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MODULE 7
DOH Programs Related to Family Health

Overview:
 Health is the right of every human being
 It views health care of individuals within the context of the family.
 The term “family” is defined as the basic unit of the community.
 All members of the family are empowered to maintain their health status.
 The family health office is tasked to operationalize health programs geared towards the health of the
family.
 It is concerned with the health of the mother and the unborn, the newborn, infant, child, the
adolescent and youth, the adult men and women and older persons.

AIMS
 Improve the survival health and wellbeing of mothers and the unborn through a package of services
for the pre pregnancy, prenatal and past natal stage.
 Reduce morbidity and mortality roles for children 8-9 years old.
 Reduce mortality from preventable cause among adolescent and young people.
 Reduce morbidity among Filipino adults and improve their quality of life.
 Reduce morbidity and mortality of older and improve their quality of life.

Module Objectives:
At the end of this module, the student should be able to:
1. Apply knowledge of physical, social, natural and health sciences, and humanities in the care of the
individual and family in the community setting.
2. Apply guidelines and principles of evidence-based practice in the delivery of care to the individual
and family in the community setting.
3. Adopt the nursing core values in the delivery of care to individual and families.

Module Coverage
A. Expanded Programs of Immunization
B. Integrated Management of Childhood Illnesses (IMCI)
C. Newborn Screening
D. BemONC/CEmONC
E. MhGap
F. Other Related Programs

TOPIC A
Topic Title: Expanded Programs of Immunization

Topic Contents:
  The Expanded Program on Immunization (EPI) was established in 1976 to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines.
Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. In 1986, 21.3% “fully immunized” children less than
fourteen months of age based on the EPI Comprehensive Program review.

Mandates:
 PD 996 Providing for compulsory basic immunization for infants and children below 8 years
old.
 Republic Act No. 10152“Mandatory Infants and Children Health Immunization Act of 2011
Signed by President Benigno Aquino III on July 26, 2010. The mandatory includes basic
immunization for children under 5 including other types that will be determined by the
Secretary of Health.
 The conceptualization and introduction of the disease reduction initiative in early 90s
contributed to the declined of numerous cases of immunization disease.
The four major strategies include:
1. Sustaining high routine FIC coverage of at least 90% in all provinces and cities.
2. Sustaining the polio free country for global certification.
3. Eliminating measles by 2008.
4. Eliminating neonatal tetanus by 2008

THE CONCEPT AND IMPORTANCE OF VACCINATION

 Immunization is the process by which vaccines are introduced into the body before infection sets in.
vaccinations promote health and protect children from disease. Infants and newborns need to be
vaccinated an early age since they belong to vulnerable age group. They are susceptible to
childhood disease.

SEVERAL GENERAL PRINCIPLES WHICH APPLY IN VACCINATING CHILDREN:

 It is safe and immunologically effective to administer all EPI vaccines on the same day at different
sites of the body.
 Measles vaccines should be given as soon as the child is 9 months old, regardless of whether other
vaccines will be given on that day. Measles vaccines given at 9 months provide 85% protection
against measles infection. When given at one year and older provides 95% protection.
 The vaccination schedule should not be restarted from the beginning even if the interval between
doses exceeded the recommended interval by months or years.
 Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not
contraindications to vaccination. Generally, one should immunize unless the child is so sick that he
needs to be hospitalized.

 The absolute contraindications to immunization are:

 DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose.
Vaccines containing the whole cell pertussis component should not be given to children with an
evolving neurological disease (uncontrolled epilepsy of progressive encephalopathy).
  Live vaccines like BCG vaccine must not be given to individuals who are immunosuppressed
due to malignant disease (child with clinical AIDS), therapy with immunosuppressive agents, or
irradiation.
 It is safe and effective with mild side effects after vaccination. Local reaction, fever and systematic
symptoms can result as part of the normal immune response.
 Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the antibody
response. Lengthening the interval between doses of vaccines leads to higher antibody levels.
 No extra doses must be given to children/mother who missed a dose of DPT/HB/OPV/TT. The
vaccination must be continued as if no time had elapsed between doses.
 Strictly follow the principle of never, ever reconstituting the freeze-dried vaccines in anything other
than the diluents supplied with them.
 False contraindications to immunizations are children with malnutrition, low grade fever, mild
respiratory infections and other minor illnesses and diarrhea should not be considered a
contraindication to OPV vaccination. Repeat BCG vaccination if the child does not develop a scar
after the 1st injection.

 Use one syringe one needle per child during vaccination

THE EPI ROUTINE SCHEDULE OF IMMUNIZATION

 Every Wednesday is designated as immunization day and is adopted in all parts of the country. In a
barangay health station immunization is done monthly while in far flung areas it is done quarterly.
However, some areas adopted local practices to provide everyday vaccination in their areas to cover
all targets.

ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

PREVENTABLE DISEASES AND AGE TO BE GIVEN

REASON WHY VACCINES IS GIVEN AS EARLY AS POSSIBLE

 BCG given at the earliest possible age protects against the possibility of infection from other family member
 An early start with DPT reduces the chance of severe pertussis.
 The extent of protection against polio is increased the earlier the OPV is given.
 An early start of hepatitis B reduces the chance of being infected and becoming a carrier.
 At least 80% of measles can be prevented by immunization at this age.

COLD CHAIN
A system used to maintain the potency of a vaccine from the time of manufacture to the
time it is given to the child or the pregnant woman.
1. Storage of vaccines should not exceed:
 6 months at the regional level
 3 months at the provincial level / district level
 1 month at the main health centers (with refrigerators)
 Not more than 5 days at health center
2. Transport of vaccines; use transport boxes of vaccine carriers
3. Handling of vaccines: once opened or reconstituted, vaccines must be placed in a
special cold pack during immunization sessions
4. DISCARD:
 BCG vaccines after 4 hours
 Pentavalent, Polio, measles, and tetanus toxoid vaccines after 8 hours or at the
end of a working day.
 ADMINISTRATION OF VACCINES

Vaccine Dose Route of Site of Administration

Administration
BCG Infant 0.05 ml Intradermal Right Deltoid region of the
arm

School entrants 0.10 ml Intradermal Left Deltoid region of the

arm
Hepatitis B 0.5 ml Intramuscular Upper, outer portion of
the thigh
Pentavalent 0.5 ml Intramuscular Upper, outer portion of
the thigh
Oral Polio Vaccine 2 drops or depending
on manufacturer’s
instruction
Inactivated Polio 0.5 ml Intramuscular Upper, outer portion of
Vaccine the thigh
0.5 ml Subcutaneous Outer part of the upper
Measles arm
Tetanus Toxoid 0.5 ml Intramuscular Deltoid Region of the
upper arm

TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN

 It is important to prevent tetanus in both mother and the baby. When the two doses of TT
injection given at one-month interval between each dose during pregnancy or even
before pregnancy period the baby is protected against neonatal tetanus.
 Completing the five doses following the schedule provide lifetime immunity.
 NORMAL COURSES AND EFFECTS OF VACCINE

Vaccine Side Effects Management

BCG KOCH’S PHENOMENON No management needed
Wheal – raised by An acute inflammatory reaction,
injections; disappears in appearing within 2 to 4 days of
about 10 minutes vaccination

Small Red Tender DEEP ABSCESS AT VACCINATION SITE Incision and drainage
Swelling – about 10 mm OR LYMPH NODES
across appears at the Almost invariable due to
injection site after subcutaneous or deeper injection.
approximately 2 weeks.
After 2-3 weeks the INDOLENT ULCERATION Treat with INH powder
swelling becomes a small An ulcer which persist after 12
abscess, which then weeks from date of vaccination or an
ulcerates ulcer more than 10 mm deep.

Ulcer – heals by itself and GLANDULAR ENLARGEMENT If suppuration occurs, treat

leaves a scar. The glands draining the injection as a deep abcess.
site may become enlarged.
Scar Formation – about
12 weeks
Pentavalent FEVER Advice mother to give
Many children develop fever after antipyretic or sponge tepid
injection, which lasts only for one water.
day but more than that is not due to
vaccine but to other causes.

LOCAL SORENESS Reassure mothers that this

If this starts early after the needs no treatment and
injection, then it is only due to the will disappear within 3 to 4
vaccine days.

ABSCESS Incision and Drainage are

Appears a week more or more necessary
after the injection is due to a wrong
technique. Either the vaccine was
not injected deep enough or the
needle was not sterile. Give proper management
and do not continue the
CONVULSION normal course.
Very rare and occur more in
children above three months of age.
 This is due to the pertussis
component of the vaccine.

Polio Usually none

Hepatitis B LOCAL SORENESS No treatment needed
Some infants may develop mild
soreness at the injection site, but
this will go away within 24 hours.
Measles FEVER AND RASH Reassure the mother and
Children may develop a fever advise her to give
after 5 to 7 days from the time of antipyretics to the child or
vaccination. The fever lasts from sponge the child with tepid
only 1 to 7 days. Sometimes, there is water
also a mild measles rash.

Tetanus Toxoid PAIN, REDNESS, AND SWELLING No treatment needed

PROCEDURES IN THE GIVING OF VACCINES:

Giving BCG vaccine:
 Clean the skin with a cotton ball moistened with water and skin dry.
 Hold the child’s arm with your left hand so that: your hand is under the arm, and your thumb and fingers come
around the arm stretch the skin.
 Hold the syringe in your right hand with the bevel and the scale pointing up towards you.
 Lay the syringe and needle almost flat along the child’s arm.
 Insert the tip of the needle into skin.
 Put your left thumb over the needle end of the syringe to hold it in position.
 If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange peel will
appear at the injection site.
 Withdraw the needle gently.

Giving oral polio vaccine:

 Read the manufacturer’s instructions to determine number of drops to be given. Use the dropper provide for.
 Let the mother hold the child lying firmly on his back.
 If necessary open the child’s mouth by squeezing the cheeks gently between your fingers to make his lips
point upwards.
 Put drops of vaccine straight from the dropper onto the child’s tongue but do not let the dropper touch the
child’s tongue.
 Make sure that the child swallows the vaccine. If the spits it out, give another dose.

Giving hepatitis B/Pentavalent

 Ask mother to hold the child’s across her knees so that his thigh is facing upwards. Ask her to hold child’s legs
 Clean the skin with the cotton ball moistened with water and let skin dry.
  Place your thumb and index finger on each side of injection site and grasp the muscles slightly.
 Quickly push the needle into the space between your fingers, going deep in the muscle.
 Slightly pull the plunger back before injecting to be ensure that the vaccine is not injected into vein (if using
disposable syringe and needles)
 Inject the vaccine. Withdraw the needle and press the injection spot quickly with a piece of cotton.

Giving measles vaccine

 Ask the mother to hold the child firmly.

 Clean the skin with the cotton ball moistened with water and let skin dry.
 With the fingers of one hand, pinch up the skin on the outer side of the upper arm.
 Without touching the needle, push the needle into the pinched-up skin so that it is not pointing.
 Slightly pull the plunger back to make sure that the vaccine is not injected into a vein (if using disposable
syringes and needles)
 Press the plunger gently and inject

Tetanus toxoid
 Shake the vial.
 Clean the skin with the cotton ball moistened with water and let skin dry.
 Place your thumb and index finger on each side of injection site and grasp the muscles slightly.
 Slightly pull the plunger back to make sure that the vaccine is not injected into a vein (if using disposable
syringes and needles)
 Quickly push the needle into the space between your fingers, going deep in the muscle.
 Inject the vaccine. Withdraw the needle and press the injection spot quickly with a piece of cotton.

THE ROLE OF A NURSE IN IMPROVING THE DELIVERY OF IMMUNIZATION SERVICES IN THE COMMUNITY
 Health workers are vital to health care delivery system. Your presence in the community is a big community is
a big contribution to program health development. For every child you have been immunized reduces missed
opportunity and help increase population immunity of the population groups.
 As a nurse you need to:
 Actively master list infants eligible for vaccination in the community.
 Immunize infants following the recommended immunization schedule.
 Observe aseptic technique on immunization and use one syringe and one needle per child.
 Dispose used syringes and needles properly by using collector box and disposing it in the septic vault to
prevent health hazard
 Inform educate and communicate with the parents
 To create awareness/motivate to submit their children for vaccination.
 To provide health teachings on the importance and benefits of immunization.
 To inform immunization schedule as adopted by local units.
 Conduct health visits in the community to assess other health needs of the community and be able to provide
package of health services to targets.
 Identify cases of EPI target per standard case definition
 Mange vaccines properly by following the recommended storage of vaccines.
 Record the children given with vaccination in the target client list and GECD/GMC card or any standard
recording form utilized.
  Submit report and record of children vaccinated, cases and deaths on EPI diseases, vaccine received and
utilized and any other EPI related reports.
 Identify and actively search cases and deaths of EPI target diseases following standard case definition.

TOPIC B
Topic Title: Integrated Management of Childhood Illnesses (IMCI)
Topic Contents:

Definition
 IMCI is an integrated approach to child health that focuses on the well-
being of the whole child.
 IMCI strategy is the main intervention proposed to achieve a significant
reduction in the number of deaths from communicable diseases in children under
five
Goal

 By 2010, to reduce the infant and under five

mortality rate at least one third, in pursuit of the goal of reducing it by two thirds
by 2015.
Aim
 To reduce death, illness and disability, and to promote improved growth and
development among children under 5 years of age.
 IMCI includes both preventive and curative elements that are implemented by
families and communities as well as by health facilities.

IMCI Objectives
 To reduce significantly global mortality and morbidity associated with the major
causes of disease in children
 To contribute to the healthy growth & development of children

IMCI Components of Strategy

 Improving case management skills of health workers
 Improving the health systems to deliver IMCI
 Improving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
 Cough and/or fast breathing
 Lethargy/Unconsciousness
 Measles rash
 “Very sick” young infant
Possible course/ associated condition:
 Pneumonia, Severe anemia, P. falciparum malaria
 Cerebral malaria, meningitis, severe dehydration
 Pneumonia, Diarrhea, Ear infection
 Pneumonia, Meningitis, Sepsis

Five Disease Focus of IMCI:

 Acute Respiratory Infection
 Diarrhea
 Fever
 Malaria
 Measles
 Dengue Fever
 Ear Infection
 Malnutrition

The IMCI Case Management Process

 Assess and classify
 Identify appropriate treatment
 Treat/refer
 Counsel
 Follow-up

The Integrated Case Management Process

Check for General Danger Signs:
 A general danger sign is present if:
 The child is not able to drink or breastfeed
 The child vomits everything
 The child has had convulsions
 The child is lethargic or unconscious
Assess Main Symptoms
 Cough/DOB
 Diarrhea
 Fever
 Ear problems
Assess and Classify Cough of Difficulty of Breathing

 Respiratory infections can occur in any part of the respiratory tract such as the nose,
throat, larynx, trachea, air passages or lungs.
Assess and classify PNEUMONIA
 Cough or difficult breathing
 An infection of the lungs
 Both bacteria and viruses can cause pneumonia
 Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis
(generalized infection).
** A child with cough or difficult breathing is assessed for:

 How long the child has had cough or difficult breathing

 Fast breathing
 Chest indrawing
 Stridor in a calm child.

Remember:
 ** If the child is 2 months up to 12 months the child has fast breathing if
you count 50 breaths per minute or more
 ** If the child is 12 months up to 5 years the child has fast breathing if
you count 40 breaths per minute or more.
 COLOR CODING

PINK
(URGENT REFERRAL)
YELLOW
(Treatment at outpatient health GREEN
facility) (Home management)

 HOME
 Caretaker is
counseled on:
 Home
 OUTPATIENT HEALTH      OUTPATIENT HEALTH FACILITY treatment/s
FACILITY  Treat local infection  Feeding and
 Pre-referral  Give oral drugs fluids
treatments  Advise and teach  When to return
 Advise parents caretaker immediately
 Refer child   Follow-up  Follow-up

 Give first dose of

an appropriate
antibiotic
 REFERRAL FACILITY  Give Vitamin A
 Emergency  Treat the child to
Triage and prevent low
Treatment blood sugar
( ETAT)  Refer urgently to
 Diagnosis, the hospital
Treatment SEVERE PNEUMONIA OR VERY  Give
 Monitoring, SEVERE DISEASE paracetamol for
follow-up fever > 38.5oC

  Any general PNEUMONIA   Give an

danger sign or appropriate
 Chest indrawing antibiotic for 5
or days
 Stridor in calm  Soothe the
child throat and
relieve cough
with a safe
 remedy
 Advise mother
when to return
immediately
 Follow up in 2
days
 Give
Paracetamol for
fever > 38.5oC

  If coughing more

than more than
30 days, refer for
assessment
 Soothe the
throat and
relieve the cough
with a safe
remedy
 Advise mother
when to return
immediately
 Follow up in 5
NO PNEUMONIA : COUGH OR days if not
 Fast breathing COLD improving

  No signs of
pneumonia or
very severe
disease 
Assess and classify DIARRHEA
 A child with diarrhea is assessed for:
 How long the child has had diarrhoea
 Blood in the stool to determine if the child has dysentery
 Signs of dehydration.

Classify DYSENTERY
 Child with diarrhea and blood in the stool
 Two of the SEVERE  If child has no other severe
following signs? DEHYDRATIO classification:
 Abnormally N  Give fluid for severe
 dehydration ( Plan C )
OR
sleepy or  If child has another severe
difficult to classification :
awaken  Refer URGENTLY to
 Sunken eyes hospital with mother
 Not able to giving frequent sips of
drink or ORS on the way
drinking  Advise the mother to
poorly continue breastfeeding
 Skin pinch  If child is 2 years or older and there
goes back is cholera in your area, give
very slowly antibiotic for cholera

 Two of the following  Give fluid and food for some

signs : dehydration ( Plan B )
 Restless,  If child also has a severe
irritable classification :
 Sunken eyes  Refer URGENTLY to
 Drinks hospital with mother
eagerly, giving frequent sips of
thirsty ORS on the way
 Skin pinch SOME  Advise mother when to
goes back DEHYDRATIO return immediately
slowly N  Follow up in 5 days if not improving

  Not enough  Home Care

signs to  Give fluid and food to treat
classify as diarrhea at home ( Plan A )
some or NO  Advise mother when to return
severe DEHYDRATIO immediately
dehydration N  Follow up in 5 days if not improving

 Treat dehydration before referral

unless the child has another severe
SEVERE classification
  Dehydration PERSISTENT  Give Vitamin a
present DIARRHEA  Refer to hospital

 Advise the mother on feeding a

child who has persistent diarrhea
  No PERSISTENT  Give Vitamin A
dehydration DIARRHEA  Follow up in 5 days
  Treat for 5 days with an oral
antibiotic recommended for
Shigella in your area
  Blood in the  Follow up in 2 days
stool DYSENTERY  Give also referral treatment

Does the child have fever?

    **Decide:
 Malaria Risk
 No Malaria Risk
 Measles
 Dengue
Malaria Risk

 Give first dose of quinine ( under

medical supervision or if a
hospital is not accessible within
4hrs )
 Give first dose of an appropriate
antibiotic
 Treat the child to prevent low
blood sugar
 Give one dose of paracetamol in
health center for high fever
  Any general VERY SEVERE (38.5oC) or above
danger sign FEBRILE  Send a blood smear with the
or DISEASE / patient
 Stiff neck MALARIA  Refer URGENTLY to hospital

 Treat the child with an oral

  Blood antimalarial
smear ( + )  Give one dose of paracetamol in
If blood smear not done: health center for high fever
(38.5oC) or above
 NO runny  Advise mother when to return
nose, and immediately
 NO measles,  Follow up in 2 days if fever
and persists
 NO other  If fever is present everyday for
causes of more than 7 days, refer for
fever MALARIA assessment
  Give one dose of paracetamol in
health center for high fever
 Blood smear (38.5oC) or above
( – ), or  Advise mother when to return
 Runny nose, immediately
or  Follow up in 2 days if fever
 Measles, or persists
Other FEVER :  If fever is present everyday for
causes of MALARIA more than 7 days, refer for
fever UNLIKELY assessment

No Malaria Risk
 Give first dose of an appropriate
antibiotic
 Treat the child to prevent low
blood sugar
 Any general  Give one dose of paracetamol in
danger sign VERY SEVERE health center for high fever
or FEBRILE (38.5oC) or above
 Stiff neck DISEASE  Refer URGENTLY to hospital

 Give one dose of paracetamol in

health center for high fever
(38.5oC) or above
 Advise mother when to return
immediately
 Follow up in 2 days if fever
 No signs of persists
very severe  If fever is present everyday for
febrile FEVER : NO more than 7 days, refer for
disease MALARIA assessment
Measles

 Give Vitamin A
 Give first dose of an
 Clouding of appropriate antibiotic
cornea or  If clouding of the cornea or
 Deep or pus draining from the eye,
extensive SEVERE apply tetracycline eye
mouth COMPLICATED ointment
ulcers MEASLES  Refer URGENTLY to hospital
  Give Vitamin A
 If pus draining from the
 Pus draining eye, apply tetracycline eye
from the eye ointment
or MEASLES WITH EYE  If mouth ulcers, teach the
 Mouth OR MOUTH mother to treat with
ulcers COMPLICATIONS gentian violet

 Measles
now or
within the
last 3
months MEASLES  Give Vitamin A
Dengue Fever

 Bleeding from
nose or gums
or
 Bleeding in
stools or
vomitus or
 Black stools or
vomitus or
 Skin petechiae  If skin petechiae or
or Tourniquet test,are the
 Cold clammy only positive signs give
extremities or ORS
 Capillary refill  If any other signs are
more than 3 positive, give fluids rapidly
seconds or as in Plan C
 Abdominal pain  Treat the child to prevent
or low blood sugar
 Vomiting SEVERE DENGUE  DO NOT GIVE ASPIRIN
 Tourniquet test HEMORRHAGIC  Refer all children Urgently
(+) FEVER to hospital

 No signs of FEVER: DENGUE  DO NOT GIVE ASPIRIN

severe dengue HEMORRHAGIC  Give one dose of
hemorrhagic UNLIKELY paracetamol in health
fever center for high fever
(38.5oC) or above
 Follow up in 2 days if fever
persists or child shows
 signs of bleeding
 Advise mother when to
return immediately

Does the child have an ear problem?

 Give first dose of

appropriate
antibiotic
 Give
paracetamol for
 Tender swelling pain
behind the ear MASTOIDITIS  Refer URGENTLY

 Give antibiotic
for 5 days
 Give
 Pus seen draining paracetamol for
from the ear and pain
discharge is reported  Dry the ear by
for less than 14 days wicking
or ACUTE EAR  Follow up in 5
 Ear pain INFECTION days

  Pus seen draining  Dry the ear by

from the ear and wicking
discharge is reported CHRONIC EAR  Follow up in 5
for less than 14 days INFECTION days

  No ear pain and no

pus seen draining NO EAR   No additional
from the ear INFECTION treatment
Check for Malnutrition and Anemia
Give an Appropriate Antibiotic:
A. For Pneumonia, Acute ear infection or Very Severe disease
COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS

     
Adult   Tablet Syrup
Age or Weight tablet Syrup    
 2 months up to 12
months ( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml

12 months up to 5 years
( 10 – 19kg ) 1 7.5 ml 1 10 ml

B. For Dysentery
AMOXYCILLIN
COTRIMOXAZOLE BID FOR 5 DAYS
BID FOR 5 DAYS
   

      SYRUP 250MG/5ML
AGE OR WEIGHT TABLET SYRUP  

2 – 4 months

( 4  – < 6kg ) ½ 1.25 ml ( ¼ tsp )

5 ml
     

4 – 12 months
½ 2.5 ml ( ½ tsp )
( 6 – < 10 kg ) 5 ml
   

1 – 5 years old
1 ( 1 tsp )
( 10 – 19 kg ) 7.5 ml
   

C. For Cholera
TETRACYCLINE COTRIMOXAZOLE
QID FOR 3 DAYS BID FOR 3 DAYS

 AGE OR WEIGHT Capsule 250mg Tablet  Syrup

2 – 4 months ( 4  – < 6kg ) ¼ 1/2 5ml

 4 – 12 months ( 6 – < 10 kg ) ½  1 / 2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

Primaquine
 
CHOLOROQUINE Give single Primaquine Sulfadoxine +
dose in Pyrimethamine
Give for 3 days health Give daily for
center for P. 14 days for Give single
  Falciparum P. Vivax dose

TABLET TABLET TABLET

AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG)

DAY1 DAY2 DAY3

       

2months –

5months ½ ½ ½
    ¼

5 months –

12 months ½ ½ ½
    1/2

12months 1 1 ½ ½ ¼ ¾
–

3 years old
  

3 years old 
–

5 years old 1½ 1½ 1 3/4 1/2 1

GIVE VITAMIN A
 AGE  VITAMIN A CAPSULES  200,000 IU

 6 months – 12 months  1/2

 12 months – 5 years old  1

GIVE IRON
 Iron Syrup
 Iron/Folate Tablet FeSo4 150 mg/5ml
FeSo4 200mg + 250mcg (6mg elemental
 AGE or WEIGHT Folate (60mg elemental iron) iron per ml )

 2months-4months
(4 – <6kg )  2.5 ml

 4months – 12months
(6 – <10kg )  4 ml

 12months – 3 years      
(10 – <14kg)  1/2  5 ml

 3years – 5 years ( 14
–  19kg )  1/2  7.5 ml
GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN
 TABLET  SYRUP ( 120MG /
 AGE OR WEIGHT ( 500MG ) 5ML )

 2 months – 3 years        ( 4 –
<14kg )  ¼  5 ml

 3 years up to 5 years     (14 – 19
kg )  1/2  10 ml
GIVE MEBENDAZOLE
 Give 500mg Mebendazole as a single dose in health center if :
 hookworm / whipworm are a problem in children in your area, and
 the child is 2 years of age or older, and
 the child has not had a dose in the previous 6 months

TOPIC C
Topic Title: Newborn Screening
Topic Contents:

NEWBORN SCREENING
 1996 REPUBLIC ACT 9288 A public health program aimed at the early identification of infants who are
affected by certain genetic/metabolic/ infectious conditions.
 Newborn screening (NBS) is a simple procedure to find out if a baby has a congenital metabolic disorder that
may lead to mental retardation and even death if left untreated.

SIGNIFICANCE: NEWBORN SCREENING

o Most babies with metabolic disorders look normal at birth. onset of signs and symptoms irreversible.

When is newborn screening done?

o Newborn screening is ideally done on the 48th hour or at least 24 hours from birth..
o The baby must be screened again after 2 weeks for more accurate results.

Newborn screening is a simple procedure.

o Using the heel prick method, a few drops of blood are taken from the baby's heel and blotted on a
special absorbent filter card.
o The blood is air dried for 4 hours and sent to the Newborn Screening Laboratory (NBS Lab) in
Manila.
Who may collect the sample for newborn screening?
o A Trained
o physician
o nurse
o midwife or
o medical technologist

Disorder Screened Effects SCREENED Effect if SCREENED and treated TREATMENT

 CH (Congenital Hypothyroidism Severe Mental Retardation Normal HORMONES
 CAH (Congenital Adrenal Hyperplasia) Death Alive and Normal HORMONES
 GAL (Galactosemia) Death or Cataracts Alive and Normal DIET RESTRICTION
 PKU (Phenylketonuria) Severe Mental Retardation Normal DIET RESTRICTION
 G6PD Deficiency Severe Anemia, Kernicterus Normal AVOIDANCE OF TRIGGERING FACTORS The five (5)
metabolic disorders being identified by newborn screening

TOPIC D
Topic Title: BemONC/CEmONC
Topic Contents:
Basic Emergency Obstetric and Newborn Care
a. Parenteral administration of oxytocin in the third stage of labor.
b. Parenteral administration of initial dose of antibiotics.
c. Assisted vaginal delivery during imminent breech delivery.
d. Manual removal of placenta.
e. Removal of retained placental products.
f. Administration of loading dose of steroids for premature labor.
g. Intravenous fluid administration, blood volume expander and/or blood transfusion.
h. Newborn resuscitation.
i. Treatment of neonatal sepsis.
j. Oxygen support for the newborn.

Comprehensive Emergency Obstetric and Newborn Care

a. Caesarian section
b. Blood transfusion
c. Management of newborn complications

TOPIC F
Topic Title: Mental Health Global Action Program

Topic Contents:

Description

Mental health and well-being is a concern of all. Addressing concerns related to

MNS contributes to the attainment of the SDGs. Through a comprehensive mental health
program that includes a wide range of promotive, preventive, treatment and
rehabilitative services; that is for all individuals across the life course especially those at
risk of and suffering from MNS disorders; integrated in various treatment settings from
community to facility that is implemented from the national to the barangay level; and
backed with institutional support mechanisms from different government agencies and
CSOs, we hope to attain the highest possible level of health for the nation because there is
no Universal Health Care without mental health

Vision

A society that promotes the well-being of all Filipinos, supported by transformative multi-
sectoral partnerships, comprehensive mental health policies and programs, and a
responsive service delivery network

Mission
To promote over-all wellness of all Filipinos, prevent mental, psychosocial, and neurologic
disorders, substance abuse and other forms of addiction, and reduce burden of disease by
improving access to quality care and recovery in order to attain the highest possible level
of health to participate fully in society.

Objectives

1. To promote participatory governance and leadership in mental health

2. To strengthen coverage of mental health services through multi-sectoral
partnership to provide high quality service aiming at best patient experience in a
responsive service delivery network
3. To harness capacities of LGUs and organized groups to implement promotive and
preventive interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services

Program Components

1. Wellness of Daily Living

 All health/social/poverty reduction/safety and security programs and the

like are protective factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention and Control of Diseases, Family
wellness programs, etc
 School and workplace health and wellness programs

2. Extreme Life Experience

 Provision of mental health and psychosocial support (MHPSS) during

personal and community wide disasters

3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction

 Provision of services for mental, neurologic and substance use disorders at

the primary level from assessment, treatment and management to
referral; and provision of psychotropic drugs which are provided for free.
 Enhancement of mental health facilities under HFEP

Partner Institutions

NGAs ( DOLE, DSWD, DepEd, Tesda, CHED, DILG)

NGOs (WHO, PPA, PAP, PNA, PLAE, AWIT Foundation, WAPR, NGF)
Policies and Laws

DOH Administrative Order No. 8 series of 2001 The National Mental Health Policy
DOH Administrative Order No. 2016-0039 Revised Operational Framework for a
Comprehensive National Mental Health Program
Republic Act No. 11036 Mental Health Act

Strategies, Action Points and Timeline

 Governance
 Service coverage
 Advocacy
 Evidence
 Regulation

Program Accomplishments/Status

1. Passage of the Republic Act No. 11036 dataed June 20, 2018 "An Act Establishing a
National Mental Health Policy for the Purpose of Enhancing the Delivery of Integrated
Mental Health Services, Promoting and Protecting the Rights of Persons Utilizing
Psychiatric, Neurologic and Psychosocial Health Services, Appropriating Funds
Therefore and for Other Purposes"
2. DOH Administrative Oreder No. 2016-0039 dated October 28, 2016 " Revised
Operational Framework for a Comprehensive National Mental Health Program"
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation of the RA No. 11036 also
known as The Mental Health Act
6. Conduct of the Advocacy Activities such as 2nd Public Health Convention on Mental
Health, Observance of the World Health Day, World Suicide Prevention Day, National
Mental Health Week and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental Health
9. Establishment of the Medicine Access Program for Mental Health

Calendar of Activities

September 10 - World Suicide Prevention Day

October 10 -World Mental Health Day
2nd Week of Ocotber - National Mental Week

Statistics

The World Health Organization (WHO) estimates that

 a. 154 million people suffer from depression
b. million from schizophrenia
c. 877,000 people die by suicide every year
d. 50 million people suffer from epilepsy
e. 24 million from Alzheimer’s disease and other dementias
f. 15.3 million persons with drug use disorders 

In the Philippines

1. 2004 WHO study, up to 60% of people attending primary care clinics daily in the
country are estimated to have one or more MNS disorders.
2. 2000 Census of Population and Housing showed that mental illness and mental
retardation rank 3rd and 4th respectively among the types of disabilities in the country
(88/100,000    
3. Data from the Philippine General Hospital in 2014 show that epilepsy accounts for
33.44% of adult and 66.20% of pediatric neurologic out-patient visits per year.  
4. Drug use prevalence among Filipinos aged 10 to 69 years old is at 2.3%, or an
estimated 1.8 million users according to the DDB 2015 Nationwide Survey on the
Nature and Extent of Drug Abuse in the Philippines
5. 2011 WHO Global School-Based Health Survey has shown that in the Philippines, 16%
of students between 13-15 years old have ever seriously considered attempting
suicide while 13% have actually attempted suicide one or more times during the past
year.
6. The incidence of suicide in males increased from 0.23 to 3.59 per 100,000 between
1984 and 2005 while rates rose from 0.12 to 1.09 per 100,000 in females (Redaniel,
Dalida and Gunnell, 2011).
7. Intentional self-harm is the 9th leading cause of death among the 20-24 years old
(DOH, 2003).
8. A study conducted among government employees in Metro Manila revealed that 32%
out of 327 respondents have experienced a mental health problem in their lifetime
(DOH 2006).
9. Based on Global Epidemiology on Kaplan and Sadock’s Synopsis of Psychiatry, 2015
and Kaufman’s Clinical Neurology for Psychiatrists, 7th edition, 2013
A. Schizophrenia ---1% …..1 Million
B. Bipolar ---1% …. 1 Million
C. Major Depressive Disorder     ---17% …. 17 M
D. Dementia  ---    5% (of older than 65) …..
E. Epilepsy   ---0.06% …. 600,000

TOPIC F
Topic Title: OTHER RELATED PROGRAMS

Topic Contents:
The Maternal Health Program
The Philippine is tasked to reduce the maternal mortality ratio (MMR) by three quarters by 2015
to achieve its millennium development goal.

Maternal Mortality Ratio

measures the risk of dying from causes related to pregnancy, childbirth and puerperium.
it is an index of the obstetrical care needed and received by women in a community.

Millennium Development Goal

1. Eradicate Extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve Maternal Health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

“ The overall goal of the program is to improve the survival, health and well being of mothers and
unborn through a package of services for the pre pregnancy, prenatal, natal and post natal
stages”.

The Strategic Thrusts for 2005-2010 includes:

1. Launch and implement the Basic Emergency Obstetric Care (BEMOC) strategy in
coordination with the DOH.
2. Improve the quality of prenatal and post natal care
3. Reduce women’s exposure to health risks
4. LGU’s, NGOs and other stakeholders must advocate for health

Essential health services packages available in health care facilities

1. Antenatal registration
2. Tetanus Toxoid Immunization
3. Micronutrient supplementation
4. Clean and Safe Delivery

FAMILY PLANNING
Overview
The Philippine Family Planning Program is a national program that systematically provides information and services
needed by women of reproductive age to plan their families according to their own beliefs and circumstances.
Goals and Objectives
Universal access to family planning information, education and services.

Mission
To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting
their pregnancies can realize their reproductive goals.

Aims:
 Reduce infants death
 Neonatal deaths
 Under five deaths
 Maternal deaths
Strategies:
 Focus services delivery to the urban and rural poor
 Reestablish family planning outreach program
 Program and implement CSR delivery

TYPES OF METHODS
NATURAL METHODS
a. Calendar or Rhythm Method
b. Basal Body Temperature Method
c. Cervical Mucus Method
d. Sympto-Thermal Method
e. Lactational Amennorhea

ARTIFICIAL METHODS
A. Chemical Methods
1. Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant

B. Mechanical Methods
1. Male and Female Condom
2. Intrauterine Device
3. Cervical Cap/Diaphragm

C. Surgical Methods
1. Vasectomy
2. Tubal Ligation

Warning Signs
 Pills
 Abdominal pain (severe)
 Chest pain (severe)
 Headache (severe)
 Eye problems (blurred vision, flashing lights, blindness)
 Severe leg pain (calf or thigh)
 Others: depression, jaundice, breast lumps
IUD
 Period late, no symptoms of pregnancy, abnormal bleeding or spotting
 Abdominal pain during intercourse
 Infection or abnormal vaginal discharge
 Not feeling well, has fever or chills
 String is missing or has become shorter or longer

Injectables
 Dizziness
 Severe headache
 Heavy bleeding

BTL
 Fever
 Weakness
 Rapid pulse
 Persistent abdominal pain
 Vomiting
 Dizziness
 Pus or tenderness at incision site
 Amenorrhea

Vasectomy
 Fever
 Scrotal blood clots or excessive swelling

BREASTFEEDING
 Optimal maternal and child health nutrition in the ultimate concern of the Promotion of
Breastfeeding Program.

LEGAL MANDATES
RA 7600 The Rooming – In and Breastfeeding act of 1992
 o Requires both public and private health institutions to promote rooming-in and to
encourage, protect and support the practice of breastfeeding.
o This means that health facilities practicing rooming in should provide human milk
banks to ensure collection, storage, and utilization of breastmilk.
o Aims to provide an environment where the physical, emotional, and psychological
needs of mothers and infants are fulfilled through the practice of rooming-in and
breastfeeding.
o Ensures that the mother and the baby be together, as long as both are in the hospital.

3 E’S OF BREASTFEEDING
o EARLY – initiate breastfeeding within 1 hour after birth
o EXCLUSIVE – exclusive breastfeeding for the first 6 months of life, plus appropriate
complementary food at 6 months excluding milk supplements.
o EXTENDED – breastfeeding should be practiced up to 2 years and beyond.

EXCLUSIVE BREASTFEEDING – giving a baby only breastmilk and no other liquids or solids,
including water. Vitamins, mineral supplements, or medicines however are permitted.
WHY SHOULD A MOTHER BREASTFEED IMMEDIATELY?

 It increase the likelihood that she will breastfeed for a long time.
 If she delays breastfeeding for a few hours, it is more likely to fail.
 Sucking reflex is strongest right after birth; thus, it is a good time to teach the baby to
suck.
 Breastfeeding helps the uterus contracts, thus helping reduce bleeding.
 Sucking of the breast immediately after birth creates a stronger bond between mother
and baby.

UNIQUE CHARACTERISTICS OF BREASTFEEDING

Best for baby
Reduced allergic reaction
Economical
Antibodies present
Safe
Temperature is always right

Fresh
Emotional bonding between mother and child is ensured
Easily established
Digestible
Immediately available
 Nutritionally optimal
GIT problems greatly reduced.

COMPLEMENTARY FEEDING

Complementary foods – are all other food given to babies starting at the age of 6 months.
When these are introduced, breastfeeding should still continue up to 2 years or even
beyond.
Complementary foods should possess the following characteristics:

 Safe – hygienically stored and prepared with clean hands using clean utensils
 Adequate – provides sufficient energy, protein, and micronutrients that meet a
growing child’s needs.
 Timely Introduction – introduced at the time when the need for energy and
nutrients exceeds that provided by exclusive and frequent breastfeeding.
 Suitable – type of food given suits the child’s age
 Fed Properly – given consistent with the child’s hunger signals.

KEY MESSAGES ON FEEDING BABIES OVER 6 MONTHS OLD

 Breastfeeding for two years or longer helps a child to develop and grow strong and
healthy.
 Starting other foods in addition to breastmilk at the age of 6 months helps a child grow
well.
 Foods thick enough to stay in the spoon give the child more energy.
 Animal-source foods help children grow strong and lively.
 Peas, beans, lentils, nuts, and seeds are also good for children
 Dark green leaved and yellow colored fruits and vegetables help the child have healthy
eyes and fewer infections.
 A growing child needs three meals plus snacks.
 A growing child needs increasing amounts of foods.
 A growing child needs to learn to eat. The caregivers should have lots of patience in
encouraging the child to eat.
 Encourage the child to drink and eat during illness and provide extra food after illness to
help him/her recover immediately.

Reference:
1. Monina H. Gesmundo, RN RM MAN, (2010). The Basics of Community Health Nursing; A study Guide for
Nursing Students and Local Board Examinees. Philippines
2. DOH, (2008). Public Health Nursing in the Philippines. Philippines
3. Ms Ma. Adelaida Morong, Far Eastern University- Institute of Nursing
4. https://www.doh.gov.ph/integrated-management-of-childhood-illness
5. https://www.doh.gov.ph/national-mental-health-program
6. https://www.youtube.com/watch?v=_UFAAF4cZ2o
7. https://www.slideshare.net/rrrbernabe/newborn-screening-updated