain days.
Precautions:
Method not advisable for:
• Couples who cannot communicate with each other about sexual
matters
• Couples with unstable relationship
• Women who cannot or are not willing to observe, record &
interpret fertility signs and symptoms
• Couples not willing to abstain from sexual intercourse during the
fertile phase of the woman’s cycle
Advantages of LAM
• no artificial device used
• can be used by women without medical assistance
• inexpensive
• convenient
Disadvantage of LAM:
• possibility of getting pregnant if the mother does not observe
exclusive breastfeeding
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WHAT TO OBSERVE:
• The occurrence of dry or wet mucus and feeling of dryness or wetness.
How to observe mucus secretions:
How to schedule sexual intercourse if you see paste like, flour like, opaque
and sticky mucus and you feel dry?
- May have sex in all days and anytime of the day.
How to schedule sexual intercourse if you see egg white like, stretchy,
slippery and clear or watery mucus and you feel wet?
• Abstain from sex. May have sex only until 2 days after: peak day” or
the last day of wetness.
For NFP User using Basal Body Temperature Method
What to observe:
• The rise and fall of body temperature all throughout the menstrual
cycle
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any mucus. Does this throughout the day then make an overall
assessment of the mucus at the end of the day?
What to do if the fertile days in the mucus method and the infertile days on
the BBT method coincide
• By using whichever has the longer infertile period.
Pill
How it works:
• It is an oral contraceptive composed of synthetic hormones,
which, when taken regularly prevents pregnancy.
Advantages of Pill:
• easy and effective
• relieves the tension of a woman during her ovulation period
• does not interrupt the sexual activity of the couple
• reduces dysmenorrhea
• prevent anemia
Disadvantages of Pill:
• needs to be taken daily
• decreases milk production for some women
• dependent on availability of supply
Precautions:
Not advisable when:
Pregnancy either known or suspected
suffering from or has a family history of diseases like high blood
pressure, weak heart, cancer of the breasts and others
The woman is over 35 years old and a heavy smoker (15 or more
cigarettes a day)
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- spotting
- weight gain or weight loss
- fullness of breasts
What are the warning signs to watch out for in taking the pills?
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the cervix is thick. This plugs the cervix, making sperm
penetration difficult.
Advantages of DMPA:
• Most convenient to use
• Long lasting (3 months)
• does not interfere with sexual intercourse
• Highly effective
Disadvantages of DMPA:
• increased appetite leading to weight gain for some women
• Long acting & cannot easily be discontinued or removed from the
body in case of complications
• Delay in return of fertility after discontinuing DMPA
Precautions
Not advisable for a woman who:
is pregnant or may be pregnant
has vaginal bleeding of unknown cause
has breast cancer
Has no menstruation but not related to pregnancy or breast
feeding.
Advantages of IUD:
No fear of getting pregnant
does not interrupt sexual activity
does not disrupt breastfeeding
It is easy to use with few instructions to remember
can be easily removed by health worker
Disadvantages of IUD:
May be expelled from womb
Does not protect against AIDS and other STIs
Requires trained personnel for insertion and removal
Precautions
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Not advisable for women who:
is pregnant or think she is pregnant
has different sexual partners
has never had children
has infection of the reproductive system
Advantages of BTL:
Effective and safe
Easy to perform
Permanent
No long term side effects
Does not interfere with sexual activity
Disadvantages of BTL:
Has to rest for several days after the operation
Cannot be easily reversed
Precautions
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Operation not advisable to:
- Couples who may want more children
- Women below 25 years old
- Women pregnant or may be pregnant
- Women too fat
- Women severely malnourished
- Women with goiter, diabetes or hypertension
Advantages of Vasectomy:
- Effective and safe
- Easy to perform
- Permanent
- No long term side effects
- Does not interfere with sexual intercourse
Disadvantages of Vasectomy:
o Requires the assistance of a trained doctor
o Has to wear a condom or use any other family planning
method after the operation or until the tubes have no
more sperm cells in them (15-20 ejaculations)
Precautions
Operation is not advisable to:
- Couples who may want more children
- A male below 25 years old
- A male with lump in the scrotum
- A male with hernia
- A male who is allergic to drug (anesthesia)
CHILD CARE
I. Introduction:
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Children are the future “movers and shakers” of our society and they
form an important sector of our population as they grow to become the
leaders of the Philippines. The well-being and protection of children,
therefore, is our fundamental concern.
The programmatic approach to child health care uses the life cycle
approach, which covers the stages in life from unborn to being newborn,
infant, pre-schooler, school aged child & adolescent. The packages take
into consideration the needs of a child at a certain life stages for his
growth and full development of his potentials. The period of development
of a child has its onset before conception and continues beyond
adolescence into adulthood. The different stages of a child’s growth
cannot be considered independently from the entire development
process, and every child will eventually pass through each of the
developmental stages. The rights-based life cycle approach allows better
observation of the differentiated needs for each stage of life ensuring the
responsiveness, focus and integration of interventions.
The greatest threat to a child’s survival occurs within the first month of
life. During infancy, the risk of death in the first month of life is equal to
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the risk cover the next 11 months. Prematurity, congenital defects, low
birth weight may be the underlying causes of death. Inherent disorders of
pregnancy and complications arising from delivery contribute to the
mortality risks of the risks of the newborn. Most of these are direct
consequences of sub-optimal conditions in the antepartum and
intrapartum periods. The circumstances surrounding delivery and the
early recognition of complications of childbirth also significantly affect
neonatal survival.
The risks to survival and well being during the period 1 to 6 years of
age similar to those during infancy. Infectious diseases, nutritional
deficiencies, and the consequences of neglect and accidents contribute to
child mortality. Survivors of this age group face multiple health risks such
as malnutrition, acute respiratory infection and diarrheal diseases.
The psychosocial needs of this age group can no longer be fully met
the immediate family. The child has to interact with children of similar
age to develop socially and emotionally. The school year (SY) 1997-1998
data on early childhood care and development (ECCD) shows that only
one third of the 3-5 year old children have gone to preschool or day care.
Children who have undergone ECCD tend to better prepared for formal
schooling and thus, less likely to drop out. Due to inadequate facilities,
access to ECCD is slightly lower in rural areas than in urban areas.
The level II standards do not deal only with individual childcare but of
children as a whole in the catchments area. High coverage of each health
service is necessary to achieve the over-all goals for children’s health,
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e.g. herd immunity or at least 95% Fully Immunized Child coverage to
sustain eradication/elimination efforts, high utilization of iodized salt and
Vitamin A so that micronutrient deficiencies are no longer a public health-
problem, increased and sustained breastfeeding up to two years old and
beyond. Screening of newborns for congenital metabolic disorders was an
added feature in the standard because of its impact on preventing mental
retardation and death.
1. The health facility has achieved a high coverage among 0-71 months
old children for the following basic Early Child Care and Development
(ECCD) services:
- At least 95% fully immunized child (FIC) coverage in every
catchments barangay
- At least 90% Vitamin A supplementation coverage among 6-71
months old
- At least 70% OF 48-71 months old who visited the RHU/HC given
Dental Services
- At least 80% of 0-71 months old have normal nutritional status, or
at least 10% increase per year of children with normal nutritional
status.
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• Birth registration
• Proper care of the newborn- resuscitation when needed, prevention
and management of hypothermia, eye prophylaxis, Vitamin K, cord
care, birth weighing
• Breastfeeding – early initiation within one hour, exclusive for 6 months
and continued up to 2 years and beyond
• Appropriate complementary feeding starting at 6 months
• Newborn screening within 2-10 days after birth
• Full immunization
• Regular Growth monitoring and promotion
• Nutrition counseling
• Micronutrient supplementation, particularly Vitamin A and iron
supplementation when anemic
• Appropriate management of sick children using the IMCI treatment
guidelines
• ECCD developmental screening
• Psychosocial stimulation
• Disability detection
• Regular oral care/dental check-up
• Child safety
• Use of iodized salt
1. The health facility achieves a high coverage among 0-71 months old
children for the following basic early child care and development (ECCD)
services.
The Public Health Nurse (PHN) provider should know the following
rationale or justification why a high coverage should be maintained. The
succeeding section after the brief description of each quality standard
describes the highlights of selected child
health programs.
Below are the formulas for computing the selected indicators. All
indicators,
except the percentage of children with normal nutritional status, used the
projected population for the year assessed based on the 2000 NSO
estimates as the denominator.
Basic for computations:
Actual no. of infants 0-11 months given 1 BCG, 3 DPT, 3 OPV, 3 HBV, 1 MV
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Before their first birthday
___________________________________________________________ X 100%
Total population X 3% (éligible population)
To ensure that families use only iodized salt, salt vendors should only
sell
Iodized salt. Rather than doing salt testing at household level, it will be
more practical to test salt available in the market, as this will entail lesser
samples for testing than households.
“Patak SA Asin” is quarterly done. For the purpose of Sentrong Sigla,
the proportion of salt vendors selling iodized salt shall be computed on
an annual basis, thus:
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________________________________________ X 100 %
Total number of salt samples tested for the year
6. The health facility ensures the availability of the following supplies at all
times
Auto-disabled syringes with needles are the recommended type to
ensure safe
immunization. After injection, the syringe cannot be re-used as it is locked.
ECCD card/mother and child book are the necessary tools for recording as
well as remind mothers of the important health services for the child.
Newborn screening supplies should be available in main health
centers offering NBS. For purposes of Sentrong Sigla, the required quantity
available is based on the average number of children seen for the month.
The health staff should not violate the Milk Code and no promotional
materials, such as posters, wall clocks, ball pens, or any gifts of any sort
should be seen in the health facility.
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The health facility should have links with active breastfeeding support
groups and should be able to show proofs, such as minutes of meetings,
MOAs, attendance to training and orientation activities.
Management/Nursing Care:
a. symptomatic
b. enteric precaution, universal precaution
c. High CHON, high caloric, high CHO and low fats diet.
I. OVERVIEW
Quick assessment for every child brought in the clinic:
C. Pre-referral treatment:
(e.g. 1st dose antibiotics, ORS, paracetamol, etc.)
A. Newborn Care
To provide newborn care to children 0 to 7 days old
B. History and physical examination and assesses for main signs &
symptoms
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1. Possible serious bacterial infection:
A. infants had convulsions
B. counts the breaths in one minute (60 breaths per minute or more)
C. looks for severe chest indrawing
D. looks for nasal flaring
E. looks and listens for grunting
F. looks and feels for bulging fontanel
G. looks for pus draining from the ear
H. measures temperature (38.5 C & above or below 35.5 C)
I. looks for skin pustules (many or severe)
j. See if the young infant is abnormally sleepy or difficult to awaken
2. Refer the infant immediately if positive for any of the signs above
3. Diarrhea
4. Classify as local bacterial infection if:
A. red umbilicus or draining pus
B. skin pustules
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1. Teach the mother/caregiver how to treat local infections and
corresponding home care.
2. Advise the mother/caregiver on home care and proper feeding if with
breastfeeding/feeding problem and low weight.
3. Advise the mother/caregiver when to return for follow-up
A. Takes history and physical examination and assesses for main signs &
symptoms
1. Acute Respiratory Infection
2. Diarrhea
a. Assess for diarrhea by doing the following
i. Asking for how long was the diarrhea?
ii. Asking if there is blood in the stool?
iii. Looking at the general condition?
iv. Checking if the child is abnormally sleepy or difficult to
awaken?
v. Checking if the child is restless or irritable?
vi. Looking for sunken eyes?
b. Assess the response of the child with diarrhea when the offered
fluids by observing the following:
i. The child able to drink or is drinking poorly
ii. The child drinking eagerly or thirsty
c. Assess skin turgor of the child with diarrhea by pinching the skin
of the abdomen and observing if it goes back slowly or very
slowly, longer than 2 seconds.
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i. Abnormally sleepy or difficult to awaken
ii. Sunken eyes
iii. Not able to drink or drinks poorly
iv. Skin pinch goes back very slowly
3. Fever (Malaria)
a. Assess if the child with fever has malaria risk by doing the
following:
i. Asking whether living in a malaria area or visited a malaria
area in the past 4 weeks.
ii. Obtaining a malarial smear
c. Look and feel for a stiff neck; look for a runny nose
d. Classify the child with severe disease for malaria if;
i. With any general danger sign or
ii. With stiff neck
4. Fever (Measles)
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i. Mouth ulcers and whether it is deep and extensive
ii. Pus draining from the eyes
iii. Clouding of the cornea
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i. As acute ear infection if there is pus draining from the ear
less than two weeks or presence of a red, immobile ear
drum (by otoscopy)
ii. As chronic infection if with pus draining from the ear for
two weeks or more
iii. As mastoiditis if there is tender swelling behind the ear
C. Treats accordingly
1. Acute Respiratory Infection
a. Treat the child with cough or difficult breathing according to the
following DOH protocols:
i. Refers immediately if with severe pneumonia
ii. If with pneumonia
1. Gives antibiotics (Cotrimoxazole)
2. gives 1st dose antibiotic before sending the child
home
3. advises on how to treat the child at home
4. advises when to return the child immediately
5. advises the mother/caregiver to bring the child for
follow-up in 2 days
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a. Refer immediately severely dehydrated children to the hospital
for intravenous fluid therapy
b. Give frequent sips of ORS on the way to a severely dehydrated
child referred to the hospital.
c. Manage children with some dehydration by:
i. Giving ORS at the health facility
ii. Giving two packs of ORS to take home
iii. Giving advice on:
1. continued feeding
2. give ORS at home
3. when to return
i. Giving Vitamin A
ii. Giving advice on:
1. feed the child
2. follow-up in 5 days
3. Fever (Malaria)
4. Fever (measles)
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i. If with severe complicated measles
1. gives vitamin A
2. gives 1st dose of antibiotics (cotrimoxazole)
3. applies tetracycline ophthalmic ointment if with
clouding of the cornea or pus draining from the eyes
4. refers immediately to hospital
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iii. Persistent diarrhea
iv. Severe and moderate malnutrition
v. Anemia
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Client Midwife/Nurse Doctor
Well
child
brought
in
Age
of
Chil
d
12 months 10 to 18
0 to 11 months
to 9 years years
Midwife/Nurse
Midwife/Nurse Midwife/Nurse Advises
Reiterates to Advises mother/caregive
mother/caregive mother/caregive r when to return
r when to return r when to return
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IV. WELL CHILD (< 1 year)
2. Give the correct antigen for age and schedule, correct dose and correct
route of administration
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a. Administers BCG, 0.05 ml to infants below 6 weeks old
b. Gives the vaccine intradermally on the deltoid area using
tuberculin syringe (producing a flat wheal with surface pitted like
orange peel appears at injection site).
c. Administers DPT/Hepa B to infants 6 weeks – 11 months old in 3
doses at 4 weeks interval
d. Gives DPT/Hepa B 0.5 ml intramuscular at the upper outer
portion of the thigh (gives each dose of vaccine on each thigh)
e. Administers OPV to infants 6 weeks – 11 months old in 3 doses
at 4 weeks interval
f. Gives OPV, 2 drops orally
g. Administers AMV to infants 9-11 months
h. Gives AMV 0.5 ml subcutaneous on the deltoid area of the upper
arm
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a. Assess feeding when there is growth faltering (declining line on
the growth chart) or plotted weight below the lower line of the
growth chart by asking the following
i. Child breastfeeding
ii. How many tomes during the day and at night?
iii. Complementary foods are given
iv. How many times per day?
v. Child receive adequate servings
vi. Own bowl and spoon
b. Assess other problems and gives appropriate advice
c. Instruct the mother/caregiver how to feed the child based on the
feeding recommendation on the ECCD card
A. Gives and Fills up the ECCD card (for children less than 6 years old)
- Issue and fill up the ECCD card for children less than 6 years old
a. Is child breastfeeding?
b. If yes, how many times during the day and at night?
c. What complementary foods are given?
d. How many times per day?
e. Does child receive adequate servings?
f. Has own bowl and spoon?
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3. Assess other problems
B. Gives advice
1. Give advice on the following:
a. Fertility awareness and responsible sexuality
b. Healthy diet and physical activity
c. Dangers of drugs, alcohol and tobacco
d. Awareness on physical, emotional and sexual abuse
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• A joint WHO / UNICEF initiative since 1992
IMCI Strategy
Objectives:
Key Strategy
• Focus on the health and development needs of the child rather than
the treatment of an illness
• Coordination / integration of the various child health services to meet
the child’s needs
Rationale:
• Most sick children present with signs and symptoms related to more
than one disease
• This overlap means that a single diagnosis may not be possible or
appropriate
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• Treatment may be complicated by the need to combine therapy for
several conditions
Distribution of under-five deaths in developing
countries by cause, 2002.
18%
25%
ARI
Perinatal
Measles
15 Malaria
% HIV/AIDS
Diarrhea
Others
5%
23%
10%
4%
• Respiratory Diseases
• Diarrheal Diseases
• Measles
• Malaria
• Malnutrition
• Dengue (for the Philippines)
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• Improves equity
– Ready access to simple and affordable preventive and curative
care for children which protects them from death due to ARI,
diarrhea, measles, malaria, dengue and malnutrition
3 Main components of IMCI Strategy
1. Improving Health System
2. Improving health workers’ skills
3. Improving family and community practices
2 general principles
• Gradual integration of IMCI concepts into the teaching of relevant
subjects.
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• Assess, classify and treat sick children accurately following the IMCI
case management guidelines
IMCI Process
• Relies on case detection using simple clinical signs.
• Treatment based on action-oriented classification rather than exact
diagnosis.
• Designed for a first level facility (clinic, health center, OPD).
• Treatment combined with prevention.
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– Examine the child (LOOK, LISTEN, FEEL)
– Check nutrition and immunization status
– Assess for other health problems
2. Classify a child’s illness
– Color-coded triage system
– Whether it requires urgent pre-referral treatment and referral,
specific medical treatment and advice or simple advice on home
management
48
• Vomits everything?
• Had convulsions?
– LOOK
• Abnormally sleepy or difficult to awaken
CLASSIFY
• If with general danger sign
FAST BREATHING
– 50 breaths /min or more if child is 2 – 12 months
– 40 breaths / min or more if child is 12 months – 5 years.
49
Wheezing (before or after NO PNEMUMONIA : • Give an inhaled or oral
trial of rapid acting WHEEZING bronchodilator for 5 days
inhaled bronchodilator up • If recurrent wheezing refer for
to 3 cycles) assessment if not done
• Advise the mother when to
return immediately
• Follow up in 2 days if not
improving
50
Two of the ff signs: SEVERE • If the child has no other severe
• Abnormally sleepy or DEHYDRATION classification, give fluid for severe
difficult to awaken dehydration (Plan C)
• Sunken eyes • If the child ha s another severe
• Not able to drink or classification, refer URGENTLY to
drinking poorly hospital with mother giving frequent
• Skin pinch goes back sips of ORS. Continue breastfeeding
very slowly • If child is 2 years or older than there is
cholera in your area, give antibiotic for
cholera
Two of the following signs : SOME • Give fluid , zinc supplements and food
• Restless, irritable DEHYDRATION for some dehydration (Plan B)
• Sunken eyes • If with severe classification, refer
• Drinks eagerly, thirsty URGENTLY to hospital with mother
• Skin pinch goes back giving frequent sips of ORS. Continue
slowly breastfeeding
• Advise mother when to return
immediately
• Follow up 5 days if not improving
No dehydration PERSISTENT
DIARRHEA • Advise
mother on
feeding a child
who has
persistent
diarrhea
• Give
multivitamins
and minerals
51
(including zinc)
for 14 days
• Give vitamin
A
• Follow up in
5 days
If blood in stool
• Ask :
– How long has the child had fever?
– If > 7 days, has fever been present everyday?
– Has the child had measles within the last 3 months?
• Look and feel:
– Stiff neck
– Runny nose
– Look for signs of measles
• Generalized rash
• One of these : cough, runny nose or red eyes
CLASSIFY FEVER
MALARIA RISK
52
• Any general VERY SEVERE • Give 1st dose of quinine (under
danger sign or FEBRILE DISEASE medical supervision)
• Stiff neck / MALARIA • Give 1st dose of appropriate antibiotic
• Treat child to prevent low blood sugar
• Give one dose of paracetamol in
health center for high fever (38.5°C or
above)
• Send blood smear with the patient
• Refer URGENTLY to hospital
CLASSIFY FEVER:
NO MALARIA RISK
53
If the child has measles now or within the last 3 months:
• Look for mouth ulcers
– Deep and extensive?
• Look for pus draining from the eye
• Look for clouding of the cornea
• Give Vitamin A
• Give 1st dose of an
• Clouding of cornea or appropriate antibiotic
• Deep or extensive SEVERE COMPLICATED • IF clouding of cornea or
mouth ulcers MEASLES pus draining from the
eye, apply tetracycline
eye ointment
• Refer URGENTLY to
hospital
Give Vitamin A
If pus draining from the eye, apply
Pus draining from the eye
tetracycline eye ointment
or MEASLES WITH EYE
If mouth ulcers, teach mother to treat
Mouth ulcers OR MOUTH
gentian violet
COMPLICA -TIONS
Follow up in 2 days.
54
Ask Look and Feel
• Bleeding from nose or • Bleeding from nose or
gums or in vomitus or gums
stools? • Skin petechiae
• Persistent vomiting? • Cold and clammy
• Black vomitus? extremities
• Black stools? • Slow capillary refill
• Persistent abdominal • Perform tourniquet
pain? test if child is > 6
months AND has no
other signs AND has
fever for > 3 days
55
• Bleeding from nose or If vomiting or
gums or abdominal pain or skin
• Bleeding in stools or petechiae or (+)
vomitus or SEVERE DENGUE Tourniquet test are
• Black stools or vomitus HEMORRHAGIC the only positive signs
• Skin petechiae or FEVER give ORS as in Plan B
• Cold and clammy If any other signs are
extremities or (+), give fluids rapidly
• Capillary refill > 3 as in Plan C
seconds or Treat the child to
• Persistent abdominal prevent low blood
pain sugar
• Persistent vomiting Refer all children
• (+) Tourniquet test URGENTLY to hospital
DO NOT GIVE ASPIRIN
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Give 1st dose of an appropriate antibiotic
Tender swelling
Give 1st dose of paracetamol for pain
behind the ear
Refer URGENTLY to hospital
MASTOIDITIS
Pus is seen
Give antibiotic for 5 days
draining from the
Give paracetamol for pain
ear & discharge is
Dry the ear by wicking
reported <14 days ACUTE EAR
Follow up in 5 days
Ear pain INFECTION
– Palmar pallor
• Severe
• Some
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• Visible severe SEVERE • Give Vitamin A
wasting or MALNUTRITION OR • Refer urgently to hospital
• Edema of both SEVERE ANEMIA
feet
• Severe palmar
pallor
Some palmar pallor or ANEMIA OR VERY LOW • Assess feeding and counsel
Very low weight for age WEIGHT mother – ff up in 5 days
• If some pallor
-Give iron
-Mebendazole if 1 year
or older and no dose in
last 6 mos.
-Ffup in 14 days
– If very low weight for
age- Vit A, ff up in 30
days
– Advise when to return
immediately
Not very low weight for NO ANEMIA AND NOT If the child is < 2 years old, assess
age and no other signs VERY LOW WEIGHT the child’s feeding and counsel the
of malnutrition mother – ff up in 5 days
Advise when to return immediately
9 months Measles
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Check Vit A Supplementation Schedule
• First dose at 6 months or above
• Subsequent doses every 6 months
Assess child’s feeding if with ANEMIA or VERY LOW WEIGHT or < 2 years old
• For dysentery
• For cholera
Cotrimoxazole Amoxicillin
(2 x daily for 5 days) (3x daily for 5
days)
AGE Tablet : 80 mg Tablet: 250 mg
trimethoprim + 400 mg Syrup : 125mg/5
sulphamethoxazole ml
Syrup : 40 mg T + 200 mg
S/5ml
2 – 12 mos. (4 -<10 ½ tab ½ tab
kg) 5 ml syrup 5 ml syrup
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12 mos – 5 years 1 tab 1 tab
(10-19 kg) 10 ml syrup 10 ml syrup
• Children with wheeze and fast breathing and/or lower chest indrawing
should be given a trial of rapid acting inhaled bronchodilator before
they are classified as pneumonia and prescribed antibiotics. 0.5 ml
salbutamol diluted in 2.0 ml of sterile water per dose per nebulization
should be used.
For dysentery
Update
60
Ear infections
Helminth infestations
WHEN TO RETURN
• Follow up visit
• Next well child visit
• Return immediately
Return immediately
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• Not able to drink or
breastfeed
Any sick child • Becomes sicker
• Develops a fever
• Fast breathing
If child has NO PNEUMONIA : COUGH OR • Difficult breathing
COLD, also return if
• Blood in stool
If Child has Diarrhea, also return if • Drinking poorly
• If the mother is sick, provide care for her, or refer her for help
• If she has a breast problem, provide care for her or refer her for help
• Advise her to eat well to keep up her own strength and health
• Check the mother’s immunization status and give her Tetanus Toxoid
if needed
• Make sure she has access to:
– Family planning
– Counseling on STD and AIDS prevention
ASSESS
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- Look and feel for bulging fontanel
- Look at the umbilicus. IS it red or draining pus? Does the redness
extend to the skin?
- Measure Temp (or feel for fever or low body temp)
- Look for skin pustules. Are there many or severe pustules?
• Ask
63
– For how long?
– Is there blood in the stool?
Two of the following Give fluid and food for some dehydration
signs: SOME (Plan B)
Restless, irritable DEHYDRATION If infant also has POSSIBLE SERIOUS
Sunken eye BACTERIAL INFECTION OR
Skin pinch goes back DYSENTERY: Refer URGENTLY to
slowly hospital with mother giving frequent sips
of ORS on the way. Advise mother to
continue breastfeeding.
Not enough signs to Give fluid to treat diarrhea at home (Plan
classify as some or NO A)
severe dehydration DEHYDRATION
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• If diarrhea 14 days or more
• If blood in stool
• Ask
– Is there any difficulty feeding?
– 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?
• IF AN INFANT :
– Has any difficulty feeding,
- Is breastfeeding < 8 x in 24 hrs.
- Is taking any other foods or drinks or
- Is low weight for age AND
- Has no indications to refer urgently to hospital
ASSESS BREASTFEEDING
65
– Is the infant able to attach? (no attachment at all, not well
attached, good attachment)
– Is the infant suckling effectively (that is slow deep sucks,
sometimes pausing)? – not sucking at all, not suckling
effectively, suckling effectively
– Clear a blocked nose if it interferes with breastfeeding
– Look for ulcers or white patches in the mouth (thrush)
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If thrush, teach the mother to
treat thrush at home
Advise mother to give home
care for the young infant
Follow up any feeding problem
or thrush in 2 days
Follow up low weight for age in
14 days
Not low weight for age NO FEEDING PROBLEM Advise mother to give home
and no other signs of care for the young infant
inadequate feeding Praise the mother for feeding
the infant well.
AGE VACCINE
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V. HIGHLIGHTS OF SELECTED CHILD HEALTH PROGRAMS
A fully immunized child (FIC) is a child who received one dose of BCG, 3
doses of OPV, 3 doses of DPT, 3 dose of Hep B vaccine and one dose of
measles before the child reaches the age of one year.
There are strategies than can be done to achieve high coverage e.g.
reaching every infant in every barangay (strategy of integrating
immunization during the Garantisadong Pambata campaign. When the
estimated number of unimmunized children almost approximates the infant
cohort for the year or when outbreaks occur, supplemental immunization
activities are done (mass immunization with expanded target group). An
example of this is the Ligtas Tigdas Campaign.
68
visits are done to check whether the recommended actions are
undertaken and to see improvements in coverage…
3. Linking community with service delivery – this is involving the
community in the assessment of the health situation in the
community and plan activities where the community can
participate to ensure that the necessary health interventions are
provided to children.
4. Monitoring and use of data for action – the health worker should
be able to monitor the progress of indicators by learning how to
use available data in the target clients list, accomplishment
report and other data. By analyzing the data the health worker
will know whether the low immunization coverage is due to
problem with access, especially when there are many
unimmunized children, or problem of utilization as in the case of
defaulters. Appropriate actions are then identified.
5. Plan and manage to optimize scarce resource utilization – a plan
of action is formulated considering the resources available or
those that can be tapped and identifying the locus of
responsibility for each action.
-The vaccines like OPV, DPT, HEP B, & TT once open can still be used within
4 wks. provided the following conditions are met:
- expiry date has not passed
- vaccines are placed under appropriate cold chain conditions
- vaccine vial septum has not been submerged in water
- aseptic technique has been maintained at all times
- vaccine vial monitor (VVM) if attached has not reached its discard point.
69
VVM – (vaccine vial monitor)
• Is a device that is directly applied to the vaccine vials to measure the
temperature that the vaccines have been exposed to.
I. Rationale
Hepatitis B is a major public health problem in the Philippines with
an estimated seven million people (approximately 10-12% of the
total population) chronically infected with the virus. Twenty to 30%
of these chronically infected people will develop chronic liver
disease (cirrhosis of liver, liver cancer, etc.) mostly between 30-50
years of age. Many will die from it as there is no effective and
affordable drug treatment currently available for hepatitis B.
Approximately 9000 people are estimated to die from chronic liver
disease in Philippines annually – a mortality rate comparable to that
of tuberculosis. Majority of chronic carriers of infection acquire their
infection either at birth (when the risk of becoming a chronic carrier
is almost 90%) or in the early childhood by exposure to
serous/blood exudates from cuts/wounds/bites of other infected
children (the risk of becoming chronic carrier is almost 30% if
exposed between age 1 and 5 years, though gets reduced to 10%
of infected after five years of age).
70
less than 8 years old, Hepatitis B vaccination shall be routinely
strengthened with the activities and plans of the Expanded Program
on Immunization (EPI) to effectively control hepatitis B in the
country by reducing the chronic infection rate of hepatitis B to less
than 1% among future birth cohorts from the current levels of 10-
12%. The giving of Hepa B vaccination within 24 hours of birth is to
prevent mother to child (perinatal) transmission. Perinatal
transmission is known to be a major source of maintaining a pool of
chronic infection carriers who are at risk of developing long term
complications of infection in their economically productive years
besides serving as source of infection for others. Republic Act No.
2029 otherwise known as the “Liver Cancer and Hepatitis B
Awareness Month Act” which declares the month of February as the
liver cancer and hepatitis B awareness month throughout the
Philippines was also passed.
The order shall apply to all DOH health facilities at all levels of
health care including all public and private health facilities and
other institutions providing immunization services for children
nationwide.
1. DOH shall procure 75% of the hepatitis B vaccine needs for 2007 and
100% starting 2008 and onwards to provide all 0-11 months old with
three doses of hepatitis B vaccine in the first year of life free of charge
in all health facilities and other institutions providing immunization
services for children nationwide.
2. All newborn infants shall be given immunization against hepatitis B
immediately within 24 hours after birth.
3. Infants born outside of hospital, medical clinic or birthing facilities
should be brought to any available healthcare facility so as to be
immunized against Hepatitis B within 24 hours after birth but not later
than 7 days.
4. The subsequent doses of hepatitis B vaccination shall be completed
according to the new recommended schedule of Hepatitis B
immunization.
5. All health care practitioners or health care workers providing prenatal
care shall educate all pregnant mothers on the importance of giving
their infants the basic immunization services.
6. Every child shall be immunized through the Reach Every barangay
strategy.
71
7. Health education and information campaign shall be intensified at the
ground level especially among the disadvantaged population to
increase the proportion of mothers and caretakers practicing
behaviors that promote child immunization.
8. The implementation of RA 7846, also known as Compulsory Hepatitis B
immunization among infants and children less than 8 years old and
other laws and policies for the protection of infants shall be pursued.
V. IMPLEMENTING GUIDELINES
a. Type of Vaccine
b. Formulations
72
Combination vaccines that include Hepatitis B MUST NOT BE USED
for the birth dose of hepatitis B vaccine because DPT and Hib
vaccines should not be administered at birth.
c. Presentation
d. Dosage
The standard pediatric dose is 0.5 ml.
e. Sites Of Administration
73
• Hepatitis B SHOULD NOT be mixed in the same syringe with
other vaccines.
74
• Soreness. About 5% of children may develop tenderness,
redness, or mild swelling at the injection site
• Fever. About 1% to 60% of those who receive the vaccine
may develop a mild fever that lasts 1-2 day after injection of
the vaccine.
a. All health centers and BHS shall follow the revised schedule of
Hepatitis B immunization among infants provided in these
guidelines.
75
case, the pregnant woman decides to have her delivery attended by TBA,
the TBA or the mother should be advised to inform the nearest health facility
either by phone of by personal visit for the provision of the HepB and BCG or
should bring the newborn to the health facility for vaccinations or a midwife
to give immunization during house visit within 7 days after delivery. The
midwife at BHS/health center should provide the hepatitis B vaccine as soon
as possible after getting the information along with other post-natal
services.
1. Department of Health
a. Central Office/National Center for Disease Prevention and
Control
The EPI-National Center for Disease Prevention and Control
(NCDPC) shall provide the standards, policies and guidelines on
the Hepatitis B immunization program an ensures adequate and
potent Hepatitis B vaccines are procured and delivered
nationwide. Auto-disabled needles and syringes shall also be
procured for all the 5th and 6th class municipalities nationwide.
b. CHDs/Hospitals
The CHDs shall ensure that all the vaccines are potent, adequate
and timely delivered to their catchments areas, ensure the
timely submission of the accomplishment reports, provide
technical assistance to include supervisory/monitoring visits to
the LGUs to ensure all infants receive 3 doses of Hepatitis B
vaccines including Hepatitis B at birth. CHD shall ensure that all
LGUs have sufficient supply of needles and syringes. This shall
entail monitoring, advocacy as well as augmentation of supplies.
All local government units shall ensure that the vaccines are given to
the targeted eligible population-the infants, reach all infants in every
barangay, ensure those who received initial vaccination from the
private sectors are fully vaccinated, follow-up the missed and the
76
under-immunized infants including transients, and submit
accomplishment reports on time.
All LGUs shall provide funds for the procurement of the auto-disabled
syringes for Hepatitis B and other primary vaccinations series for
infants; provide adequate funds for the traveling and incidental
expenses for the health workers for them to conduct outreach
activities. They must also ensure that regular immunization activity is
being done at least once a week.
All health practitioners shall ensure that every infant receives all
vaccinations covered in the DOH policy. Professional organizations
shall disseminate this policy to its members.
4. Partner Agencies
5. Academe
The academe shall incorporate updated EPI policies and laws into its
curriculum and continuing education.
Step three
Eligible population x no. of doses x wastage multiplier
77
20 dose/vial
Example: DPT requirement for Municipality XYZ where the total population
1) TUBERCULOSIS
• In general, children are not considered contagious, and usually get the
infection from infected adults.
• The incubation period varies from weeks to years, depending on the
individual and whether the infection is primary, progressive, or
reactivation TB.
2) POLIOMYELITIS
78
Poliomyelitis or polio is a highly contagious viral infection that affects the
nervous system.
Children can be infected with polio when they eat or drink food and water
contaminated with the virus or when they come into direct contact with an
infected person’s fecal matter or saliva.
a) A mild called abortive polio (most people with this form of polio may
not even suspect they have it because their sickness is limited to mild
flu like symptoms such as mild upper respiratory infection diarrhea,
fever, sore throat, and a general feeling of ill)
b) A more serious form associated with septic meningitis called
nonparalytic polio (1% to 5% show neurological symptoms such as
sensitivity to light and neck stiffness)
c) Severe debilitating from called paralytic polio (this occurs in 0.1% to
2% of cases)
Paralytic polio, as its name implies, causes muscle paralysis and can even
result in death. Paralytic polio, the virus leaves the intestinal tract and
enters the bloodstream, attacking the nerves (in abortive or asymptomatic
polio, the virus usually just stays in the intestinal tract) the virus may affect
the nerves governing the muscles in the limbs and the muscles necessary
for breathing, causing respiratory difficulty and paralysis of the arms and
legs.
Nursing Care/Treatment:
Symptomatic
Avoid over fatigue
Place the child in firm mattress with feet support
Change position regularly, maintain good body alignment
Fluid and food intake
Relieve anxiety and promote rest
Physiotherapy (moist heat to alleviate muscular pain)
Dispose of stool properly
3) DIPTHERIA
79
Causative Agent: Corynebactrium dipthense
Incubation period: 2 – 6 days
Mode of Transmission: droplet from infected person or carrier
In these early stages, diphtheria can be mistaken for a bad core throat. A
low grade fever and swollen neck glands are the other early symptoms. The
toxin, or poison, caused by the bacteria can lead to a thick coating in the
nose, throat, or airway. This coating is usually fuzzy gray or black and can
cause breathing problems and difficulty in swallowing. The formation of this
coating (or membrane) in the nose, throat, or airway makes a diphtheria
infection different from other more common infections (such as ) that cause
sore throat.
Nursing Care/Treatment
a) IV administration of antibiotics (erythromycin or penicillin) for 14 days.
b) Contact must be taken specimen for testing/culture & observed
c) Strict bed rest, prevent exertion
d) Cleansing sore throat gargle, liquid and soft diet
e) Observe for respiratory obstruction
Possible Complications:
Bed rest is particularly important if the person’s heart has been affected by
the disease. Myocarditis, or inflammation of the heart muscle, can be a
complication of diphtheria.
4.) PERTUSSIS
Mode of Transmission:
a) direct contact with infected person
b) droplet
80
Pertussis is a respiratory infection characterized by a signature cough.
During severe coughing spells, the infected child may have difficulty
breathing and make a “whooping” noise as he or she tries to inhale.
Mode of Transmission:
Nursing Care/Treatment
a. symptomatic
b. erythromycin used to limit communicability
c. sulfonamides and antibiotics may be given to prevent 2nd
infection
d. oxygen may be given, humidity air
e. small frequent feeding
81
Possible complications
a. bronchopneumonia
b. malnutrition, bronchoiectasis
c. hemorrhage may occur during coughing
d. encephalitis
5.) TETANUS
Mode of transmission:
Organisms are found in soil and enter body through a wound. Deep puncture
wound are ideal for the growth of the organism (anaerobic); burns are also
ideal due to the necrotic tissues
The bacteria spores live in soil, in animal drug, and in feces-and tetanus can
affect anybody. The bacteria produce a toxin (poison) that attacks the
central nervous system.
Symptoms
• It takes about 8 days for symptoms of tetanus to appear.
• One of the earliest signs of tetanus is stiffening of the jaw muscles,
which is why tetanus is often referred to as lockjaw (insmus)
• There is also spasm of facial muscles
• Symptoms progress to stiff neck and pain in the shoulders and back
(opistoronus). Difficulty swallowing, and tightening of the muscles of
the abdomen and limbs.
• Other symptoms include a fever, sweating, high blood pressure and
periods of irregular heartbeat.
• Muscle spasms, which may be severe, are also likely to occur and may
last 3 to 4 weeks. Recovery from tetanus may take months.
Complications
82
• Complications associated with tetanus include spasms of the muscles
of the vocal cords and/or breathing), spinal and long-bone fractures,
high blood pressure, and abnormal heart rhythm. Other complications
include infections in patients who experience extended hospital stays,
blood clots in the lungs (the elderly and drug users are especially at
risk), and pneumonia.
• About 11% of people who get tetanus die from the disease.
Treatment/Nursing care
• Neutralize toxins: tetanus immune globulin (TIG) IM; equine tetanus
anti-toxin (TAT)
• Penicillin G or tetracycline is effective against tetanus organism
• Place child in darkened room, avoid stimulation
• May give muscle relaxant, sedative and tranquilizer
• Tracheostomy may be necessary
The measles virus multiplies in the respiratory tract and is transmitted via
droplets released into the air when an infected person coughs or sneezes.
Children can catch the disease by breathing in these droplets, or by coming
in contact with the fluids from the infected person’s nose or throat.
Treatment/Nursing Care
• Symptomatic
• Bed rest until fever and cough subsides
• Dim lights in room
• Tepid baths and soothing lotion to relive itching of skin
• Increase fluids
• Antibacterial therapy given for complications
83
Remember, you should never give aspirin to a child who has a viral illness
since the use of aspirin in such cases has been associated with the
development of Reye syndrome.
Reye syndrome, cause is unknown, associated with infections mainly caused
by virus. Causes a disruption in liver mitochondria or in the urea cycle
resulting in fatty deposits in the liver, renal tubules, myocardium and
pancreas. Severe brain edema may also occur, encephalopathy & cerebral
swelling.
Possible Complications
Measles can lead to other health problems, such as croup (acute infection of
the larynx and trachea), and infections like bronchitis, pneumonia,
conjunctivitis, (pinkeye), myocarditis, and encephalitis. Measles also can
make the body more susceptible to ear infections or other health problems
caused by bacteria.
7.) HEPATITIS B
84
Sangkap Pinoy Seal, a department of Health (DOH) Seal of Acceptance,
after complying with the fortification standards and requirements set by
the Bureau of Food and Drugs (BFAD).
The fortification law mandates that the following staples shall be fortified:
Rice with iron
Wheat flour with vitamin A and iron
Refined sugar with vitamin A
Cooking oil with vitamin A
Other staple foods with nutrients as may be required later by the
National Nutrition Council (NNC) Governing Board
The fortification of the food products shall cover all imported processed
foods or food products for sale or distribution and for human consumption
in the Philippines.
The NNC Governing Board shall serve as the advisory board on food
fortification.
The Land Bank of the Philippines (LBP) and the livelihood Corporation are
required to assist and support the implementation of the law by granting
loans to affected manufacturers. The following shall assist the BFAD in
the monitoring and review of the food fortification program:
Recall of food products from the market
Imposition of fine of not less than Three Hundred Thousand pesos
(Php 300,000) and the suspension of registration for the first
violation; not more than Six Hundred Thousand pesos (Php
600,000) and the suspension of registration for the second
violation; not more
Sugar regulatory administration for sugar
National Food Authority for rice
Philippine Coconut Authority for oil
Bureau of Customs for imported products
85
Sanctions:
The DOH through the BFAD shall impose the following administrative
sanctions in cases of non-compliance with the provisions of the law:
Denial of registration
Than One Million pesos (Php 1,000,000) and cancellation of the
registration of the product for the third violation.
C. MICRONUTRIENT SUPPLEMENTATION
Rationale/Background:
1. Vitamin A Supplementation
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Children 12-71 200,000 IU 1 capsule every six (6) months
months old
Pregnant Women
Total population x 3.5% = number of pregnant women
Post-partum Women
Total population x 3% = number of post-partum women
2. Iron Supplementation
87
The high physiological requirement of iron during pregnancy is difficult
to meet with diet alone; therefore, pregnant women must take iron
supplements. It is recommended that supplementation must start as
soon as pregnancy diagnosed.
Post-partum women
Total population x 3% = number of lactating women
To get total population, use 2000 National Statistics Office (NSO) 2005
projected population.
The Philippines is one of the 42 countries that account for 90% of global
under 5 infant and young child deaths. Last year alone, 82,000 Filipino
children under –five years old died. About 16,000 of these deaths could have
been prevented with exclusive breastfeeding for the first six months, and
continued breastfeeding and appropriate complementary feeding to at least
two years. Malnutrition is a primary outcome of children who do not
breastfeed. Malnutrition is not associated with 60% of young child and infant
deaths, but has lifelong implications. They are less healthy, more vulnerable
to infections and less intelligent. We need to fundamentally rethink our
approach or we risk jeopardizing the future of the Filipino children.
Exclusive breastfeeding means the infants receives only breast milk. Not
even water should be given to an infant. Appropriate complementary
feeding is the progressive addition of adequate solid foods beginning at six
(6) months. Infant formulas are not appropriate complementary foods; they
are breastmilk substitutes, regulated under the Philippine Code of Marketing
88
of Breastmilk Substitutes, Breastmilk Supplements and Other Related
Products (E.O. #51).
I. GOAL
“Reduce Child Mortality Rate by 2/3 by 2015”
II. OBJECTIVE
“To improve health and nutrition status of infants and young
children.”
III. OUTCOME
“To improve exclusive and extended breastfeeding and
appropriate complementary feeding”
V. Government Policies
Breastfeeding is initiated within 1 hour
Exclusive breastfeeding for the first 6 months of life
Continued breastfeeding up to two years and beyond
89
Breastfeeding with complementary feeding at 6 months with
appropriate foods, excl. milk supplements
Micronutrients supplementation
Universal salt iodization
Food fortification
Breastfeeding is still best option in exceptionally difficult
circumstances
i. Calamities
ii. Orphans
iii. HIV-positive mothers
Support systems shall be made available
Health facilities
Work places
Schools
Industry
Communities and homes
I. Rationale/Background
In the Philippines, the two main oral health problems are tooth decay and
gum diseases. Fewer than 8% of our people are free of the experience of
tooth decay. Gum diseases are so widespread that 78.0% of people suffer
from it. This does not mention yet, crooked teeth, mal-relation of the
jaws, cancer of the oral cavity and others. No community in the
Philippines is free from dental diseases.
90
10.9 percent were in suburban centers while only 0.7 percent were in a
rural location. However, the prevalence of dental caries and periodontal
disease are also high in urban areas.
B. Orally Fit Child (OFC) – a child who meets the following conditions
upon oral examination and/or completion of treatment:
a) caries – free or carious tooth/teeth filled either with temporary
or permanent filling materials,
b) have healthy gums,
c) has no dental plaque, and
d) no handicapping dento-facial anomaly or no dento-facial
anomaly that limits normal function of the oral cavity
Vision
- Empowered and responsible Filipino citizens taking care of their own
personal oral health for an enhanced quality of life.
Mission
- The state shall ensure quality, affordable, accessible and available oral
health care delivery.
Goal
- Attainment of improved quality of life through promotion of oral health
and quality oral health care.
Objectives
General Objectives:
- Reduction of the prevalence rate of dental caries and periodontal
diseases to 85% and 60% respectively by end of 2010 (Baseline: 92%
and 78% 1998 NMEDS)
Specific objectives:
a. To attain an 80% Orally Fit Children (OFC) under 6 years old by 2010
(Baseline to be determined)
b. To control risk oral health among young people
91
c. To improve oral health conditions of pregnant women by 80% and
older persons by 50% in 2010
These are remedial measures applied to halt the progress of oral disease
process and restore to a sound condition of the teeth and supporting tissues.
The following are the basic package of essential oral health services/care for
every lifestage group to be provided either in health facilities, schools or at
home.
92
Children 12-71 months old ** • Dental check-up: as soon as the
first tooth appears and every 6
months thereafter
• Supervised tooth brushing drills
• Oral urgent treatment (OUT)
- removal of unsavable teeth
- referral of complicated cases
- treatment of post extraction
complications
- drainage of localized oral abscess
• application of Atraumatic
Restorative Treatment (ART)
A. Introduction:
93
infectious diseases by empowering them with the facts/information and
ways to protect themselves from disease and live healthy lives.
As a whole the goals aim to make the Philippines Disease Free from
RABIES, FILARIASIS, MALARIA, LEPROSY AND SCHISTOSOMIASIS and to
intensify the programs on TUBERCULOSIS, STI-HIV, DENGUE, SOIL
TRANSMITTED HELMINTHIASIS AND EMERGING DISEASE.
B. Technical Protocol
The standards were chosen based on the National Health Objectives,
program standards and approved guidelines and policies.
The specific standards on Prevention and Control of Infectious Diseases are:
94
• 100% coverage of targeted 1-12 year old children for deworming
• 100% of targeted 6 years old and above population in established
Schistosomiasis endemic areas given Praziquantrel
• 100% of animal bite cases, dengue & other infectious diseases
managed based on standard guidelines
• 100% of diagnosed Malaria cases treated
3. Check the availability of the drugs and supplies for outbreaks and
emergencies using the list of drugs and medicines for the treatment of
infectious diseases.
95
5. The health facility has the capability for a sustained systematic
implementation and evaluation of technically-sound and acceptable
vector control strategies
There is no one step procedure for this because there are different
procedures for different diseases. The health workers are trained on these
procedures extensively anyway per disease. For specific laboratory
diagnostic procedures refer to the Manual of Procedures (MOP) or guidelines.
The PHN should be known on how to achieve a cure rate of at least 85% of
new smear (+) TB cases. He/she knows the importance and consistency of
NTP cases registry & Updated Quarterly Reports on TB. Likewise he/she
should have technical knowledge on how to attain the standard cure rate,
assess and evaluate the TB reports. The following should be of importance in
achieving the mentioned cure rate above:
• DOTS Strategy
• Correct categorization of TB cases
• Availability of reporting Forms
• Ensure the updating of TB reports
• Availability of TB drugs
• Recording and reporting system
96
Cure rate – refers to the number of cases who are cured over the
total number of cases registered multiplied by 100. This is validated through
the Tb registry and the Quarterly Report on the Treatment Outcome of
Pulmonary TB cases.
Guidelines in vector control of selected Cure – sputum smear positive
patient who has been completed and is sputum smear negative in the last
month of treatment and on at least one previous occasion.
He/She should also know the advantages of performing the above treatment
strategies for infectious diseases and the importance of compliance to
treatment. In doing so, there should have the following:
97
Skills on how to conduct outbreak investigation
Procedures on how to refer during outbreaks
Technical knowledge on:
o Outbreak investigation
o Monitoring
o Community surveillance for infectious diseases except Acute
Flaccid Paralysis
In order to provide the above standard, he/she should look for the following:
*Rapid diagnostic test – for Malaria and Filaria. These are provided at the
RHU by the programs through WHO
** Holding Area – any separate area within a health facility or an area with
curtain/partition for patient while waiting for transport to the reference
hospital. There is no required measurement for a holding area.
The PHN should have the capability to implement and evaluate the
sustained systematic technically sound and acceptable vector control
strategies. He/She ought to be acquainted with the following:
*Procedure to determine vector surveillance indices data
98
*Procedure in mapping barangays endemic for malaria, dengue,
filariasis, schistosomiasis, etc.
In upgrading RHU, the PHN should work to accomplish the above standard,
the RHU should have:
Supplies & equipment to conduct vector surveillance
Existence of an RHU Med. Tech.
House Index (HI) – it should be less than 5% (<5%); if high, the area is a
priority for vector surveillance
Breteau Index (BI) – it should be less than 20; if there are cases, the area is
a priority for vector control
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a. Topography – mountains, foothills, plains, coastal
b. Accessibility to health center – difficult (mainly by boat or
walking), medium (> 5 hours w/transport), easy (<5 hours
w/transport)
c. Accessibility to BHS - >5 km distance, <5 km distance, BHS on
site
d. Population stability – mobile, seasonal movement, stable
e. Agricultural development – developed, less developed
f. Housing conditions – good, poor
g. Presence of cultural community
3. Drug supply
a. Drugs and medicines are available for all infectious diseases
100
4. Surveillance/Networking/Outbreak Response
a. Outbreak response system in place and working
6. Support System
a. Presence of a community system on the prevention and control
of infectious diseases
b. Implementation of local ordinances/resolutions/policies on
infectious diseases
c. Budget for infectious diseases are appropriated
TB Situation
One of the 22 high-burdened countries (WHO TB Watch list)
3rd in the Western Pacific - Case Notification
6th leading cause of deaths
6th leading cause of morbidity
I. Case Finding
a) Identifies and Registers patient as TB Symptomatic
101
c) Collects 3 sputum specimens from the patient within 2 days
a. Collect three sputum specimens within two days according to
the following procedures
i. First specimen or spot specimen: It is collected at the time
of consultation or as soon as the TB symptomatic is
identified
ii. Second specimen or early morning specimen: It is the very
first sputum produced in the morning and collected by the
patient according to the instructions given by the midwife
iii. Third specimen or spot specimen: It is collected at the
time the TB symptomatic comes back to the health facility
to submit the second specimen
e) Properly labels, seals and secures the sputum specimen collected and
transports it to the microscopy unit or laboratory
a. Label the body of the sputum cup with the patient’s complete
name and the name of the referring unit
b. Seal each sputum container, pack it securely and transport the
same to a microscopy unit or laboratory as soon as possible or
not later than four days from collection
c. Send the specimen together with the properly filled up
laboratory request form to the microscopy center
102
• Incubation period :
> 4 – 12 weeks from infection
> A year or two after infection of pulmonary or extra- pulmonary TB
• Period of Communicability:
A person who excretes tubercle bacilli is communicable
Degree of communicability depends upon:
- The number of excreted bacilli in the air
- Virulence of the bacilli
- Environmental conditions like overcrowding
NTP THRUSTS
Improve quality of DOTS implementation
Increase demand for DOTS services
NTP STRATEGIES
I. Quality DOTS services:
1. Fixed-Dose Combination (FDC)
3. Recording/Reporting System
4. Program indicators
103
II. Participation of the Private Sector:
Public-Private Mix DOTS (PPMD)
TB Diagnostic Committees (TBDC)
- 2 approaches: Public-initiated
Private-initiated
RATIONALE
DOH has forged partnership with Phil CAT
Harmonize & unify the TB control efforts in the Philippines
Adopts the D.O.T.S. strategy of the National TB Program (NTP)
Shall be the basis of implementation of TB control among stakeholders
First Philippine TB Summit Conference
Program Components
CASEFINDING:
Objective:
Early identification and diagnosis of TB cases
104
Passive Case finding - TB symptomatic present them in a DOTS facility.
Case holding
Objectives:
To render as many smear (+) cases as non- infectious & cured as early as
possible.
To treat seriously-ill Smear (-) cases & other potentially infectious cases.
TB cases . . . .
- Base on history of anti-TB treatment
- important in determining treatment regimen
TYPES OF TB CASES:
New - no tx or <1m tx
Relapse - cured & Sm (+)/culture (+) again
Transfer - In - change in tx facility
Return After Default - interrupted tx for > 2
mos & Sm (+)/culture (+)
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Treatment Failure - still (+) on 5th month
Others - initially (-) but became (+) on 2nd month
- interrupted tx / Sm (-)
- Chronic case (remains sputum + at end of re-treatment)
H = Isoniazid Z = Pyrazinamide
R = Rifampicin E = Ethambutol
S = Streptomycin
Cat I : 2 HRZE / 4 HR
II Relapse;
2 HRZES/ Treatment Failure; Return After 2 HRZES/
1 HRZE/ Default 1 HRZE 5 HRE
5 HRE) Others
106
Major Policies on Case holding
Supervised Treatment
- A mechanism of ensuring treatment compliance
- TB patient is motivated to take his drugs - Cured.
* Treatment Partner *
- watches the patient take his drugs daily
- reports & traces the patient if he defaults
- provides health education regularly
- motivates the patient on sputum ff-ups
107
NTP Referral Form
Reports
Quarterly Report on Laboratory
Quarterly Report on Case finding
Quarterly Report on Treatment Outcomes
Shall include private physicians & private clinics, after agreement with
parties concerned has been made.
Shall allow the calculation of the main indicators for evaluation. (Cure
Rate, Case Detection Rate)
COHORT ANALYSIS
A group of patients having the same attributes at a certain period of
time to determine respective Treatment Outcome.
Treatment Outcomes :
Cure Rate = 85 %
Completion Rate
TX Failure Rate Defaulter Rate
Death Rate Trans-Out Rate
Cure Rate
Cure - New Sputum (+) case, completed treatment
Sputum (-) at the end of treatment
General Attributes:
New, Pulmonary Sputum (+) case
TREATMENT OUTCOMES
Cured
108
Completed - completed TX BUT no sputum ff-up result at
end of treatment
Treatment Failure - Smear (+) at 5 mos. of TX
Defaulter - interrupted TX for 2 months or more and not
retrieved back
Transfer Out - change in treatment facility
Died - dies during the course of treatment
YES
Go to
flowchart
on case
holding
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> Estimated to be in the order of 300-500 million clinical cases each
year
Agent
Plasmodium falciparum
• Most common in the Philippines, around 70% of cases
• Causes severe/complicated malaria and death if not treated promptly
and appropriately
• Resistance to antimalarial drugs in the country is widespread but low
grade
Plasmodium vivax
• Comprised around 30% of cases
• Very rarely causes severe disease
• Sensitive to antimalarial drugs; resistance suspected in some
countries (New Guinea, Indonesia)
• Relapse is common if not treated adequately with anti-relapse drug
Plasmodium malariae
• Very rare; less than 1% of cases in the country
• Infection is usually not severe but may last up to 50 years if not
treated
• Drug resistance has not yet been documented
Plasmodium ovale
• Not found in the Philippines; present in some Africa countries
• Relapse may occur if not treated adequately with anti-relapse drug;
• Drug resistance has not yet been documented
VECTORS
• Anopheles flavirostris primary vector; breeds in clear, slow flowing
streams
• Anopheles litoralis - vector in coastal areas
112
• Anopheles maculatus
• Anopheles mangyanus
• Anopheles balabacensis
NATIONAL SITUATION
• It still costs the economy over 100 million pesos to sustain control
efforts
113
Other inter-related socio-economic, biological and environmental
factors include:
• poverty
• drug and insecticide resistance
• socio-political conflict
• population movement
• climatic change
VISION
MISSION
To empower the health workers, the population at risk, and all others
concerned to eliminate malaria in the Philippines
MALARIA DIAGNOSIS
1. Clinical Diagnosis
• based on signs and symptoms and history of travel to a malaria-
endemic area
• done by all trained health workers especially in areas where
microscopic diagnosis is not available within 24 hours
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CHEMOTHERAPY GUIDELINES
Quinine + Tetracycline/Doxycycline
• third line drug
• should be given to those who did not respond to Co-Artem
• or if CQ+SP is not available
• drug of choice in the treatment of severe malaria
• Tetracycline and doxycycline are contraindicated for pregnant women
and children under 8 years old; instead, give Quinine with
Clindamycin
Primaquine
• given single dose to confirmed P. falciparum cases to prevent
transmission
• given for 14 days to confirmed P. vivax to prevent relapse
Chloroquine
• Drug to be used in the treatment of confirmed P. vivax
VECTOR CONTROL
Selective vector control
• Targeted, site-specific, cost effective
• What (control method), When, Where
• Consider magnitude of malaria problem, epidemiology, levels of
transmission and risks, priority groups/areas, technical and
operational realities, infrastructure, resources and information
• The vectors behavior clarified and relates to disease
transmission
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Kills adult mosquitoes resting on wall surfaces, resulting to reduction
of their population.
VC method of choice during outbreaks
A wettable powder formulation is appropriate
Insecticide deposit effectiveness would last 6 months if not
wiped/washed off
Insecticide and spraying equipment to be provided by GFATM
116
CAR 456 0 0
III 2739 10 0.36%
IV-A 621 6 0.96%
IV-B 16 0 0
NCR 3859 28 0.72%
V 1202 10 0.83%
VI 1718 12 0.7%
VII 1921 25 1.3%
VIII 1051 2 0.2%
IX 505 4 0.8%
X 2542 41 1.61%
XI 2657 61 2.3%
XII 909 14 1.54%
ARMM 118 2 1.7%
CARAGA 739 18 2.43%
TOTAL 22610 244 1.08%
BIONOMICS OF AEDES
A. Aegypti A. Albopictus
Feeding habit Day biters Day biters
(1-2 hrs after sunrise/ 1-2(1-2 hrs after sunrise/ 1-2
hrs before sunset) hrs before sunset)
Resting Habit Indoor Outdoor
Oviposition Lay eggs 60-100 eggsLay eggs 60-100 eggs
per batch per batch
Breeding Habitat Artificial containers Natural containers
Flight Range 200-300 meters 200-300 meters
Host preference Human Human
Life span 20 days (male) 20 days (male)
30 days (female) 30 days (female)
Dengue Virus
Causes dengue fever & dengue hemorrhagic fever
Is an arbovirus
Transmitted by infected female mosquitoes
Composed of single-stranded RNA
Has 4 serotypes (DEN 1, 2, 3 & 4)
Each serotype provides specific lifetime immunity & short term cross
immunity
All serotypes can cause severe & fatal disease
117
Genetic variation within serotypes
Some genetic variants within each serotype appear to be more
virulent or have greater epidemic potential
Asymptomatic Symptomatic
118
Thrombocytopenia;
Plasma leakage (hemoconcentration or pleural effusion or
ascites);
Hemorrhagic manifestations
Outpatient Case:
ORESOL
In adults: replace fluids as in moderate dehydration at
75 ml/KBW in 4-6 hrs or up to 2-3 L/day
119
Spontaneous bleeding
Persistent abdominal. pain
Persistent vomiting
Listlessness
Changes in mental status
Restlessness
Moderate to severe dehydration
Weak and rapid pulse
Cold, clammy skin
Circumoral cyanosis
Dyspnea
Seizures
Hypotension
Thrombocytopenia - less than 100,000/cu.mm.
Hemoconcentration
Cover water drums and water pails at all times to prevent mosquitoes
from breeding.
Replace water in flower vases once a week.
Clean all water containers once a week. Scrub the sides well to remove
eggs and mosquitoes sticking to the sides.
Clean gutter of leaves and debris so that rain water will not collect as
breeding places of mosquitoes.
Old tires used a roof support should be punctured or cut to avoid
accumulation of water.
Collect and dispose all unusable tin cans, jars, bottles and other items
that can collect and hold water.
Larval Survey:
COMPUTATION OF RESULTS
A. HOUSE/PREMISE INDEX (HI)
HI = no. of houses (+) for Aedes sp. x 100%
no. of houses inspected
120
BI = no. of positive containers x 100
total no. of houses inspected
Priotization of Areas
Priority 1 - localities where an outbreak of DF/DHF
had occurred
Priority 4 - localities where there are no dengue cases and low Aedes
densities. w/in 24 hrs of the 1st case from an outbreak locality
Mosquito bites a
Microfilariae person and
develop transmits larvae
into larvae in into
mosquito
Blood circulation
In lymph vessels
Adult female and glands,
produce larvae develop
Microfilariae that
into adult male
circulate in blood
and female
stream
worms
121
Pathophysiology
Microfilariae live for 2 years in the body causing periodic fever attacks
Adult worms live for 10 years and when they die granulomas form
around them in the lymphatic channels
It blocks the flow of lymph causing gross and irreversible chronic
deformity (Elephantiasis and hydrocoeles)
The disease is considered as a disease of the poor
Primarily affects the working age group living in remote and endemic
rural areas.
WHO has identified it as one of the eradicable diseases and has called for its
global elimination as a priority. – DOH A.O. 25 – A s. 1998
Filariasis endemicity
1. Category 1 – provinces with reports within the past 10 years
establishing its endemicity : 20 provinces (R 4, 5, 8, 9, 11)
2. Category 2 – with no report of endemicity but were reported as
endemic in the 1960 prevalence survey : 25 provinces
3. Category 3 – without any report of endemicity and considered as non-
endemic for the disease : 33 provinces
Program Goal:
Filariasis is eliminated as a public health problem.
122
Diagnosis
Demonstration of microfilariae in a blood smear examination
conducted at night due to nocturnal periodicity of the parasite (NBE –
nocturnal blood examination)
Coverage
Individuals from ages 2 and above living in endemic areas
Exclusion Criteria and Special Precautions:
> Treatment of pregnant women will be deferred until delivery.
> Special precautions in treating individuals with cardiac and kidney
diseases should be observed.
Frequency:
The combination drugs for Mass Treatment will be given once
annually for a minimum of four consecutive years in all established
municipalities.
123
The cercariae penetrate the skin of the host, find their way into the
blood circulation, then to the liver and into their final habitat—the
mesenteric veins in the wall of the intestines where they become adult
male and female flukes.
Through minute ulcers or sores in the intestinal walls, the eggs get
inside the gut and are passed out in the feces.
Once they reach water, the egg hatch into miracidia which will now
seek the snail, thus repeating the cycle.
> Access to safe water supply is also one of the people’s primary needs in
rural areas where schistosomiasis is endemic.
> There is also need to build sanitary toilet facilities that can reduce the
prevalence of the disease.
> Records show that around 25% of households have no access to safe
water while around 40% of households have no sanitary toilet facilities in
endemic areas.
School children
3.78% 1.79%
(1-6 years old)
124
(Schistosomiasis is considered eliminated as a public health problem if the
prevalence rate is maintained at less 1.0 percent for at least five
consecutive years.)
Cumulative
Totals Totals for Aug.
Reported Modes of
Jan. 1984 – 2005
Transmission
Feb.2006
N=2,484 N =30
Sexual Transmission
Heterosexual 1,551 21
contact
Homosexual 452 7
contact
Bisexual contact 135 1
Blood/blood products 19 0
Injecting drug use 7 0
Needle prick injuries 3 0
Perinatal 36 0
No Exposure Reported 281 0
TOTAL 2,484 30
125
Viral
Genital herpes
Genital warts
Genital molluscum
HIV
Hepatitis B *
Protozoa
Trichomonas
Fungal
Candidiasis
Skin Parasites
Pubic Lice
Scabies
- passed on by close body contact and do not require actual
penetrative intercourse
Syndromes
Vaginal Discharge
Gonorrhea, Chlamydia, Candidiasis, Trichomoniasis, Bacterial
vaginosis
Urethral discharge
Gonorrhea, Chlamydia, Trichomoniasis
Genital Ulcers
Syphilis, Herpes Genitalis
Lower abdominal pain in women
Scrotal Swelling
Gonorrhea, Chlamydia
Neonatal eye infection
Gonorrhea
Preventive Measures
A - Abstinence
B – Be faithful
C – Correct and Consistent use of Condom
D – Don’t use illicit drugs/ share
syringes and needles
E – Educate you/other
Strategies
126
1. STI Case Services
2. Prevention Activities
3. Specialist Services
4. Laboratory Support
Levels of Care
1. Primary
> Risk reduction
CONDOM PROMOTION (CONSISTENT AND CORRECT USE OF CONDOM)
- Prevention of STI from occurring in the first place popularizing
active health seeking behavior
2. Secondary
> Risk assessment
1. Early detection/Screening
2. Promotion of safer sexual behavior
3. Contact tracing
4. Treatment of contact/s
5. Effective treatment and compliance
6. Counseling
7. Universal Precaution
3. Tertiary
> Maintain positive sexual behavior
1. Management of complications
2. Prevention of Complication and Sequela
3. Mobilization Wider Base of Multi-Sectoral Support should be expanded
127
The cost of post-exposure treatment is very high, ranging from P4, 000
to P24, 000, depending on the category of bite exposure.
IMMUNIZATION
1. Active Immunization
(a) Vaccine is administered to induce antibody and T-cell production in
order to neutralize the rabies virus in the body. It induces an active immune
response (in 7-10 days after vaccination) and may persist for one year or
more.
(b) The types of anti-rabies vaccine available in the Philippines: a.
Purified FreeCell Rabies Vaccine (PVRV)-0.5 ml/vial; b. Purified Duck Embryo
Vaccine (PDEV)-1.0 ml/vial; and c. Purified Chick Embryo Cell Vaccine
(PCECV)-1.0 ml/vial.
(c) All vaccines are considered to be highly immunogenic and safe. For
active immunization, any of the three vaccines may be administered either
intramuscularly or intradermally.
2. Passive Immunization
(a) Rabies Immunoglobulin (RIG) is given in combination with anti-
rabies vaccine to provide immediate protection to patients with Category III
exposure. RIG has a half life of approximately 21 days.
128
(b) Only rabies vaccines and RIG that have been evaluated and
recognized by WHO and approved by BFAD should be used. National health
authorities should evaluate any new vaccine or RIG prior to use.
TREATMENT
1. Post-Exposure Treatment
a. Local Wound Treatment
A.1. Wounds should be immediately and vigorously washed and
flushed with soap and water preferably for 10 minutes.
A.2. Apply alcohol, tincture of iodine or any antiseptic.
A.3. If possible, suturing of wounds should be avoided; however, if
suturing is necessary, anti-rabies immunoglobulin should be infiltrated
around and into the wound before suturing.
A.4. Do not applies any ointment, cream or occlusive dressing to the
bite site.
A.5. Anti-tetanus immunization and anti microbial may be given if
indicated. Animal bites are considered tetanus prone wounds.
b. Treatment Regimen
b.1. 2 –site intradermally Schedule (2-2-2-0-1-1)
• One dose for intradermal administration is equivalent to
0.1 ml. for PVRV and 0.2 for PDEV/PCECV.
• One dose should be given at two sites on Days 0, 3, and 7
and at one site on Day 30 and 90
• Injections should be given on the deltoid area of each
upper arm in adults, or infants, at the anterolateral aspect
of the thigh.
• A one (1) ml insulin syringe with gauge 25 or 26 needle
should be used for intradermal injection.
• A vaccine should be stored within 40.0C and 8.0C and
after reconstitution should be used within 8 hours.
Mode of transmission:
>Airborne – inhalation of droplet /spray from coughing and sneezing of
untreated leprosy patient
>Microorganism may also enter the body through the skin by prolonged
intimate contact.
129
Signs and Symptoms
Long standing skin lesions that do not disappear with ordinary
treatment
Loss of feeling/numbness on the skin
Loss of sweating and hair growth over the skin lesions
Thickened and/or painful nerves in the neck, forearm, near elbow joint
and the back of knees
Diagnosis
Based on clinical signs and symptoms, especially if there is a history of
contact with Person with Leprosy (PWL)
Only in rare instances is there really a need to use laboratory and
other investigations to confirm a diagnosis.
Slit Skin Smear (SSS) examination is an optional procedure. It is done
only when clinical diagnosis is doubtful.
Important:
Classification
130
Nerve damage No nerve trunk None or one nerve Many nerve trunk
(resulting in loss of involvement trunk
sensation or
weakness of muscles
supplied by the
affected nerve
MB Regimen:
PB Regimen:
Monthly Treatment: Day 1
Rifampicin 600 / 450 mg
Dapsone 200 / 50 mg
Daily treatment: 2 – 28
Dapsone 100 mg
The standard regimens are considered safe for both mother and the
child and therefore be continued during pregnancy.
Disabilities in leprosy is caused by damage to the peripheral nerves
The best way to prevent disabilities:
Early diagnosis and prompt treatment with MDT and early recognition
of signs and symptoms of nerve involvement and prompt treatment
with prednisone.
131
The three major cause of intestinal parasitism in the Philippines are:
1. Ascaris lumbricoides,
2. Trichuris trichiura,
3. Hookworms (Anylostoma duodenale and Necator americanus).
OTHER PARASITOSES
> The infection which often involves the lungs has manifestations similar to
pulmonary tuberculosis (PTB). >Chronic coughing productive of blood
streaked sputum and chest pains are some of the signs and symptoms.
>It is frequently encountered in places where people eat raw or
inadequately cooked crabs or possibly snails which harbor the infective
stage of Paragonimus.
>It was first reported in Ilocos Norte in 1963. One hundred eight deaths from
1,800 cases were documented in the same area in 1967.
There are twice as many males the females affected. Most of the
males affected are fishermen who usually eat their catch raw.
132
Intestinal capillariasis is characterized by intestinal mal-absorption,
chronic diarrhea and borborygmi.
MENINGOCOCCEMIA
Situationer
• 81 lab-confirmed cases from September 26, 2004 to March 26, 2005.
• Also 31 probable and 108 suspect cases.
• Baguio had the most cases with 38, Benguet had 29 and Mountain
Province had 13.
• Baguio had the most fatalities which was followed by Benguet with a
CFR of 21%
Epidemiological parameters
• 90% of cases belong to the lower socio-economic group.
• There are more in the cases in the 15 to 25 year age bracket.
• There are more fatalities in the 0 - 7 year age group.
• There is no predisposing occupation or profession
Background
• Neisseria meningitidis is encapsulated, gram-negative diplococci, the
causative agent for meningococcal infections.
• Acquisition can result in asymptomatic pharyngeal colonization or
invasive disease.
• Presentation can take any one of three syndromes.
PATHOPHYSIOLOGY
• Humans are the only natural host.
• Transmission is by direct transfer of respiratory secretions.
• Infection is preceded by colonization of the nasopharynx.
• Entry into the bloodstream and introduction to the target sites/organs.
• 5% become long-term carriers.
Virulence factors…
133
• A polysaccharide capsule which is resistant to phagocytosis.
• An endotoxin which could be shed in large amounts (blebbing) which
accounts for the signs and symptoms.
• An immunoglobulin A1 protease which cleaves LAMP1 allowing its
intra-cellular survival.
Frequency
• In the US:
- 1 case/100,000 pop. /year
- CFR is 13%.
- Outbreak when there are 3 cases or more in a 3 month
period or an AR of 10 cases/100,000 pop.
- In UK, close to 4,000 cases/yr. CFR of 10%. Peaks at
winter months.
- In Africa, close to 12,000 cases/yr. and CFR of 13%. Peaks during dry
season and ceases with onset of rains.
MORTALITY RATES
• Case fatality rate is approximately 10-12% for meningitis and 20% for
meningococcemia.
• In fulminant infections, rate is as high as 30% and occurs within 24
hours after onset of the disease.
• The first six hours of the disease remains the most critical period.
3 SYNDROMES:
1. Meningitis
2. Meningitis with meningococcemia
3. Meningococcemia with meningitis
4. History presents with a non-specific prodrome of cough, headache
and/or sore throat.
5. Followed by fever with chills, myalgia and arthralgia
Physical Findings
• Tachycardia +/- hypotension
• Moderate to high grade fever
• Peticheal rash (80%) becomes rapidly purpuric then ecchymotic
• CHF, gallops, pulmonary edema
• Progression is usually rapid
• Variations in manifestation dictated by presentation
Lab Studies
• Definitive diagnosis requires culture from blood, CSF, joint fluid, skin
lesions
• Findings on blood culture are positive in 60-80% of untreated patients.
• PMN leukocytes are usually elevated
• Thrombocytopoenia present in 20% of cases.
• Gram-negative diplococci may be observed in stains from peticheae or
buffy coat preparations or from joint fluids.
• PCR (polymerase chain reaction) is a rapid method for diagnosing CSF
infection
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Management
• Medical care :
- hospitalization is required for severely ill patients
with fever, headache and rashes
- begin antibiotic treatment promptly
- intensive care is necessary for suspected fulminant
cases
- provide supportive care
- surgical care when necessary
ANTIMICROBIALS
250t u IV/4hrs
Pen G Na Bacteriostatic
4M u IV/4hrs
- Stiff neck
- Altered consciousness
- Bulging fontanelle
- Non-blanching rash (petechiae, purpura)
- Turbid CSF
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- Non-blanching rash (petechiae, purpura)
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Identification of N. meningitidis DNA from a sterile site (CSF or blood)
AVIAN INFLUENZA
Transmission to humans:
• Close contact with live infected birds through infected aerosols,
discharges and surfaces
• Birds excrete the virus in their feces, which dries and becomes
pulverized, and is then inhaled
• Flapping of wings hastens the transmission
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• Fever
• Body weakness or muscle pain
• Cough
• Sore throat
• Dyspnea in severe cases
• Sore eyes
(more than 50% of cases die)
1. Incubation
3 days, range 2-8 days
2. Prodromal Stage
0-1 day
High fever (above 38 °C, Cough and shortness of
breathe/pleuritic pain, Watery Diarrhea
Abdominal pain
Vomiting
Bleeding from nose and gums in some
3. Lower Respiratory Stage
1-7 days
- Early dyspnea
- Inspiratory crackles
- ARDS
- Multi-organ failure
Individuals at risk
1. Poultry handlers/workers
2. People living near poultry farms
3. Sellers/people involved in live chicken sale
4. Aviary workers
5. Ornithologists
6. Cullers involved in destruction
• Would have to dry out the chicken meat and sniff the carcass to be at
any risk
• Virus is easily inactivated by heat, one does not get bird flu from
thoroughly cooked chicken
Diagnosis
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• A laboratory confirmation of the bird flu infection and epidemiologic
link with unusual death or epidemics of chickens will support the
diagnosis of bird flu.
- Virus isolation
- RT-PCR (Polymerase Chain Reaction)
• NONE.
• The vaccine currently available against the circulating strains in
humans will not protect against the disease caused by the H5N1
influenza strain. However, it is recommended for individuals who are
potentially exposed to avian influenza virus like poultry handlers,
workers and breeders to prevent recombination of A1 virus with the
human influenza virus.
Confer no protection against infection with the H5N1 avian virus. However,
the seasonal vaccine may be useful to prevent re-assortment of human and
avian viruses.
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Prophylaxis for exposed persons: 1 capsule once a day for at least 7
days
Prevention:
• Hand hygiene
• Cleaning and disinfection
• Avoiding contact with wild birds
• Safe food practices
• Practice of proper hand washing and cleaning and disinfection
procedures in poultries
Stages:
• STAGE 1 – BIRD FLU FREE PHILIPPINES
• STAGE 2 - AVIAN FLU IN BIRDS
• STAGE 3 - AI VIRUS TRANSMITTED TO HUMANS
• STAGE 4 - HUMAN TO HUMAN TRANSMISSION
Exposure:
Contact (within 1 meter) with live or dead domestic fowl or wild birds or with
persons suspected to have bird flu during the 10 days before the onset of
symptoms.
Quarantine
Exposed persons for 10 days and monitor for signs and symptoms of illness.
Quarantine of contacts
• Stay at home for 10 days
• Monitor self for fever, cough or difficulty of breathing or any sign and
symptoms of illness.
• Refer sick persons to the Referral Hospital for SARS and other severe
emerging infections.
3. Cough Manners
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• Cover your nose and mouth with tissue or handkerchief every time you
sneeze, cough or blow your nose. If you don’t have tissue, cough into
your sleeve.
• Wash your hands with soap and water.
– Before touching your eyes, nose or mouth.
– Before shaking hands with other people.
RATIONALE:
IT AIMS TO:
1) Raise the awareness of the Filipinos on the need to practice healthy
lifestyles.
2) Raise the consciousness of policy makers on the need to provide the
Filipinos with an environment supportive of healthy lifestyle.
BACKGROUND:
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CAUSE OF DEATH NUMBER RATE
1. Diseases of the heart 70,138 88.2
2. Diseases of the vascular system 49,519 62.3
3. Malignant neoplasm 38,821 48.8
4. Pneumonia 34,218 43.0
5. Accidents 33,617 42.3
6. Tuberculosis, all forms 28,507 35.9
7. Chronic obstructive pulmonary disease and allied
conditions 19,320 24.3
8. Certain conditions originating in the perinatal period 14,209 17.9
9. Diabetes mellitus 13,922 17.5
10. Nephritis, nephritic syndrome and nephritis 9,192` 11.6
VISION:
A nation of Filipinos with healthy lifestyles and habits, living and
working in clean and safe environment, and with access to adequate
medical care for cardiovascular diseases.
OBJECTIVES:
> Reduction in mortality and morbidity from CVD.
> Reduction in the economic burden of CVD in the individual, the
family and community.
> Improvement in the productivity and quality of life of CVD.
Program Components:
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1. Community-Based;
> Prevention and control of cardiovascular disease morbidity and
mortality thru;
- Increasing awareness of the community on CVD and their causes
- Elevating the CVD knowledge, attitude and practices of the people.
- Improvement of the registration, diagnosis and management of the CVD at
the community level
- Initiation of community rehabilitation of CVD patients
- Improvement of the of the registration system of CVD.
2. School-Based
> Prevention and control of healthy lifestyles thru;
- Integration of teaching of CVD in school curriculum.
- Institution of anti-smoking measures in high schools
- Provision of CVD services in school health
- Screening of high risk school children
3. Industry-Based
> Adoption of healthy lifestyles, reduction of CVD risk and
improvement in productivity and quality of life of CVD cases in
working population thru;
- Promotion of healthy lifestyles among workers
- Identification and management of workers with high CVD risk
- Provision of medical care for CVD cases
- Creation of a healthful social climate and environment in Industrial
companies.
4. Hospital-Based
> Improvement in the outcome of CVD and in the productivity and
social life of
CVD cases thru:
- Increasing the awareness among patients, their families and the general
public
of the measures which they can take to prevent cardiovascular disease and
minimize
their effects, if disease is present.
- Improvement in the detection and diagnosis of CVD in all levels of the
hospital system.
- Improvement in the management of CVD cases at the different levels of
the hosp system
- Systematic referral mechanism for CVD.
An integrated approach to National Communicable Disease prevention and
control means that;
- Risk factors are not solely health issues but should be part of the total
development of the community
- Strategies and activities employed should cut across other agencies and
sectors concerns.
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3. Counseling of identified high risk individuals.
4. Recognition of some risk factors such as obesity, smoking, sedentary
lifestyle as well as hypertension and diabetes mellitus.
5. Monitoring the compliance of patients at home to prescribed medical
regimen.
6. Follow up of patients under treatment for any side effects, untoward
manifestations or complications.
7. CVD emergency care during Hypertensive crisis, including basic life
support in emergency situations.
1. OBESITY
• Results from excess intake of food over an extended period of time
• Excess weight and body fat
• Determined by Body Mass Index (BMI)
Formula:
Weight in kilos
(Height in meters) 2
2. WEIGHT REDUCTION
- The overweight individual, the obese in particular, faces the
risk of overburdening the heart. The body’s demand for oxygen and
nutrients
<16 >Severe chronic energy deficiency(CED)
16 to <17 >Moderate CED
17 to <18.5 >Mild CED
18.5 to <20 >Low normal
20 to <25 >Normal
25 to <30 >1st Obese
30 to <40 >2nd Obese
≥ 40 >3rd Obese
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Guide to a healthful diet
Overweight or Obese-
An important component in weight loss therapy is exercise. Most
SYSTOLIC DIASTOLIC
CATEGORY (mm Hg) (mm Hg) RECOMMENDED TX
HYPERTENSIONS
There are four things to remember about high blood pressure:
1. There are no symptoms in the early stage.
2. In its early stages, hypertension may be indicated only be elevated
blood pressure reading.
3. There may be no way of finding out if a person is hypertensive except
by having the blood pressure measured.
4. All high blood pressure cases must be treated.
• In Hypertension
> Aerobic exercise training can be effective in
controlling mild hypertension, either without medication or in
conjunction with medication.
> Experts recommend an aerobic capacity of 60-70% of the maximal
heart rate.
Walking is the ideal exercise to produce these physiologic results.
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> If hypertension is acute or uncontrolled, you must delay exercise
until it is controlled.
3. Sedentary Lifestyle
Exercise-
> Reduces the risk of hypertension, heart attack and stroke. It is also
an
important measure in the maintenance of ideal body weight or
weight reduction.
> Scientific Exercise for biologic fitness
4. SMOKING
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B. Tips before stopping
Example; Don’t think of never smoking again, think of stopping in
terms of 1 day at a time and stop carrying cigarettes at home and at work.
C. Tips for the day you stop
Example; Throw away all your cigarettes and matches; hide your
lighters and ashtrays.
D. Tips for coping with relapse
Example; Stop smoking immediately and realize that most successful
former smokers stop for good only after more than one attempt.
STRESS
-is considered to be an essential element contributing to the progress
of degenerative diseases and even identified as a significant risk factor for
lifestyle-related diseases.
Emotional Indicators:
Anger, frustration, depression, anxiety, irritability, impatience, difficulty in
concentrating, forgetfulness, confusion, feeling of time pressure
Behavioral Indicators:
Rapid speaking and walking, chain smoking, excessive drinking,
restlessness, pacing (walking to and fro), nail biting and sexual problems
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“12 S” in Stress Management:
Spirituality
Spirituality is a state or quality of being spiritual. It is pure, holy, relating of
matters of sacred nature, not worldly, possessing the nature or qualities of a
spirit.
Whenever we are beset with problems, the very first thing to do is to
think and do look for possible solution to the problems. As a human being,
there is always that strong faith and belief that above all, there is that
powerful being that created us, whom we can turn to and who will remain to
be with us in all our joys and pains, ups and downs. He who will remain to be
our friend. Thus giving that feeling of confidence and peace. When everything
falls to Him, nothing is impossible
The spiritual level holds the entire human person together. Spirituality
carries with it the meaning of man’s relationship with a world beyond what is
felt by the sense - a world beyond himself, others and the environment - but
which somehow gives meaning, purpose and coherence to one’s own
existence. It is also points to an articulated by the individual. It is the spiritual
level that gives something to live for.
Stress Debriefing
Critical incident stress debriefing means to assist crisis workers/ team
member to deal positively with the emotional impact of a severe event /
disaster and to provide education about current and anticipated stress
responses, as well as information about stress management.
Critical incident is any unusually strong or overwhelming emotional
reactions which have potential to interfere with work during the event or
thereafter in the majority of those exposed.
Sports
Spots are skills and games which involve the participation of group of
people or a person, competing with others for a common goal.
Stress is a normal and unavoidable part of life. Without some stress,
life would be dull. Stress motivates a person to do its best and provides the
challenges we need to improve physically, mentally and emotionally. The
sources of stress are environment (physical stressors, social stressors, and
occupational stressors) and personality (biological changes, behavior and
lifestyle). Mind and body works together as a single unit and therefore,
stress affects the bodily system. It has effects on heart muscle, blood
pressure, pulse rate, blood red corpuscles, and the nervous system.
It is important that workforce engage in sports activities that create
awareness. Sports have been identified as one of the management of
relieving and preventing stress.
Self-Awareness
Self-Awareness means knowing yourself, getting in touch with your
feeling, or being open to experience. It increases your sensitivity to inner
self and your relationship with the world around you, how you respond to
people and what effect you have on them.
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Self-Awareness is important in evaluating one’s abilities realistically,
identifying the areas in which you need to improve, recognize and build
strengths, develop more effective interpersonal relationship, understand the
kind of motivations that are influencing such behavior, develop empathy and
understanding to recognize both personal needs and needs of other people.
Once you have experiences your genuine and unique self, you become
more flexible, autonomous, independent in decision making and able to
accept constructive and destructive criticism and you can easily adopt to
your environment.
Siesta
Siesta means taking a nap, short rest, a break or recharging of
“battery” in order to improve productivity. It helps relax the mind and body
muscles.
Rest or siesta is as important as giving enough exercise. Rest is
necessary to support human life. If the body is deprived of sleep certain
changes takes place such as personality disturbances and loses of
coordination and the ability to concentrate. Rest refreshes the whole body
and a person feels a sense of well-being. The mind is alert, the muscles are
relaxed, and digestion function properly as appetite is healthy.
It had been proven through a study that siesta invigorates one’s body.
Making our body revitalize like a machine it needs a little break in order to
function well. Performances of an individual scored high when siesta is
observed 15-30 minutes nap. If you exceed neither 30 minutes long nor one
hour. It relieves stress tension and one wakes up and set for the next
activity.
Siesta can be done by having a nap, lying down, closing your eyes and
resting your head.
Stretching
Stretching are simple movements performed at a rhythmical and slow
pave executed at the start of demanding activity to loosen muscles,
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lubricate joints increase body’s oxygen supply. It requires no special
equipment, no special clothes, and no special skills and can be done
anywhere and anytime.
Stretching every hour or so throughout the day can help you avoid
stiffness and muscle soreness and make you feel better like as follows:
- On the job release nervous tension
- While our computer is processing something for 5 to 10 seconds
- Whenever you feel stiffed, sore or tired
- Before and after taking a walk
- In the morning just often getting up and in the evening before sleep
- When you need more energy
- Whenever you want to focus and do your best
You can stretch:
When you are a passenger in a car, or in a bus or a
train on way to work
At your desk
While on the phone
Stretching is the simplest of all physical activities. It is the
perfect antidote for long periods of inactivity and holding
still. Regular stretching throughout the day will reduce
muscle tension, reduce anxiety, stress and fatigue,
improve mental alertness and tune your mind into your
body that will make your work easier and feel better.
Socials
A man is a social being who exist in relationships with his physical
environment and in relationship with people and society.
Socialization plays a very important role in the development of
interpersonal relationship. Through socialization life becomes meaningful,
happy and worthy. On the contrary, without socialization, life will be boring
and empty.
Dance is a form of social activity. Through dance man enjoy his body’s
love and express gesture and releases tension through rhythmic.
Smile
It has been observed that individual workers who always smile are
healthy people. Health workers who provide an atmosphere that is
favorable, conductive to the attainment of goals and objectives of the
organizations.
Smile is an expression of pleasure, amusement, affection and irony. It
has been found out through research that it relieves all kinds of stresses,
physical or mental. It is also considered one of the ingredients or factors that
will motivate and encourage workers to work harder and improve their level
or performance in the organization.
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As healthy workers to be efficient and effective in the performance of
duties and obligation they should not hesitate to smile. When you smile,
muscles are relaxed because 15 muscles are working but when you frown
the muscles are tense because 65 muscles are affected.
Speak to me
The world is designed as a mutual support system in which all things
relate to each others, we suppress the motivation of much of our behavior.
Interpersonal conflicts generally are resolves most effectively by open
communications that accepts the feeling of the persons involved and leads
to better mutual agreement. The feeling of being loved and accepted by
others is a critical level in Maslow’s hierarchy of needs for achieving a high
quality of life.
Sometimes even when you keep a positive attitude, you may need to
talk to someone. Talking to someone when you feel overwhelmed or unable
to deal with stress on your own, airing your feelings to someone who can
understand your feelings to someone who can understand your feelings
even when you feel “helpless” is often the best medicine.
GOAL:
Is to establish and maintain a system that integrates scientific
progress and its practical applications into a comprehensive program that
will reduce cancer morbidity and mortality in the Philippines.
INTERVENTIONS:
Cervical Cancer – Pap smear/Acetic acid wash
All female health staff 25-55 years of age should be subjected to an
initial screening procedure for cervical cancer. Occurrence of precursor and
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or early cancer lesions is about age 25 years, 10 years before 35 years,
when cervix cancer becomes clinically apparent. Carcinoma-in-situ (stage 0)
takes as long as 10 years to develop into invasive disease.
Policy statements:
1) An acetic Acid Wash (AAW) screening method for cervical cancer shall
be made available at the RHUs and Main Health Centers.
2) Acetic Acid Wash (3-5%) shall be used as the screening method of
choice for cervical cancer in the Phils. And shall be established at Local
Health Units., District Hospital, and Provl Hosp. with no Pap smear
capability.
3) AAW shall be used as triage method before pap smear at District,
Provl. and Regional Hosps. With pap smear capability.
4) Colposcopy with biopsy as needed shall be a diagnostic test after
positive or suspicious screen findings. The test shall be provided as
appropriate tertiary level health facility.
5) Papsmear shall be a monitoring diagnostic test in instances of cervical
intraepitheleal neoplasia Stage 1 findings and non-availability of
colposcopy facility. The test shall be provided at secondary and
tertiary level facilities with the required infrastructure and logistics.
6) Women 25-55 years old shall undergo AAW cervical cancer screening
at least once every 5-7 years.
7) AAW shall be advocated as an alternative screening method for
cervical cancer by the health and welfare sector in government, non-
government organizations, professionals, and civil societies at national
and local level.
8) Positive or suspicious lesion noted upon screening shall be referred
immediately to a referral facility where competent specialists shall do
confirmatory tests such as colposcopy and tissue biopsy.
9) Referral centers for cervical cancer diagnostic tests and treatment
shall be established in tertiary facilities.
10) Gender sensitive counseling and disclosure shall be a
component of any training program for cervical cancer prevention and
control. Gender as well as culture sensitivity of health staff involved in
cervical cancer screening and treatment shall be emphasized as part
of quality health service delivery.
11) Sustainability of the screening program shall be ensured through local
financing e.g., subsidy from the local government unit or health facility
concerned, Phil health financing, or fee for service (user fee) scheme.
12) A standard system of recording and reporting shall be developed
and adopted at service delivery points.
13) Periodic evaluation shall be done at all levels to assess the
progress of AAW and its impact on cervical cancer prevention and
control initiative.
14) A regular yearly public information and education campaign
aimed at changing behavior shall be done via mass media and inter-
personal communication with each health center to inform and entice
target women about the cervical cancer screen services.
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Lung Cancer – Anti smoking Campaign
- Public information and health education; increases public awareness
on the hazards of smoking and changing attitude and primary behavior
among primary and secondary school children.
- legislation measures on elimination of smoking habit, elimination of
advertisements and promotion of tobacco products, labeling, tax and price
policies on cigarettes.
Smoking counseling clinics in strategic localities will provide service to all
identified smokers in the catchments areas.
- Research and epidemiology thru generation and collection of data on
all aspects of smoking is carried out thru research.
- Early detection/diagnosis
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- Diabetic kidney disease
- Hypertensive kidney disease.
This often led to end-stage renal diseases (ESRD) due to failure to recognize
them in their early stages.
What are the things that should be done to prevent kidney diseases?
1. Drink adequate volume of water and fruit juices.
2. Eat a balanced diet, not too salty, not too sweet.
3. For females, observe good personal hygiene.
4. Exercise moderately
5. Practice regular towel habits
6. Check blood pressure at least twice a year.
7. Consult a doctor for throat and skin infections.
8. Complete immunizations.
9. Do not hold or play with urine.
10. Avoid playing with your private parts (genitals).
11. Annual urinalysis.
Cardiovascular Diseases
A patient who has already suffered a heart attack or has a coronary
artery disease should have a regular, brisk
Physical activity in order to help reduce the risk of another heart attack
and it also aid in lowering blood cholesterol. Walking is usually
recommended to these patients. Other forms of exercise will require
consultation with a doctor for clearance. Warm-up exercise is very
important when engaging in moderate intensity physical activity. The
patient must be advised to have longer time for warm-up and gradual
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progression to more strenuous activity. Patients must be taught to watch
out for signs and symptoms of over-exertion, e.g., increased pulse rate,
increased breathing, chest pain or general tiredness.
Diabetes Mellitus
>The standard recommendations for physical activity are the same as
in non-diabetic individuals. However, the diabetic patient needs to be
carefully screened for the presence of macro and micro-vascular
complications that may be worsened by the exercise program.
>A careful history and physical examination should focus on the signs
and symptoms of the disease affecting the heart and blood vessels, eyes,
kidneys and nervous system.
- The physician will almost likely have to adjust (decrease) the insulin
dosage to accommodate exercise.
- Consider gradual increase of physical activity towards the conditioning
program to accommodate adjustment of any existing cardiovascular
impairment.
- Persons with diabetes have to eat a controlled amount of carbohydrates
before exercising to prevent hypoglycemia.
- Care of the feet - Good shoes and wrinkle-free socks to prevent blisters
and trauma to the lower extremities.
HEALTH PROMOTION
Health Promotion is the process of enabling people to make the right
choices for health.
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Don't smoke
Manage stress
Have a regular health check-up
Eat a healthy diet everyday
Do regular exercise
Target audiences
> Working adults for manage stress
> Mothers and daughter for watch your weight
> School children for healthy diet
> Adults to elderly for exercise
> Teenagers for don’t smoke
Secondary Audience
• Executives and employees of local government units
• Legislators/politicians
• Media
The Generics Act was enacted to ensure that drugs and medicines are
safe, effective and affordable. Specifically, the Generics Acts has the
following objectives.
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1. To promote, encourage and require the use of generic
terminology in the importation, manufacture, distribution,
marketing, advertising and promotion, prescription and
dispensing of drugs;
2. To ensure adequate supply of drugs with generic names at the
lowest possible cost and endeavor to make hem available for
free to indigent patients;
3. To encourage the extensive use of drugs with generic names
through a national system of procurement and distribution;
4. To emphasize the scientific basis for the use of drugs, in order
that health professionals may become more aware and
cognizant of their therapeutic effectives; and
5. To promote drug safety by minimizing duplication of medicines
and/or use of drugs with potentially adverse drug interaction.
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It is a list of drugs prepared and periodically updated by the DOH on
the basis of health conditions obtaining in the Philippines as well as on
internationally accepted criteria. It consists of the following;
CORE LIST – list of drugs that meet the health care needs of the
majority of the population.
COMPLIMENTARY LIST – list of alternative drugs used when there
is no response to the core essential drugs or when, for one
reason or another, the core essential drug cannot be given.
2) MILK CODE
PHILIPPINE CODE OF MARKETING OF BREASTMILK SUBSTITUTE
EXECUTIVE ORDER 51 SERIES 1987
158
WHAT SHOULD THE HEALTH FACILITY WILL DO TO IMPLEMENT THE MILK
CODE?
LISTS SOME VIOLATIONS OF THE MILK CODE THAT THE HEALTH FACILITY
STAFF SHOULD AVOID.
159
o Age is between 16-65 years (parental consent required for
under 18 years old)
o Weight of at least 100 lbs. (40 kg) for blood donation of
250 ml. or at least 110 lbs. (50 kg) for blood donation of
450 ml.
o Pulse rate between 60 and 100 beats/min with regular
rhythm.
o Blood pressure between 90 to 160 mm Hg systolic and 60
to 100 mm Hg diastolic.
o Hemoglobin of at least 125 g/l (12.5 g/dl).
1. Pregnancy
2. Acute febrile illness
3. Alcohol intake – within the last 12 hours
4. Ear/body piercing and/or tattooing within the last 12 months
5. Recent surgery- minor or trivial surgery during the last 12
months
6. Cancer
7. Cardiac disease
8. Severe lung disease
9. Viral hepatitis
10. HIV infections, AIDS or STI
11. High risk occupation (e.g. prostitution)
12. Prolonged bleeding
13. Unexplained weight loss of more than 5 kg. over 6 months
14. Chronic alcoholism
15. Intake of medication
16. Blood dyscracias
4) SANITATION CODE
PRESIDENTIAL DECREE NO. 856
“CODE ON SANITAITON OF THE PHILIPPINES”
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o Defining the standards and the regulatory procedures for
food and industrial establishments and public facilities
such as markets, hotels, ports, terminals, and schools,
among others.
o Regulating the disposal of sewage, dead bodies and other
wastes, and
o Defining the interventions to control vermin.
HOW DOES THE SANITAITON CODE ENSURE THE SAFETY OF THE WATER
SUPPLY AND FOOD ESTABLISHMENTS?
1. Water supply
2. Wholesomeness of food
3. Protection of food
4. Toilet provision
5. Hand washing facilities
6. Liquid waste management
7. Solid waste management
8. Personal cleanliness
9. Construction of premises
10. Maintenance of premises
11. Vermin control
12. Housekeeping and management
13. Sanitary conditions of appliance and utensils
14. Disease control
1. Sanitary permit
2. Location and sitting of the establishment complies with
existing zoning laws, ordinances or policies
3. Potable water supply
4. Sewage disposal
5. All wastes of the industrial establishment are all collected,
stored, or disposed of in a manner to prevent health
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hazards, nuisances, and pollution. It should utilize the
city/municipal collection and disposal system, it exists
6. Maintenance of a abatement program for vermin control
7. Adequate restrooms and mess halls for employees
8. All places of employment and all workrooms, including
machinery and equipment are kept clean and sanitary.
5) ASIN LAW
REPUBLIC ACT 8172
This is one of the laws to protect and promote the health of the nation
through food fortification. Salt iodization shall contribute to the elimination
micronutrient malnutrition particularly iodine deficiency disorders or the
broad spectrum of deficiencies resulting from lack of iodine from the diet
which leads to the reduction of intellectual and physical capacity, and may
manifest as goiter, mental retardation, physical and mental defects and
cretinism.
It is the law that mandates the iodization of salt for human and animal
consumption. It applies to;
All producers/manufactures/importers and traders of salt for
human or animal consumption
All restaurants and other food establishments where food is
being served or sold.
All food manufacturers/processors using salt in their
manufacturing process.
All local government units
All government and private hospitals and other institutions
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All other government agencies
All non governmental agencies and related professional
organizations.
When there are salt producers present in the locality, the iodine
content in salt is tested at the production level. Samples are collected
from the production line at regular intervals and are tested in the
laboratories.
Where local ordinance require, salt testing may also be done at the
household level.
All food outlets, restaurants, food processing plants, retail stores and
wet markets are monitored to ensure that only iodized salt are made
available to the public.
SECTION 1.Short Title. – This Act shall be known as the "Newborn Screening
Act of 2004."
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collaboration among government and non-government agencies at the
national and local levels, the private sector, families and communities,
professional health organizations, academic institutions, and non-
governmental organizations. The National Newborn Screening System shall
ensure that every baby born in the Philippines is offered the opportunity to
undergo newborn screening and thus be spared from heritable conditions
that can lead to mental retardation and death if undetected and untreated.
ARTICLE 2, Section. 4.
164
joint responsibility of the parent(s) and the practitioner or other person
delivering the newborn to ensure that newborn screening is performed. An
appropriate informational brochure for parents to assist in fulfilling this
responsibility shall be made available by the Department of Health and shall
be distributed to all health institutions and made available to any health
practitioner requesting it for appropriate distribution.
Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of
1995
[0] An Act Granting Benefits and Incentives to Accredit Barangay Health
Workers and for Other Purposes.
165
Republic Act 6425 - Dangerous Drugs Act of 1972
This Act shall be known and cited as "The Dangerous
Drugs Act of 1972."
Republic Act No. 7876 - Senior Citizens Center Act of the Philippines
An Act to Maximize the Contribution of Senior Citizens to Nation Building,
Grant Benefits and Special Privileges
Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997)
An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND
166
ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of
traditional and alternative health care in the Philippines, providing for a
TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for
other purposes
Executive Order
Presidential Decree
Empowering the secretary of health to regulate the labeling, sale and distribution of hazardous
substances
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Ten (10) Herbal Medicines in the Philippines
Approved by the Department of Health (DOH)
Parts utilized
Seeds (dried nuts) and leaves.
- Constituent’s
Fatty oil, 15%; gum; resin.
- Folkloric uses
Antihelminthic: Dried seeds preferable for deworming.
Adults: Dried nuts-chew 8 to 10 small- to medium-sized dried nuts two hours
after a meal, as a single dose, followed by a half glass of water. If fresh nuts
are used, chew only 4-5 nuts. Hiccups occur more frequently with the use of
fresh nuts.
Children: 3-5 years old: 4-5 dried nuts; 6 - 8 years old: 5-6 dried nuts; 9-12
years old: 6-7 dried nuts.
Caution: Adverse reactions - diarrhea, abdominal pain, distention and
hiccups more likely if nuts are eaten in consecutive days or when fresh nuts
are eaten.
Others
Roasted seeds for diarrhea and fever.
Pounded leaves externally for skin diseases.
Decoction of boiled leaves used for dysuria.
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abundantly in the Philippines. In folkloric medicine, the leaves has been used
as a disinfectant wash during child birth, as cure for diarrhea, as tea for
general good heath and because Tsaang Gubat has high fluoride content, it
is used as a mouth gargle for preventing tooth decay. Research and test
now prove it's efficacy as an herbal medicine. Aside from the traditional way
of taking Tsaang Gubat, it is now available commercially in capsules, tablets
and tea bags.
Tsaang Gubat is also knows as: Wild Tea, Forest Tea, Alibungog (Visayas
Region), Putputai (Bicol Region) and Maragued (Ilocos Region).
Scientific name: Ehretia Microphylla Lam.
Yerba Buena has been consumed for centuries as tea and herbal
medicine as a pain reliever (analgesic). Native American Indians used it even
before the "white men" colonized the Americas. Today, this folk medicine's
efficacy has been validated by scientific research. In the Philippines, Yerba
Buena is one of the 10 herbs endorsed by the Department of Heath (DOH) as
an effective alternative medicine for aches and pains.
As an herbal medicine, a decoction (boil leaves then strain) of Yerba
Buena is effective for minor ailments such as headaches, toothaches and
joint pains. It can also relive stomach aches due to gas buildup and
indigestion. The fresh and dried leaves can both be used for the decoction.
And because Yerba Buena belongs to the mint family, soaking fresh leaves
in a glass of water (30 to 45 minutes) makes for a good mouth wash for a
clean, fresh smelling breath.
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Benefits & Treatment of:
• Arthritis
• Head aches
• Tooth aches
• Mouth wash
• Relief of intestinal gas
• Stomach aches
• Indigestion
• Drink as tea for general good health.
Benefits: Preparation:
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5.Pansit-pansitan (family: Piperaceae) is an herbal medicine also known as
Ulasiman-bato, olasiman-ihalas & tangon-tangon in the Philippines. English
name: peperomia.
Pansit-pansitan is a small herb that grows from 1 to 1 1/2 feet. It can be
found wild on lightly shaded and damp areas such as nooks, walls, yards and
even roofs. Pansit-pansitan has heart shaped leaves, succulent stems with
tiny flowers on a spike. When matured, the small fruits bear one seed which
fall of the ground and propagate.
The leaves and stalk of pansit-pansitan are edible. It can be harvested,
washed and eaten as fresh salad. Taken as a salad, pansit-pansitan helps
relive rheumatic pains and gout. An infusion or decoction (boil 1 cup of
leaves/stem in 2 cups of water) can also be made and taken orally - 1 cup in
the morning and another cup in the evening.
For the herbal treatment of skin disorders like abscesses, pimples and
boils, pound the leaves and/or the stalks and make a poultice (boil in water
for a minute or two then pounded) then applied directly to the afflicted area.
Likewise a decoction can be used as a rinse to treat skin disorders.
For headaches, heat a couple of leaves in hot water, bruise the surface
and apply on the forehead. The decoction of leaves and stalks is also good
for abdominal pains and kidney problems.
Like any herbal medicine it is not advisable to take any other medication
in combination with any herbs. Consult with a medical practitioner
knowledgeable in herbal medicine before any treatment.
The leaves, flowers, seeds and root of Lagundi can all be used as
herbal medicine. A decoction is made by boiling the parts of the plant and
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taken orally. Today, Lagundi is available in capsule form and syrup for
cough.
Plant Description: The Lagundi plant can grow up to five meters tall.
It can be described as a cross between a shrub and a tree with a single
woody stem (trunk). Lagundi's distinctive feature is the pointed leaves
with five leaflets set like a hand.
Lagundi tablets (300 mg) are
available from the Department of
Health's Philippine Institute of
Traditional and Alternative Health Care
(PITAHC).
Benefits: Preparation:
• Relief of asthma & pharyngitis • For boil half cup of chopped fresh
• Recommended relief of or dried leaves in 1 cup of water for
rheumatism, dyspepsia, boils, 10 to 15 minutes. Drink half cup
diarrhea three times a day.
• Treatment of cough, colds, fever • The lagundi flowers are also good
and flu and other bronchopulmonary for diarrhea and fever. Boil as with
disorders the leaves.
• Alleviate symptoms of Chicken Pox • The root is specially good for
• Removal of worms, and boils treating dyspepsia, worms, boils,
colic and rheumatism
7.Bayabas or guava is one of the most popular therapeutic plants in the Philippines. Bayabas
is a small tree that can grow up to 3 meters tall with greenish-brownish smooth bark. The
round globular bayabas fruit starts as a flower and is usually harvested and eaten while still
green. The fruit turns yellowish-green and soft when ripe.
Benefits &
Treatment
As a herbal medicine, the bayabas of:
fruit, bark and leaves are used. The
bark and leaves can be used as • Arthritis
astringent. The most common use of • Head aches
the leaves is for cleaning and • Tooth aches
disinfecting wounds by rinsing the • Mouth wash
afflicted area with a decoction of the • Relief of intestinal gas
leaves. The fruit, aside form being • Stomach aches
• Indigestion
delicious, contains a very high
• Drink as tea for general good health.
concentration of vitamin C.
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8.Bawang or Garlic (scientific name: Allium sativum) is one of the most
widely used herbal medicine in the Philippines. The Philippine bawang
variety is more pungent than the imported ones. Its medicinal properties
have been known for a long time and have been specially proven during
World War II. Because of Bawang's antibacterial compound known as Allicin,
lives were saved by preventing wounds from having infection and later
develop into gangrene when the juice of Bawang or garlic was applied to the
wounds.
Bawang/garlic is known as nature's antibiotic. Its juices inhibit the
growth of fungi and viruses thus prevent viral, yeast and viral infections.
Preliminary test also shows some positive results in the treatment of AIDS.
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Benefits of Bawang: Preparation of Bawang:
174
Herbal Benefits of Ampalaya: Preparation of Ampalaya:
175
Uses of Akapulko: Preparation:
ADDITIONAL INFORMATION:
Benefits:
• Relieves rheumatic pains & muscle pains
• Alleviates sore throat, fever, nausea
• Intestinal disorders and slow digestion
• Treat intestinal worms
• Hinder diarrhea, gas pains
• Relieve indigestion (dyspepsia), toothaches
• Lower cholesterol levels
• Aids treatment of tuberculosis
Preparation:
- Boil the root in water and drink. The more concentrated the better.
- For sore throat and tooth ache, remove the skin and chew small
portions.
- For cuts & bruises, apply the juice directly to the skin.
- For rheumatism and muscle pains, pound the root and apply to painful
areas -can be mixed with oil for easy application.
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Philippine Virgin Coconut Oil (VCO)
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While virgin coconut oil, being pure, unadulterated and
unhydrogenated retains its pleasant coconut taste, smell and all the health
benefits of coconut oil.
Much research still has to be done on the benefits of virgin coconut oil but
preliminary findings and anecdotal reports are very promising. This may well
be the much needed medicine to restore to health the ailing Philippine
coconut industry.
Benefits of VCO
● A boost to the body's immune system
● A good source of saturated medium chain triglycerides
● VCO helps regulate blood sugar
● Lowers the viral load of AIDS patients.
● Has anti-viral & anti-microbial properties
● Helps hepatitis C, herpes patients
● Helps maintain healthy thyroid function
● Maintain LDL & HDL cholesterol levels
● Heals & nourishes the skin, hair & scalp
● Use only half the dosage prescribed for fresh parts like leaves when
using dried parts.
● Do not use stainless steel utensils when boiling decoctions. Only use
earthen, enameled, glass or alike utensils.
● As a rule of thumb, when boiling leaves and other plant parts, do not
cover the pot, and boil in low flame.
● Decoctions loose potency after some time. Dispose of decoctions after
one day. To keep fresh during the day, keep lukewarm in a flask or
thermos.
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● Always consult with a doctor if symptoms persist or if any sign of allergic
reaction develops.
ENVIRONMENTAL HEALTH
1. FOOD Sanitation
Instructional Objectives:
At the end of the session, the NURSING students will be able to:
Objectives
4. Identify the sanitation requirements for food establishments
(Chapter III of IRR of P.D. 856)
5.1 Sanitary Permit
5.2 Health Certificate
5.3 Quality and Protection of Food
5.4 Structural Requirements
5.5 Sanitation Facilities
AIR
RESPIRATOR
Y & ORAL POISON DEATH
HANDS
DISCHARGE
SICK S
PERSONS (SNEEZING,
FLIES,
COUGHING,
COCK-
SPITTING) SUSCEP-
ROACHES
CARRIERS OTHER UTENSILS TIBLE
OPEN FOOD
INSECTS INDIVIDUAL
WOUNDS
CARELESS AND
AND BOILS
INDIVI- RODENTS
DUAL
WATER
INTESTINAL INFECTED
(DRINKING SICKNESS
DISCHARGE ANIMALS
& WASH
S (EXCRETA)
WATER)
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CIRCLE OF INFECTION
MICRO
PEOPLE ORGANISMS
TIME/
TEM
PERA FOODS
TURE
5. The permit shall be valid for one (1) year, ending on the last day of
December of each year, and shall be renewed every year. However, for
new food establishments, the validity of the Sanitary Permit will also
expire at the end of December of the current year. Upon the
recommendation of the local health officer, the Sanitary Permit shall be
suspended or revoked by the local health authority upon violation of any
sanitation rules and regulations.
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6. The sanitary Permit shall be posted in a conspicuous place of the
establishment and shall be available for inspection by the health and
other regulatory personnel.
7. Record of Permit Certificates
– Every city or municipality shall keep a record of all
establishments in respect of which permits have been issued
and all permit certificates and renewal thereof.
FOOD HANDLERS
No person shall be allowed to work in food handling and preparation
while afflicted with a communicable disease or a carrier of such
disease, which includes boils or inflected wounds, colds or respiratory
infection, diarrhea or gastrointestinal upsets, and other related
illnesses.
The manager or person-in-charge of the establishment shall notify the
health officer or the company physician if any, when any employee is
known to have a notifiable disease.
Four Rights in Food Safety
Right Source:
• Always buy fresh meat, fish, fruits & vegetables.
• Always look for the expiry dates of processed foods and avoid buying
the expired ones.
• Avoid buying canned foods with dents, bulges, deformation , broken
seals and improperly seams.
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• Use water only from clean and safe sources.
• When in doubt of the water source, boil water for 2 minutes.
Right Cooking:
• Cook food thoroughly. Temperature on all parts of the food should reach
70 degrees centigrade.
• Eat cooked food immediately.
• Wash hands thoroughly before and after eating.
Right Preparation:
Avoid contact between raw foods and cooked foods.
• Always buy pasteurized milk and fruit juices.
• Wash vegetables well if to be eaten raw such as lettuce, cucumber,
tomatoes & carrots.
• Always wash hands and kitchen utensils before and after preparing food.
• Sweep kitchen floors to remove food droppings and prevent the harbor of
rats and insects.
Right Storage:
• All cooked foods should be left at room temperature for NOT more than
two hours to prevent multiplication of bacteria.
• Store cooked foods carefully. Be sure to use tightly sealed containers for
storing food.
• Be sure to store food under hot conditions (at least or above 60 degrees
centigrade) or in cold conditions (below or equal to 10 degrees centigrade).
This is vital if you plan to store food for more than four to five hours.
• Foods for infants should not be stored at all. It should always be freshly
prepared.
• Do not overburden the refrigerator by filling it with too large quantities
of warm food.
• Reheat stored food before eating. Food should be reheated to at least
70 degrees centigrade.
Structural Requirements:
1. Floors
2. Walls
3. Ceilings
4. Lighting
5. Ventilation
6. Overcrowding 7. Change rooms
FLOORS
1) Kept clean; no sawdust used
2) Concrete, other impervious materials; easily cleaned materials, resistant
to wear and corrosion.
3) Wood: floor board laid on a fire foundation; tightly clamped together.
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4) All angles between floors and walls rounded off to height of not less than
3 inches ( 7.62 cm.) from the floor.
5) Adequately graded and drained.
6) Exterior walking and driving surfaces properly surfaced.
7) Mats and duck boards cleanable and removable.
WALLS
1) Internal surfaces, smooth, even, non-absorbent, cleanable
2) Constructed of dust-proof materials
3) Walls subject to wetting or splashing: impervious, non-absorbent
materials, height not less than 4.79 inches (2M) from the floor.
4) Painted light color; wall finish approved by DOH.
5) All wall attachment /decoration clean.
LIGHTING
1. Twenty (20) foot candles-room where food is prepared, packed,
utensils and
Hand washing rooms.
2. Five (5) foot candles – where food is consumed.
3. Intensities of illumination measured 30 inches from floor.
4. Lighting reasonably free from glare; no shadows.
5. Other artificial light source approved by DOH.
VENTILATION
1) Rooms reasonably free from steam, condensation, odors, fumes, some
other impurities; relative humidity – 60% temperature = 80 F.
2. Rooms and equipment vented to outside as required.
3. Hoods properly designed; filters easily removable.
4. Intake air ducts properly designed and maintained.
5. Systems comply with fire prevention, population / nuisance
requirements.
OVERCROWDING
1) Sufficient floor spaces
a) Enabling every employee to carry-out their duties efficiently.
b) Easy access for cleaning.
2.) Working spaces, aisle, passageways and areas which customers have
access:
a. Unobstructed
b. Sufficient to permit movement; no contamination of food by clothing
or
personal contact of employees and customers.
Sanitation Standard
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Reasons for Practicing Food and Water Safety
It may save a life
You will spare yourself and your family a painful bout of illness
Save money
Safe food handling inspires confidence and keeps peace in the family
Safe food handling lets you enjoy to the fullest the nutritional benefits
of food
Safe food handling practices are the ones most likely to preserve
food’s peak quality
.
FOOD SAFETY NETWORK PHIL
G - GOVERNMENT
BFAD, DENR, DOH, DA, BAFPS, DOST
A – ACADEME
Schools
I – INDUSTRY
BFAD, DENR, DOH, DA, BAFPS, DOST
N - NON-GOVERNMENTAL ORGANIZATIONS
FAFST, FSNP, PAFT
WATER SANITATION
Drinking water must be clear, colorless and free from objectionable taste
and odor. Above all, it must not contain any substance, organism, chemical
or radioactive material at a level and /or concentration which could
endanger the health and lives of the consuming public.
The determination of the safety and potability of the local water requires
reference to a set of water quality parameters.
Goal: Halve the proportion of people with no access to safe drinking water
184
TRADITIONAL HAZARDS
- Related to poverty and insufficient development
91% in Urban
Serve
d
71% in Rural
87 %
Source: National Health Demographic Survey Safe Water Coverage, 1998
Water Supply
Definition of Terms:
185
- Spring – Washing and bathing within 25 meters radius of the spring is
prohibited. Also, protection of the entire catchments area is a must. No
dwellings shall be constructed within the catchments area and it shall be off-
limits to people and animals
Standard Values
For Biological Organism
For Physical and Chemical Quality
i. Health Significance
- Inorganic Constituents
186
- Organic Constituents
Composition of LDWQMC:
1. Health Authority - Chairman
2. Health Officer – Vice Chairman
3. Water Districts/Private Water Suppliers
4. SangguniangPanlalawigan/Panlungsod/Bayan
5. Engineer’s Office
6. CENRO Representative
7. NGO related to Health & Sanitation
8. DOH Representative to the Local Health Board
9. Sanitary Engineer/ Sanitation Inspector
187
Certificate of Potability of Drinking Water – the Health Officer is hereby
deputized by the Secretary of Health to issue the certificate Water-Related
Disease
Chemical Contaminants
Organic compounds
Synthetic organic compounds
Volatile organic compounds
Inorganic compounds
Microbial Pathogens
- Bacteria: E. coli,
Enterotocci
- Parasitic protozoa
- Viruses
HEALTH CARE WASTE MANAGEMENT
GENERAL WASTE
Infectious waste
Blood- soaked dressings
Bandages
188
Sticking plaster
Contaminated gloves
Sharps
Used hypodermic needle
Intravenous sets
Pathological waste
Body fluids
189
d. To increase the number of children receiving food assistance.
___4. The target set by WHO for the Cure Rate of the TB patients under the
National Tuberculosis program is:
a. 70%
b. 80%
c. 85%
d. 95%
___5. One of the following is not among the 5 elements of D.O.T.S:
A . Political Commitment
b. Case detection by sputum microscopy
c. Uninterrupted treatment and regular drug supply
d. None of the above
___6. How many sputum collections should a nurse get from a patient who is
suspected of having TB?
a. one
b. two
c. three
d. four
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c. The significance of its control measures is that its primary victims are the
rural poor.
d. Use of self protective measures like repellant is encouraged.
___14. In the Philippines, early diagnosis for breast cancer is done through:
a. Mammography
b. Breast self-exam
c. Ultrasound
d. Good history of the patient
___15. The drug for effective pain relief of cancer which is available for free
to patients under the Cancer Prevention and Control program is:
a. Nubian
b. Demerol
c. Paracetamol
d. Morphine
191
c. A and b
d. Neither a nor b
___18. The following antigens are given for three doses in EPI, except:
a. BCG
b. Polio
c. DPT
d. Hepatitis B
___19. The Multi-dose Vial Policy can be applied to the following vaccines
except:
a. DPT
b. TT
c. Hepa B
d. BCG
___21. The most sensitive index to measure the level of the health status in
a community is: a. MMR
b. IMR
c. Mortality rate
d. Swaroop’s Index
___22. The rate that has the denominator of the number of registered live
births:
a. IMR
b. MMR
c. Perinatal mortality rate
d. All of the above
___24. The first line of antibiotic for the treatment of Pneumonia in the
Control of Acute Respiratory Infection for children:
a. Cotrimoxazole
b. Amoxicillin
c. Penicillin
d. Cephalosporin
___25. In the Integrated Maternal and Child Illness (IMCI) approach, health
workers can diagnose a child with Pneumonia by:
A/ Counting the respiratory rate
B. Chest X-ray examination
c. Taking a good history of the patient
d. Hearing crackles in the chest upon auscultation
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___26. What signs are used to assess a sick child with cough for difficult
breathing?
a. Fast breathing
b. Chest indrawing
c. Stridor
d. All of the above
___27. One should asses feeding if the child has one of the following, except:
child has anemia
a. no appetite
b. very low weight
C. less than two years old
___28. The four main symptoms included in IMCI are the following, except:
a. cough, fever
b. diarrhea
c. malaria
D. ear problem
___29. Fast breathing for a child that is 12 months old is:
a. 50 breaths/minute or more
b. 40 breaths/minute or more
c. 60 breaths/minute or more
d. None of the above
___30. What is a true statement in a child aged five years old:
a. Can still use the IMCI chart for sick child 2 months up to 5 years
b. Can use the IMCI chart for young infant 1 week up to 2 months
c. Cannot use the two charts since signs and symptoms are different in
older children.
d. None of the above
___31.The following are signs of good attachment, except:
a. More areola visible below than above the mouth
b. Chin touching breast
c. Mouth wide open
d. Lower lip turned outward
___32. If pus is seen draining from the ear and discharge is reported for 14
days or more; the classification is:
a. Mastoditis
b. Acute ear infection
c. Chronic ear infection
d. None of the above
___33. Paracetamol should only be given to children with high grade fever of:
a. 37.5C
b. 37.2C
c. 38.0C
d. 38.5C or more
___34. Classification for a child that is having diarrhea, restless and irritable,
skin pinch goes back slowly and has sunken eyes is:
A. severe persistent diarrhea
B. diarrhea with some dehydration
C. severe dehydration
D. no dehydration
193
___35. The earliest possible age for a child to be given a deworming drug
especially in endemic helmenthiasis area is:
a. 12 mos. c. 24 mos.
b. 6 mos. d. 36 mos.
___36.Three components of IMCI except:
a. Improving health system
b. Improving health services
c. Improving health worker’s skills
d. Improving family and community practices
___40. One of the 10 herbal medicines for stomach pains, gastro enteritis,
dysentery and body cleanser or body wash is wild tea and it is popularly
known as:
A. bayabas
B. sambong
c. Lagundi
d. Tsaang- gubat
___41. The benefit of garlic includes the following:
A. lowers LDL levels
B. lowers blood pressure
C. boost the immune system
d. All of the above
194
b. All cooked food should be left at room temperature for not more
than 2 hours to prevent bacterial multiplication.
c. If food is to be stored for more than 4 hours, the temperature should
be below 10C.
d. None of the above.
___44. Food establishment that has a very satisfactory rating from local
authority has a color code of:
A. green
B. yellow
C. red-orange
D. blue
___45. The water supply that comes from communal faucet system or
standpost that serves
4 - 6 clustered households are a:
a. Level I
b. Level II
c. Level III
d. Level IV
___46. For drinking water quality, the standard parameter or value for E. coli
or coliform bacterial count / 100 ml of water sample in all drinking water
supplies (Level I, II, and III) is:
a. 0
b. 1 – 2
C. < 5
d. None of the above
___47. In health care waste management, the color code of radio-active
waste is:
A. green
B. yellow
C. orange
D. red
___50. The four pillars in the strategy Four-mula One for Health are the
following, except:
a. Governance
b. Health regulation
c. Health care financing
195
d. Public health reforms
196