Community Health in Nursing 3.

Having closely spaced (too close)

pregnancies (less than 36 months) and;
Family Planning
4. Being too ill or unhealthy/too sickly or
- Refers to a program which enables couples and having an existing disease or disorder
individuals to decides freely and responsibly the like iron deficiency (DOH, 2001)
number and spacing of their children and to
have the information - A.O. 132, s. 2004
- Have access to full range of safe, affordable, - Doh Natural Family Planning (NFP) program
effective, no abortifacient modern natural and - Recognition of modern NFP methods.
artificial methods of planning pregnancy - A.O. 2012-0009
- National strategy towards reducing unmet
Reproductive Health Program need for modern family planning as a
- Reproductive Health (RH) means to achieving MDGs
- Is a state of complete physical, mental and - Emphasized the implementation of the FP
social well-being, and not merely the program integrated and synchronized with
absence of disease or infirmity, in all other public health programs such as the
matters relating to the reproductive system MNCH and Garantisadong Pambata in the
and to its function and processes. broader context of the Kalusugan
- Based on the right of access of appropriate Pangkalahatan.
health care services
Four Pillars of the PFPP
- RH Care
- Refers to the constellation of methods, 1. Responsible parenthood
techniques, and services that contribute to - Will and ability to respond to the needs
reproductive health and well-being by and aspirations of the family.
preventing and solving reproductive health 2. Respect for Life
problems. - The 1987 Constitution protects the life of
the unborn from the moment of
- Basis: Magna Carta of Women (R.A. 9710), conception.
which was enacted in 2009 and R.A. 10354, also - Prevent abortions, thereby saving lives of
known as the responsible Parenthood and both women and children
Reproductive Health Act of 2012. 3. Birth Spacing
- Proper spacing of 3 to 5 years from a
recent pregnancy
Philippine Family Planning Program (PFPP) 4. Informed Choice
- Couple and individual are fully informed on
- National Family Planning Policy (A.O. 50-A, s. the different modern FP methods.
2001)
- Asserts that family planning as a health Client Counseling and Assessment
intervention shall be made available to all Family planning counseling is a client-centered, face-to-
men and women of reproductive age (15 to face, interactive communication process between the
44 years old) health service provider and the client that helps the
- FP is a means to prevent high-risk pregnancies latter to make free and informed choices regarding
brought about the following conditions: his/her fertility intention or plan
1. Being too young (less than 18 years old)
or too old (over 34 years old) Essential content of the nurse-client interaction
2. Having had too many (4 or more) regarding the chosen method (DOH, 2006b):
pregnancies
1. Effectiveness
2. Advantage and disadvantages
 3. Possible side effects, complications, and signs Lactational Amenorrhea Method (LAM)
that require an immediate visit to the health - Temporary contraception for new mothers
facility whose monthly bleeding has not returned;
4. How to use the chosen method requires exclusive or full breastfeeding day and
5. Prevention of sexually transmitted infection night of an infant in less than 6 months old.
6. When to return to the health facility LAM is a short-term family planning
method based on the natural effect of the
breastfeeding on the fertility. The often
Benefits of Family Planning
suppresses the release of hormones that
Benefits to Mothers are necessary for ovulation
- Enables her to regain her health after delivery
- Gives enough time and opportunity to love
Billing Ovulation Method (BOM)
and provide attention to her husband and
- A change in the amount and texture of your
children
cervical secretions (Cervical mucus) during
- Gives more time for her family and own
different times in your menstrual cycle
personal advancement
- A hormone levels rise to prepare the body for
- When suffering from an illness, gives enough
ovulation, and it will start to produce mucus
time for treatment and recovery.
that is moist, sticky, white and creamy.
Benefits to Fathers - This is the start of the fertile period of the
menstrual cycle.
- Lightens the burden and responsibility in
supporting his family
- Enables him to give his children their basic
needs (food, shelter, education, and better
future)
- Gives him time for his family and own personal
advancement
- When suffering from an illness, gives enough
time for treatment and recovery

Methods of Family Planning

- Natural Family Planning

- Methods for planning or avoiding
pregnancies by observation of the Symptothermal Method
natural signs and symptoms of the - Woman track their fertile periods by observing
fertile and infertile phase of the changes in the cervical mucus (clear, texture),
menstrual cycle body temperature (slightly increase)
- Drugs, devices and surgical procedure Basal Body Temperature (BBT)
are not used
- NFP offers the following advantages: - Woman takes her body temperature at the
 It is effective when used same time each morning before getting out of
correctly bed observing of an increase of 0.2 to 0.5
 There are no physical side degrees Celsius.
effects Standard Days Method
 It is inexpensive
- Woman identifies a 12-day fertile window
during which women with regular menstrual
 cycles (26-32 days long) should abstain from sex
or use a barrier method to prevent pregnancy.
Depo-MedroxyProgesterone Acetate (DMPA)
- Depo-Provera, is a Progestin-only preparation
injected intramuscularly every 3 months

Monthly Injectables or Combined Injectable

Contraceptives (CIC)
- Injected monthly into the muscles containing
estrogen and progesterone.

Intrauterine Device (IUD)

- This IUD is a small device that is shaped in the
(DISADVANTAGES): form of a ‘T’
- Except for SDM, the couple need training and - Your doctor places it inside the uterus to
time to use the method effectively prevent pregnancy.
- Except for SDM, methods require - It can stay in your uterus for up to 10 years.
consistent and accurate record-keeping
- Methods require a high level of Levonorgestrel Intrauterine System
diligence and motivation by the couple - The LNG IUD is a small T-shaped device like
- Require periods of abstinence from copper T IUD
intercourse, which may be difficult for - It is placed inside the uterus by a doctor. It
some couples released a small amount of progestin each day
- They offer no protection against to keep you from getting pregnant.
STIs/HIV/AIDS - The LNG IUD stays in your uterus for up to 3 to
6 years, depending on the device.

Condoms
 Artificial Family Planning Methods
- Worn by the man, a male condom keeps sperm
from getting into woman’s body. Latex
Combined Oral Contraceptive condoms, the most common type, help prevent
- Also call “the pill” combined oral contraceptives pregnancy, and HIV and other STDs, as do the
contain and the hormones estrogen and newer synthetic condoms.
progestin
- It is prescribe by a doctor  Permanent Family Planning Methods
- A pill is taken at the same time each day. If you
are older than 35 years and smoke, have Vasectomy
history of blood clots or breast cancer, your - Surgical procedure where the vas deferens is
doctor may advise you not to take the pill tied and cut or blocked through a small opening
on the scrotal skin
Progestin Only Pill

- Unlike the combines pill, the progestin-only pill Bilateral Tubal Ligation (BTL)
(sometimes called the mini-pill) only has one - It involves cutting or blocking the two fallopian
hormone, progestine, instead of both estrogen tubes; prevents conception by blocking the
and progestin. passage of the ovum through the fallopian tube.
- It is prescribed by a doctor. It is taken at the
same time each day. It may be a good option for
women who are breastfeeding
Essential Intrapartum Newborn Care Time Band: Within 1st to 3o seconds
 EINC is a simple cost-effective newborn care Immediate thorough Drying
intervention that can improve neonatal as well 1. Dry the newborn thoroughly for at least 30
as maternal care. seconds
 It is an evidence-based intervention that 2. Wipe the eyes, face, head, front and back, arms
- Emphasized a core sequence of actions, and legs
performed methodically (step-by-step) 3. Remove the wet cloth
- Is organized so that essential time bound 4. Do a quick check of breathing while drying
intervention are not interrupted
- Fills a gap for a package of bundles Notes:
interventions in a guideline format  Do not wipe off the Vernix, bathe the
newborn
The EINC Practice during Intrapartum Period  Do not do foot printing
 Continuous maternal support, by a companion  No hanging upside-down, no slapping
of her choice, during labor and delivery  No squeezing of chest
 Mobility during labor – the mother is still mobile
within reason, during this stage Time band: After 30 seconds of drying
 Position of choice during labor and delivery Early Skin-to-skin Contact
 Non-drug pain relief, before offering labor 1. Position the newborn prone on the mother’s
anesthesia. abdomen
 Spontaneous pushing in a semi-upright position 2. Cover the newborn’s back with dry blanket
 Episiotomy will not be done, unless necessary 3. Cover the newborn’s head with bonnet
 Monitoring the progress of labor with the use of 4. Place identification band on ankle
pantograph
Time band: 1-3 minutes
Four Core Steps of Newborn Care Properly-Timed Cord Clamping
1. Immediate and thorough drying of the newborn 1. Remove the first set of gloves
2. Early skin-to-skin contact between mother and 2. After the umbilical pulsations stopped, clamped
the newborn the cord at 2 cm. from the umbilical base, clamp
3. Properly-timed cord clamping and cutting again at 5 cm from the base
4. Unang Yakap (First embrace) of the mother and 3. Cut the cord close to the plastic clamp
her newborn for early breastfeeding initiation
Time band: Within 90 minutes
Unang Yakap (First Embrace) Non-separation of Newborn from Mother Early
Time Band: At perineal bulging, with presenting part Breastfeeding
visible 1. Leave the newborn in skin-to-skin contact
2. Observe for feeding cues (opening of the
Prepare for the Delivery: mouth, tonguing, licking, rooting)
1. Check temperature of the delivery room (25- 3. Encourage the mother to nudge the newborn
28oC) towards the breast
2. Notify appropriate staff 4. Counsel on attachment and sucking
3. Arrange needed supplies in linear sequence a) Mouth wide open, lower lip turned
4. Check resuscitation equipment outwards
5. Double gloves just before delivery b) Baby’s chin touching breast
c) If the attachment or suckling is not
good, try again and reassess
d) Weighing, bathing, eye care,
examinations, injections (Hepatitis B,
 BCG, Vit.K) should be done after the elimination campaign starting 1997 (office of
first full breastfeed is completed. the President, 1997)
e) Postpone washing until 6 hours 5. To control diphtheria, pertussis, hepatitis B and
German measles.
Take Anthropometric Measurements: 6. To prevent extra pulmonary tuberculosis among
 Length – 47 cm to 54 cm children
 Head circumference – 33 to 35cm
 Chest circumference – 31 to 33cm Six vaccine preventable diseases
 Abdominal circumference – 31 to 33 cm  Tuberculosis
 Weight – 3000 grams to 4000 grams  Poliomyelitis
 Diphtheria
Reminder:  Tetanus
 Health worker should not tap the Newborn  Pertussis
unless there is a medical indication,  Measles
 Do not give sugar water, formula or other
prelacteals Immunization Schedule
 Do not give bottles or pacifiers
 Do not throw away colostrum Antigen Age Dose Rout Site
e
National Immunization Program (NIP) BCG At 0.05m ID Right
 EPI was established in 1976 to ensure that vaccine birth l deltoid
infants/children and mothers have access to region (arm)
routinely recommend infant/childhood vaccines
Hepatitis B At 0.5 ml IM Anterolater
vaccine birth al thigh
 Reducing the morbidity and mortality among
muscle
children against the most common vaccine
preventable disease DPT-HepB- 6 wks, 0.74m IM Anterolater
Hib 20 l al thigh
 Supporting Legistation: (Pentavalen wks, muscle
- R.A. 10152, also known as Mandatory t vaccine) 14 wks
Infants and Children Health Immunization
Act of 2011 Anti- 9-11 0.5ml SQ Outer part
- R.A. 7846, provided for Compulsory measles month of upper
immunization against hepatitis B for vaccine s arm
infants and children below 8 years old (AMV1)

Measles- 12-15 0.5 ml SQ Outer part

Specific Goals of NIP/EPI
mumps- month of upper
1. To immunize all infants/children against the
rubella s arm
most common vaccine-preventable disease
vaccine
2. To sustain the polio-free status of the (AMV2)
Philippines
3. To eliminate measles infection, Presidential Rotavirus 6 wks, 1.5ml Oral Mouth
Proclamation No. 4, s. 1998 launched the vaccine 10 wks
Philippines Measles Elimination Campaign
(office of the President, 1998) Target Setting and Vaccine Requirements
4. To eliminate maternal and neonatal tetanus.  Vaccine requirement is calculated based on
Presidential Proclamation No. 1066. S. 1997 target population size.
declared a national neonatal tetanus
  The nurse uses the following formulas to Side Effects and Adverse Reaction of Immunization
estimate target population size: Vaccines Side effects Management
- Estimated number of infants = total Koch’s No
population x 2.7% phenomenon: management is
- Estimated number of 12-59 months-old BCG an acute needed
children = total population x 10.8% inflammatory
- Estimated number of pregnant woman = reaction within
2-4 days after
total population x 3.5%
vaccination;
usually
Maintaining the potency of EPI vaccines
indicates
To be potent, vaccines must be properly stored, handles previous
and transported exposure to
1. Maintain the cold chain tuberculosis
- The cold chain is a system for ensuring the Refer to the
potency of a vaccine from the time of Deep abscess at physician for
manufacture to the time it is given to an vaccination site incision and
eligible client. drainage
- In RHU, PHN is the Cold Chain Officer
2. Observe the first expiry-first out (FEFO) policy Hepatitis B Local soreness No treatment
3. Comply with recommended duration of storage vaccine at the injection necessary
and transport site
Reassure
4. Take note if the vaccine container has a vaccine
mother that
vial monitor (VVM) and act accordingly
soreness will
- The VVM is a round disc of a heart-sensitive disappear after
material placed on a vaccine vial to register 3-4 days
cumulative heat exposure
DPT-HepB-Hib Abscess after a Incision and
(Pentavalent week or more drainage may
vaccine) usually be necessary
indicates that
the injection
was not deep
enough or the
needle was not
sterile

Convulsion; Proper
although very management of
rare, may occur convulsion;
in children older pertussis
than 3 months; vaccine should
5. Abide by the open-vial policy of the DOH caused by not be given
6. Reconstitute freeze-dried vaccines ONLY with pertussis anymore
the diluents supplied with them vaccine
7. Discard reconstituted freeze-dried vaccines six
hours after reconstitution or at the end of the OPV None Reassure the
immunization session, whichever comes sooner Anti-measles Fever 5-7 days mother and
8. Protect BCG vaccine from sunlight vaccine after instruct her to
vaccination in give antipyretic
some children. to the child
Sometimes,
 there is a mild - BCG to a child who has signs and symptoms
rash of AIDS or other immune deficiency
conditions or who are immunosuppressed
MMR Local soreness, Reassure the (DOH, 2003a)
fever, mother and
irritability, and instruct her to EPI Recording and Reporting
malaise in some give antipyretic Accomplished using the field health service
children to a child
Information System (FHSIS)
1. Fully Immunized Children (FIC)
Rotavirus Some children Reassure the
a) BCG
vaccine develop mild mother and
vomiting and instruct her to b) 3 doses of OPV
diarrhea, fever give antipyretic c) 3 doses of DPT
and irritability and Oresol to d) Hepatitis B vaccine or 3 doses of
the child pentavalent vaccine
e) One dose of anti-measles vaccine
Tetanus toxoid Local soreness Apply cold before reaching one year of age
at the injection compress at the 2. Completely Immunized Children
site site. No other - Completed their immunization schedule at
treatment is the age of 12 to 23 months
needed. 3. Child protected at birth (CPAB)
- Is a term used to describe a child whose
Cold Chain requirements mother has received
 OPV stored in freezer at the temperature of (- a) 2 doses of tetanus toxoid during this
15oC to -25oC) pregnancy, provided that the second
 All other vaccines, including measles vaccine, dose was given at least a month prior
MMR have to store in the refrigerator at a to delivery, OR
temperature of (+2oC to+8oC) b) At least 3 doses of tetanus toxoid any
 Keep diluents cold by storing them in the time prior to pregnancy with this child
refrigerator in the lower or door shelves
Important Consideration Related to the Administration
Contraindication to Immunization of Vaccines
 In general, there are no contraindications to  Use only one sterile syringe and needle per
immunization of a sick child if the child is well client
enough to go home  There is no need to restart a vaccination series
 Absolute contraindication –DO NOT GIVE: regardless of the time and has elapsed between
- Pentavalent vaccine/DPT to doses
 Children over 5 years of age  All EPI antigens are safe and effective when
 A child with recurrent convulsions or administered simultaneously, that is, during the
another active neurological disease same immunization session but different sites
of the central nervous system  Only monovalent hepatitis B vaccine must be
 Pentavalent vaccine 2 or 3.DPT 2 or used for the birth dose
DPT 3 to a child who has had  Children who have not received AMV1 as
convulsion or shock within 3 days of scheduled and children whose parents of
the most recent dose caregivers do not know whether they have
- Rotavirus vaccine when the child has a received AMV1 shall be given AMV1 as soon as
history of hypersensitivity to a previous possible, then AMV2 one month after AMV1.
dose of the vaccine, intussusceptions or  All children entering day care centers/
intestinal malformation, or acute preschool and Grade 1 shall be screened for
gastroenteritis (DOH, 2012B) measles immunization
Universal Health Care Law UHC Three Thrusts
Sa UHC
Financial Risk Protection
 Lahat makikinabang
- Protection from the financial impacts of health
 Lahat protektado
care is attained by making any Filipino eligible
 Lahat naaalagaan
to enroll, to know their entitlements and
 Lahat konektado
responsibilities, to avail of health services, and
 Lahat kasama
to be reimbursed by PhilHealth with regard to
health care expenditures.
Sa UHC, lahat konektado!
Improved Access to Quality Hospitals and Health Care
“Lahat tayo ay magiging parte ng isang sistemang Facilities
pangkalusugan na konektado, komprehensibo at mas
- Improved access to quality hospitals and health
madaling sundan”
facilities shall be achieved in a number of
creative approaches. First, the quality of
government-owned and operated hospitals and
February 2019, President Rodrigo Duterte signed the health facilities is to be upgraded to
Universal Health Care Bill into law, ushering in massive accommodate larger capacity, to attend to all
reforms in the Philippine health sector. types of emergencies, and to handle non-
Salient features of the UHC Law are the expansion of communicable diseases. The Health Facility
population, service, and financial coverage through an Enhancement (HFEP) shall provide funds to
array of health system amendments. improve facility preparedness for trauma and
other emergencies.
With UHC, all Filipinos are guaranteed equitable access
to quality and affordable health care goods and Attainment of Health-Related MDG’s
services, and protected against financial risk. - The public health programs is to reduce
The UHC helps ensure every Filipino is healthy, maternal and child mortality, morbidity and
protected from health hazards and risks, and has access mortality from Tuberculosis and Malaria, and
to affordable, quality and readily available health incidence of HIV/AIDS. Localities shall be
service that is suitable to their needs. prepared for the emerging disease trends as
well as the prevention and control on non-
communicable diseases.
Universal Health Care and Its Aim What are the benefits of Universal Health Care
 Universal Health Care (UHC), also referred to as (UHC)?
Kalusugan Pangkalahatan (KP), is the “provision  All Filipinos automatically covered by PhilHealth
to every Filipino of the highest possible quality  Access to quality primary health services
of health care that is accessible, efficient,  Increase in the number of public health workers
equitably distributed, adequately funded, fairly
financed, and appropriately used by an
informed and empowered public”. Major Provisions of the UHC Law
 It is a government mandate aiming to ensure Leadership and Governance
that every Filipino shall receive affordable and
quality health benefits, this involves providing  The Philippine health system is highly devolved,
adequate resources – health human resources, with significant responsibilities held by the
health facilities and health financing country’s 1, 488 municipalities
 Relationships between the DOH and municipal,
city and provincial governments complicate
policy implementation
  PhilHealth’s role has grown organically as it  Lack of interoperable mechanisms to bring
purchases a disparate set of benefit packages together multiple information systems lead to
from a variety of public and private agencies inefficiencies and restrict data consolidation
 PhilHealth Membership, Benefits and
1. ALL Filipinos are covered
Financing
- Every single Filipino citizen is automatically
 PhilHealth membership is a currently achieved
enrolled into the newly created National
through a variety of subsidized and contributory
Health Insurance Program (NHIP)
schemes
 PhilHealth reportedly covers 92% of the
The program classified membership into two types:
population, but a significant proportion of its
members are unaware of or are unable to a. Direct contributors - those who pay PhilHealth
access their benefits premiums, are employed and bound by an
 Under the UHC Law, all citizens are "employer-employee relationship," self-earning,
automatically entitled to PhilHealth benefits, professional practitioners, and migrant workers.
including comprehensive outpatient services Members’ qualified dependents and lifetime
 Philhealth will be responsible for purchasing all members are also included.
individual-based services, including supplies, b. Indirect contributors - those not considered as
medicines, and commodities as well as direct contributors, along with their qualified
maintenance and operating expense of health dependents, whose health premiums are
facilities subsidized by the government

Services Delivery Structure

2. It is NOT COMPLETELY FREE
 The delivery of public PHC services is currently
 Contrary to what some people may think, UHC
controlled at the barangay and municipality
does not mean every single health expense will
level. Patients struggle to access a continuum of
be made free. The law outlines that basic
care across administrative boundaries
services accommodations will be covered by
 To address the fragmentation of service delivery
Philhealth. As a patient, that means that if
and move towards providing comprehensive
you’re admitted in a hospital you can expect
and integrated care, providers are encouraged
regular meals, a bed in a shared room with fan
to form province and city-wide HCPN’s
ventilation and a shared toilet and bath to be
 These networks can be composed of public,
covered.
private or a mixed set of providers that will
 Also are also entitled to an “essential health
deliver primary, secondary and tertiary services
benefit package,” which includes primary care,
Access to Medical Products medicines, diagnostic, and laboratory tests. It
also includes preventive, curative, and
 The UHC Law mandates the establishment of a rehabilitative services. It will no longer be free
Health technology Assessment (HTA) Council to when one wants to stay in a hospital room
guide pharmaceutical procurement which will offering private accommodation, air
ensure that the most cost effective and conditioning, telephone, television, and meal
affordable medicines, supplies, and choices, among others.
commodities will be purchased by the
government 3. Philhealth will become the “National
Purchaser” of Health Goods and Services
Health Information System
 This means that Philhealth will be in a charge of
 Health information systems have been paying health care providers like hospitals and
challenged by lack of structural and technical clinics for services given to Filipinos.
capacities, duplication of efforts and  This is already a job Philhealth carries out but
unconsolidated and incomplete data the universal health care law wants to pool
 more funds so it can cover all Filipinos and 7. A “Health Technology and Assessment Council”
eventually more services. (HTAC) will be created

Funds for Philhealth will be sourced from the following:  Another important feature of the law is the
creation of the HTAC – a group of health experts
-Philippine Amusement and Gaming Corporation – 50%
who will be responsible for evaluating latest
of national government’s share
health developments and recommending their
-Philippine Charity Sweepstakes Office (PCSO) – 40% of
use to DOH and Philhealth.
its charity fund, net of document stamp tax
payments, and mandatory PCSO contributions 8. Health Information will be collected
-Premium contributions direct contributory members
 Both public and private hospitals and health
-Philhealth annual budget
insurers will be required to maintain a health
information system that will contain electronic
4. DOH will still be in charge of “population-based”
health records, prescription logs, and “human
health services
resource information.”
 While Philhealth, along with other private
Conclusion
health insurance companies, is expected to
cover services for individuals, the DOH is still in - The Philippine UHC Law addresses the inequities
charge of delivering health services that cover faced by the country’s health system because of
entire populations fragmented service delivery and inefficient
 Think of these as programs for disease financing systems. The government and its
surveillance, health promotion campaigns, and stakeholders continue to work towards a
mass immunization campaigns. The DOH will do responsive health system that delivers quality care
this by contracting public health care providers without the risk of financial burden to its citizens.
in cities and provinces.

5. Health Systems will become city-wide and Uhc Law Addresses Health System Challenges
province-wide
1. guaranteeing access to appropriate health
 Provinces and highly urbanized cities will now services for all Filipinos through functional
be in charge of overseeing health services in HCPNs
areas as opposed to the current set-up where 2. ensuring strategic and adequate financing and
municipalities are tasked with managing their purchasing services
own health centers. 3. engaging local governments to effectively
 The DOH will need to work with the manage local health systems
Department of the Interior and local 4. building capacity in terms of qualified
Government (DILG) to have province and city-
wide health systems or networks in about two Primary Health Care
years after the law takes affect.
 Primary Health Care (PHC) is the foundation of the
6. Return Service in the Public Health Sector healthcare system. It is often the first point of
contact people have with a health care provider
 They will be paid by and under the supervision
when they have a health concern.
of the DOH. Those who serve for an extra two
 That contact may involve a visit to a family
years will also be given incentives, which will be
physician or nurse practitioner, advice from a
determined by the DOH.
pharmacist, or information on chronic disease
 Meanwhile, graduates of health courses in state
management.
universities and colleges and private schools are
 A strong primary health care system provides
encouraged to work in the public sector
access to high quality care delivered by a team of
health professionals that meets the needs of
 patient and their families of all ages in any health Goal #1: No Poverty
care setting.  Poverty may cause disability through
malnutrition, poor healthcare and dangerous
Characteristics of PHC living conditions

 Patient/family centeredness, self-reliance and

Goal #2: Zero Hunger
participation
 End hunger, achieve food and security and
 Community engagement and participation
improved nutrition and promote sustainable
 Health workers collaborating in interdisciplinary
agriculture
teams
 Proactive prevention focus
Goal #3: Good Health and Well-being
 Integration and coordination of services
 Ensure healthy lives and promote well-being for
 Accessibility all at all ages
 Better management of chronic conditions
 Localized set of choices Goal #4: Quality Education
 Sustainability  Ensure inclusive and equitable quality education
 Multi-sector alignment and involvement and promote lifelong learning opportunities for
all
WHO Core Functions

Objective: The attainment by all people of the highest Goal #5: Gender Equality
possible level of health (WHO, 2006)  Achieve gender equality and empower all
women and girls
1. Provide leadership and engage in partnerships
on matters of health Goal #6: Clean water and Sanitation
2. Shape research agenda and promote knowledge  Ensure availability and sustainable management
Five (5) goals: of water and sanitation for all
Capacity, Priorities, Standards, Translations and
Organization Goal #7: Affordable and Clean Energy
3. Set and monitor standards  Ensure access to affordable, reliable,
4. Provide technical support, catalyze change and sustainable and modern energy for all
build sustainable capacity
Goal #8: Decent Work and Economic Growth
Millennium Development Goals  Promote sustained, inclusive and sustainable
economic growth, full and productive
 Resulted from millennium summit – September employment and decent work for all
6-8, 2000. Collective responsibility to uphold
the principles of human dignity, equality and Goal #9: Industry, Innovation, and Infrastructure
equity aat the global level  Build resilient infrastructure, promote
 Reduces extreme poverty and achieve seven  inclusive and sustainable industrialization and
other targets by 2015. In September 2015, the foster innovation
General Assembly adopted the 2030 Agenda for
Sustainable Development that includes 17 Goal #10: Reduce Inequalities
Sustainable Development Goals (SDG’s).  Reduce inequality within and among countries
building on the principle of “leaving no one
behind”, the new Agenda emphasize a holistic Goal #11: sustainable Cities and Communities
approach to achieving sustainable development  Make cities and human settlements inclusive,
for all. safe, resilient and sustainable
 DOH Roles and Functions (as mandated by EO 102)
Goal #12: Responsible Consumption and Production
 Leadership in health. Serves as national policy
 Ensure sustainable consumption and production
maker
patterns
 Enabler and capacity builder. Innovate new
strategies in health to improve effectiveness of
Goal #13: Climate Action
health programs
 Take urgent action to combat climate change
 Administrator of specific services. Manages
and its impacts
selected national health facilities and hospitals
with modern and advanced facilities that serves
Goal #14: Life Below Water
as national referral centers
 Conserve and sustainably use the oceans, seas
and marine resources for sustainable
Seven (7) Elements of Primary Health Care
development
1. Health education regarding disease prevention
Goal #15: Life on Land and cure
 Protect, restore and promote sustainable use of 2. Proper food supply and nutrition
terrestrial ecosystems, sustainably manage 3. Adequate supply of safe drinking water and
forests, combat, desertification and halt and sanitation maternal and child healthcare
reverse land degradation and halt biodiversity 4. Immunizations
loss 5. Control of endemic diseases
6. Provision of essential drugs
Goal #16: Peace, Justice and Strong Institutions 7. Primary health care system should provide the
 Promote peaceful and inclusive socities for entire population
sustainable development, provide access to  Relevant
justice for all and build effective, accountable  Acceptable
and inclusive institutions at all levels  Affordable
 Effective services
Goal #17: Partnerships for the Goals
 Strengthen the means of implementation and Comprehensive services that provide for primary,
revitalize the global partnership for sustainable secondary, and tertiary care and prevention
development
Active community involvement in the planning and
delivery of services
Department of Health (DOH)
Integration of health services with development
 National agency mandated to lead the health activities to ensure that complete nutritional,
sector towards assuring quality health care for educational, occupational, environmental and safe
all Filipinos housing needs are met
 Vision: To be global leader for attaining better
History of PHC
health outcomes, competitive and responsive
healthcare system and equitable health Alma Ata Conference of September 6-12, 1978
financing Alma Ata Declarations of PHC
 Mission: To guarantee equitable, sustainable - Health as basic fundamental right
and quality health for all Filipinos, especially the - Global burden of health inequalities
poor, and to lead the quest for excellence in - Economic and social development
health - Government responsibility
LOI 949, PHC adopted in the Philippines

Health, defined by the WHO

In the PHC declaration, the WHO defined health as “a
state of complete physical, mental and social well-
being, and not merely the absence of the disease or
infirmity”

PHC defined
Alma Ata Declaration: PHC “is essential health care
based on practical, scientifically sound and socially
acceptable methods and technology made
UNIVERSALITY ACCESSIBLE TO INDIVIDUALS AND
FAMILIES IN THE COMMUNITY through their full
participation and at a cost that the community and September 6-12 1978, WHO & UNICEF sponsored the
country can afford to maintain at every stage of their PHC in Alma Ata, Russia (Alma Ata Conference AACD)
development in the spirit of self-reliance and self-
determination.” Goal, Health for ALL for the the year 2000 & beyond to
develop self-resilience
HEALTH FOR ALL: Universal Goal of PHC
1993, DOH: Health for ALL Filipinos by Juan Flavier
 Health for all means an acceptable level of
health for all the people of the world through October 19, 1979, LOI 949 signed by Pres. Marcos
community and individua self-reliance. This adopting PHC in the Philippines
policy agenda of “health for all by the year
2000, technically was a global strategy
employed in achieving three main objectives: Four Cornerstones/Pillars of Primary Health Care

1. Community participation
2. Inter/Intrasectoral cooperation and linkages
1. Promotion of healthy lifestyles
3. Use of appropriate technology
2. Prevention of diseases, and
3. Therapy for existing conditions 4. Support system

Key Principles of PHC Ten Herbal Plants Approved By The Doh

 Use of plants or derivatives from plants for the
 Accessibility, affordability, acceptability and treatment of specific conditions
availability  One of the considered as one of the most
 Support mechanisms popular modalities od complementary medicine
 Multisectoral approach
 Community participation
 Equitable distribution of health resources Tips On Handling Medicinal Plants/Herbs
 Appropriately technology  Buy herbs that are grown organically- without
pesticides
 Medicinal parts of plants are best harvested on
sunny mornings. Avoid picking leaves, fruits, or
nuts during and after heavy rainfall
 Leaves, fruits, flowers or nuts must be mature
before harvesting. Less medicinal substances
are found on young parts
 As a rule of thumb, when boiling leaves and
other plant parts, do not cover the pot, and boil
in low flame
 Deceptions loose potency after some time.
Dispose of decoctions after one day. To keep
 fresh during the day keep lukewarm in a flask or
thermos
 Always consult with a doctor if symptoms
persist or if any sign of allergic reaction develop

DECOCTION
 Boiled recommended part of the plant in water TINCTURE
 Recommended boiling time is 20 minutes
 Mix the plant material in alcohol

INFUSION
 Plant material is soaked in hot water, much like
making a tea
 Recommended period of soaking is 10-15 SANTA LUBBY (from net yung naka bullet)
minutes  Sambong
 Akapulko
 Niyog-niyogan
 Tsaang gubat
 Ampalaya
NASTY BULBA

LAGUNDI
BLANCHING  Uses and Preparation:
 Blanching is a cooking process in which a food,  Asthma, cough, and fever- Decoction (boil
usually a vegetable or fruit, is scalded in boiling raw fruits or leaves in 2 glasses of water for
eater, removed after a brief, timed interval, and 15 minutes) Dysentery
finally plunged into iced water or placed under  Cold and Pain- Decoction (Boil a handful of
cold running water to halt the cooking process leaves and flowers in water to produce a
glass, three times a day)
 Skin diseases (dermatitis, scabies, ulcer,
eczema)- Wash and clean the skin wound
with the decoction
 Headache- Crush leaves may be applied on
the forehead
POULTICE  Rheumatism, sprain, contusions, insect bites-
 Directly apply recommended plant material on Pound the leaves and apply on affected area
the part affected, usually used on bruises,
wounds or rashes
ULASIMANG BATO YERBA BUENA
 Uses and Preparation:
 Indications: Infusion, decoction or salad for  Uses and Preparations:
gout and rheumatic pains; pounded plant  For muscle pain, arthritis, rheumatism,
warm poultice for boils and abscesses cough, colds, nausea, dizziness
 Lowers uric acid (rheumatism and gout)- One  Crush the fresh leaves and squeeze sap.
and a half cup leaves are boiled in two glass Massage sap on painful part
of water over low fire. Do not cover pot  Pain (headache, stomachache)- Boil chopped
 Divide into 3 parts and drink one part 3 times leaves in 2 glasses of water for 15 minutes.
a day Divide decoction into 2 parts, drink one part
every 3 hours
 Rheumatism, arthritis and headache- Crush
the fresh leaves and squeeze sap. Massage
sap on painful parts with eucalyptus
 Cough and Cold- Soak 10 fresh leaves in a
GUAVA glass of hot water, drink as tea (expectorant)
 Uses and Preparation:  Menstrual and Gas pain- Soak a handful of
 Indications: Antidiarrheal and antiseptic leaves in a glass of boiling water. Drink
 For washing wounds- May be used twice a infusion
day  Insect bites- Crush leaves and apply juice on
 Diarrhea- May be taken 3-4 times a day affected area or pound leaves until like a
 As gargle and for toothache- Warm paste, rub on affected area
decoction is used for gargle. Freshly pounded  Pruritus- Boil plant alone or with eucalyptus
leaves are used for toothache. in water. Use decoction as a wash on
 Boil chopped leaves for 15 minutes at low affected area
fire. Do not cover and then let it cool and
strain

SAMBONG

BAWANG (ALIUM SATIVUM L.)  Uses and Preparation:

 Indications: Fresh cloves, capsules for lowering  Indications: Diuretics in hypertension;
blood cholesterol levels antiseptic dissolves kidney stones
 Uses and Preparations:  Anti-edema, diuretic, anti-urolithiasis- Boil
 Hypertension- May be fried, roasted, soaked chopped leaves in a glass of water for 15
in vinegar for 30 minutes, or blanched in minutes until one glassful remains. Ivied
boiled water for 15 minutes decoction into 3 parts, drink one part 3 times
 Take 2 pieces, 3 times a day after meals a day
 Toothache- Pound a small piece and apply to  Diarrhea- Chopped leaves and boil in a glass
affected area of water for 15 minutes. Drink one part every
3 hours
 AMPALAYA (MOMORDICA CHARANTIA (L.DC)
 Uses and Preparation:
AKAPULKO  Diabetes Mellitus (Mild non-insulin
 Uses and Preparations: dependent)- Chopped leaves then boil in a
 Anti-fungal (tinea flava, ringworm, athlete’s glass of water for 15 minutes. Do not cover.
foot and scabies)- Fresh, matured leaves are Cool and strain. Take 1/3 cup 3 times a day
pounded. Apply soap to the affected area 1-2 after meals
times a day

REMINDERS ON THE USE OF HERBAL MEDICINE

1. Avoid the use of insecticide as these may leave
NIYOG-NIYOGAN
 Uses and Preparation: poison on plants
 Anti-helmintic- The seeds are taken 2 hours 2. In the preparation of herbal medicine, use a clay
after supper. If no worms are expelled, the pot and remove cover while boiling at low heat
dose may be repeated after one week. 3. Use only part of the plant being advocated
(Caution: Not to be given to children below 4 4. Follow accurate dose of suggested preparation
years old) 5. Use only one kind of herbal plant for each type
of symptoms or sickness.
6. Stop giving the herbal medication in case
untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to
3 doses of herbal medication, consult a doctor.
ANTI-HELMINTIC
Bag Technique
 Uses and Preparations:
- A tool making use of public health bag through
 The seeds are taken 2 hours after supper. If
which the nurse, during his/her home visit, can
no worms are expelled, the dose may be
perform nursing procedures with ease and
repeated after one week. (Caution: Not to
deftness, saving time and effort with the end in
be given to children below 4 years old)
view of rendering effective nursing care
Public Health Bag
TSAANG GUBAT - Is an essential and indispensable equipment of
the public health nurse which he/she has to
 Uses and Preparations: carry along when he/she goes out home
 Diarrhea- Boild chopped leaves into 2 glasses visiting. It contains basic medications and
of water for 15 minutes. Divide decoction articles which are necessary for giving care.
into 4 parts. Drink 1 part every 3 hours - Rationale: To render effective nursing care to
 Stomachache- Boil chopped leaves in 1 glass clients and/or members of the family during
of water for 15 minutes. Cool and strain home visit

Principles

1. The use of the bag technique should minimize if

not totally prevent the spread of infection
from individuals to families, hence to the
community.
 2. Bag technique should save time and effort on  2 pairs of forceps (curved and straight)
the part of the nurse in the performance of  Syringes (5ml and 2ml)
nursing procedures  Hypodermic needles g. 19, 22, 23, 25
3. Bag technique should not overshadow concern  Sterile dressings (OS, C.B)
for the patient rather should show the  Sterile cord tie
effectiveness of total care given to an individual  Adhesive plaster
or family  Dressing (OS, cotton ball)
4. Bag technique can be performed in a variety of  Alcohol lamp
ways depending upon agency policies, actual  Tape measure
home situation etc. as long as principles of  Baby’s scale
avoiding transfer of infection is carried out  1 pair of rubber gloves
 2 test tubes
Special considerations in the Use of the Bag  Test tube holder
 Medicines:
1. The bag should contain all necessary articles,
- Betadine
supplies and equipment which may be used to
- 70% alcohol ophthalmic ointment (antibiotic)
answer emergency needs
- Zephiran solution
2. The bag and its contents should be cleaned as
- Hydrogen peroxide
often as possible, supplies replaced and ready
- Spirit of ammonia
for use at any time
- Acetic acid
3. The bag and its contents should be well
- Benedict’s solution
protected from contact with any article in the
NOTE!! Blood pressure and apparatus and stethoscope
home of the patients. Consider the bag and its
are carried separately
contents clean and/or sterile while any article
belonging to the patient as dirty and
contaminated.
Steps and Procedures
4. The arrangement of the contents of the bag
should be the one most convenient to the user Actions Rationale
to facilitate the efficiency and avoid confusion 1. Upon arriving at - To protect the
5. Hand washing is done as frequently as the the client’s bag rom
situation calls for, helps in minimizing or home, place the contamination
avoiding contamination of the bags and its bag on the table
contents or any flat
6. The bag when used for a communicable case surface lined
should be thoroughly cleaned and disinfected with paper lining,
clean side out
before keeping and re-using
(folded part
touching the
table). Put the
bag’s handles or
Contents of the Bag strap beneath
the bag
 Paper lining
2. Ask for a basin of - To be used for
 Extra paper for making bag for waste materials water and a glass handwashing.
(paper bag) of water if faucet To protect the
 Plastic linen/lining is not available. work field from
 Apron Place these being wet
 Hand towel in plastic bag outside the work
 Soap in soap dish area
 Thermometers in case (one oral and rectal) 3. Open the bag, - To make a non-
 2 pairs of scissors (1 surgical and 1 bandage) take the contaminated
 linen/plastic work field or hygiene and
lining and spread area hasten
over work field recovery
or area. The 10. Proceed to the - To prevent
paper lining, specific nursing contamination
clean side out care or of bag and
(folded part out) treatment contents
4. Take out hand - To prepare for 11. After completing - To protect
towel, soap dish handwashing nursing care of caregiver and
and apron and treatment, clean prevent spread
place them at and alcoholize of infection to
one corner of the the things used others
work area (within 12. Do handwashing
the confines of again
the linen/plastic 13. Open the bag
lining and put back all
5. Do handwashing. - Handwashing articles in their
Wipe dry with prevents proper places
towel. Leave the possible 14. Remove apron
plastic wrappers infection from folding away,
of the towel in a one care from the body
soap in the bag provider to the with soiled side
client folded inwards,
6. Put on apron - To protect the and the clean
right side out and nurse’s side out. Place it
wrong side with uniform. in the bag
crease touching Keeping the 15. Fold the
the body, sliding crease creates linen/plastic
the head into the aesthetic lining, clean;
neck strap. appearance place it in the
Neatly tie the bag and close the
straps at the bag
back 16. Make post-visit - To be used as
7. Put out things - To make them conference on reference for
most needed for readily matters relevant future visit
the specific case accessible to health care,
(e.g. taking anectodal
thermometer, notes
kidney basin, preparatory to
cotton ball, final reporting
waste paper bag) 17. Make - For follow-up
and place at one appointment for care
corner of the the next visit
work area (either home or
8. Place waste - To prevent clinic), taking
paper bag contamination note of the date,
outside of work of clean area time, and
area purpose
9. Close the bag - To give After care
comfort and
security, 1. Before keeping all articles in the bag, clean and
maintain alcoholize them
personal
 2. Get the bag from the table, fold the paper lining  lack of diagnostics tools
and insert and place in between the flaps and  providers rely on patient history, signs and
cover the bag symptoms for diagnosis
 need to refer to a higher level of care for serious
illnesses
Evaluation and Documentation

3. Record all relevant findings about the client and Who can use IMCI?
members of the family
The IMCI process can be used by all doctors, nurses and
4. Take note of environmental factors which affect
other health professionals who see young infants and
the client/family health
children less than five years old
5. Include quality of nurse-patient relationship
6. Assess effectiveness of nursing care provided It is a case management process for a first-level facility,
such as a clinic, health center or an outpatient
department of a hospital.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS
(IMCI)

 Integrated Management of Childhood Illness (IMCI) Objectives of IMCI:

is an integrated approach to child health that
focuses on the holistic well-being of the child.  reduce death, frequency and severity of illness and
disability
 IMCI aims to reduce death, illness and disability,
and to promote improved growth and  to contribute to healthy growth and development
development among children under five years of of children.
age.
Principles Of The IMCI Management Guidelines
 IMCI includes both preventive and curative
elements that are implemented by families and
communities as well as by health facilities.
 IMCI targets the presenting complaints of children  All sick children aged up to 5 years are examined for
under 5 years then classifying then as needing general danger signs and all sick young infants are
urgent referral, treatment in health facility and /or examined for very severe disease.
home care.  The children and infants are then assessed for main
 The most common diseases targeted are symptoms include: For the older children, the main
management of respiratory infections, malaria, symptoms include: cough, or difficulty of breathing,
prevention of vaccine preventable diseases, diarrhea, fever, and ear infection.
diarrhea, worm infestations, growth  Only limited number of clinical signs are used.
anddevelopment, infant and young child feeding,  A combination of individual signs leads to a child’s
breastfeeding and clear steps to inform the classification within one or more symptom groups
caregiver for follow up care. rather than a diagnosis.
 Strategy for reducing mortality and morbidity  IMCI management procedures use limited number
associated with major causes of childhood illnesses of essential drugs and encourage active
 initiated jointly in 1992 by DOH, WHO and UNICEF participation of caretakers in the treatment of
Factors associated with mortality: children.

 poorest households Benefits Of Imci Strategy

 rural areas
 low rates of maternal education  Addresses major child health problems because it
systematically address the most important causes
Why IMCI? of children illness and death.
 Responds to demands
Children present with multiple potentially deadly
conditions at once
  Promotes prevention as well as cure because IMCI After classifying all the conditions present, a health
emphasizes important preventive interventions provider identifies specific treatments for sick children
such as immunization and breastfeeding.
 Hospital
 Most cost-effective interventions in low and
 Health Center, Rural Health Unit
middle-income countries
 Home
 Promotes cost saving. Improves equity

Three major components of IMCI:

STEP 4: TREAT
1. Improving case management skills of health
workers After identifying appropriate treatment, a healthcare
2. Improving the health system to deliver IMCI provider carries necessary procedure relevant to the
3. Improving family and community health child's conditions
practices
 gives pre-referral treatment for sick children
 gives the first dose of relevant drugs
Case Management Process: (ACITCF)  provides advice on the home management
1. ASSESS the child or young infant
2. CLASSIFY the illness STEP 5: COUNSEL
3. IDENTIFY treatment
4. TREAT the child If the follow up care is indicated the health care
5. COUNSEL the mother provider teaches the mother when to return to the
6. FOLLOW-UP care clinic, the health worker also teaches the mother to
recognize signs indicating that the child should be
brought back to the clinic immediately.
STEPS IN INTEGRATED CASE MANAGEMENT

STEP 1: ASSESS
STEP 6: FOLLOW UP
 Good Communication with mother of child
 Screen of general danger signs, which indicate life- Some children need to be seen more than once for a
threatening condition current episode of illness. The IMCI case management
 Specific questions about the most common process helps to identify those children who require
conditions affecting a child's health additional follow-up visits.
STEP 2: CLASSIFY

Based on the results of the assessment a health care

provider classifies a child's illnesses using a specially
developed colour-coded triage system. How to Select the appropriate case Management
Charts

Urgent pre-referral treatment and referral

Specific medical treatment and advice

Simple advice on home management

STEP 3: IDENTIFY TREATMENT

  age, name, address
Decide which age group the child is in:

 Birth up to 2 months


 2 months up to 5 years

CASE MANAGEMENT PROCESS: ASSESS AND CLASSIFY

1. Ask the mother what the child’s problem

are:

a. Know the age (age in months)

b. weight, temperature
c. using good communication skills, ask the mother
what the child’s problems are
d. Initial or follow-up visit

2. Check for general danger signs:

Ask: Is the child able to drink or breastfeed?
- NOT ABLE TO DRINK or BREASTFEED

 Too weak to drink and is not able to suckle or

swallow when offered a drink or breastfeed
 If you are not sure about the mother’s answer,
ask her to offer the child a drink of clean water
or breastmilk
 If the child’s nose is blocked, clear it
Ask: Does the child vomit everything?

 VOMITS EVERYTHING = not able to hold

anything down at all
Ask: Has the child had convulsions during illness? NO, look to see if you think the child has cough or
difficult breathing.
 The child’s arms and legs stiffen as the muscles
are contracting YES, ask the next question.
 The child may lose consciousness
Ask: For how long?
 Not able to spoken directions or handling even
if eyes are open > 30days = CHRONIC COUGH
 Child may shiver when the fever is rising rapidly
Look: See if the child is abnormally sleep or difficult to (tuberculosis, asthma, whooping cough)
awaken

 The child is drowsy and does not show any

interest in what is happening around him/her
 The child may stare blankly and appear not to
notice what is going around him/her
 A child who is abnormally sleep or difficult to
awaken or is lethargic does not respond when
he/she is touched, shaken or spoken to LOOK for CHEST INDRAWING:

3. Assess and classify cough or difficulty of Chest Indrawing: lower chest wall goes IN when the
breathing child breathes IN.
PNEUMONIA Normal Breathing: whole chest wall and the abdomen
•is an infection of the lungs move OUT when the child’s breathes IN.
•both bacteria and virus LOOK and LISTEN for STRIDOR:
•Streptococcus Pneumoniae and Hemophilus
Influenzae Stridor is a harsh noise made when the child’s
• Hypoxia and Sepsis breathes IN.
UPDATES 2012
LOOK and LISTEN for WHEEZE:
• inclusion of wheezing during assessment
• if wheezing is present: Wheeze is a soft musical noise made when the

child’s breathes OUT.

1. give a trial of rapid acting inhaled
bronchodilator for up to 3x with 15-20 min
interval 0.5ml salbutamol diluted in 2 ml sterile
water per dose
2. bronchodilator for 5 days

a. How long the child has had cough or

b. difficulty of breathing
c. Fast breathing
d. Chest indrawing
e. Stridor in a calm child
f. Wheeze in a calm child

Ask: Does the child have cough or difficulty of

breathing?
 ASSESS
and

CLASSIFY DIARRHEA

TYPES of DIARRHEA:

ACUTE DIARRHEA episode of diarrhea less than 14 days

PERSISTENT DIARRHEA episodes of diarrhea more than

14 days

DYSENTERY caused by Shigella bacteria

Ask: Does the child have Diarrhea?

NO, ask about next symptom, fever.

YES, assess for signs of dehydration, persistent diarrhea

and dysentery.

Ask: For how long?

Persistent Diarrhea – 14 days or more

LOOK for sunken eyes

Ask the mother if the child’s eyes look unusual

OFFER the child fluid:

NOT ABLE TO DRINK = not able to take fluid in his/her

mouth and swallow it.

DRINK POORLY = if the child is weak and cannot drink

without help.

DRINKING EAGERLY, THIRSTY = reaches out for a cup or

spoon when you offer water to him/her.
ASSESS FEVER

A child has a main symptom fever if:

 ❑ the child has a history of fever (3 days)

 ❑ the child feels hot
 ❑ The child has an axillary temp of 37.5 C or
above.

If with fever: Malaria risk, No Malaria risk, Measles or

Dengue

1. General Danger Signs

2. Stiff neck
3. Malaria risk: living in malaria area/ travel for the
Then check for malnutrition or anemia
past 4 weeks
blood smear 1. Severe wasting
runny nose 2. Edema of both feet
3. Palmar pallor
4. Measles: for the last 3 mos
Mouth ulcers: deep or extensive
Eye: pus drainage Classify Problems

Cough/ DOB:
5. Dengue: Gums and Nose: bleeding
Severe Pneumonia or Very Severe Disease

PNEUMONIA
Skin: petecchiae
Stools and vomitus: black No Pneumonia Cough or Cold
Extremities: cold and clammy; capillary refill (>3 secs)
Tourniquet: (+) persistent abdominal pain and vomiting Diarrhea: if dehydration:

Severe Dehydration
If with ear problem:
SOME DEHYDRATION
Assess if Acute or Chronic
No Dehydration
1. Ear pain: tender swelling behind the ear
If longer than 14 days:
2. Ear drainage: pus
3. Duration of ear pain: >14 day chronic Severe Persistent Diarrhea

PERSISTENT DIARRHEA

DYSENTERY

Fever: Malaria Risk:

Very Severe Febrile Disease/Malaria

Malaria

Fever: Malaria unlikely

 No Malaria Risk: A. Pneumonia, Acute ear infection, Very Severe
Disease, Mastoiditis
Very Severe Febrile Disease
Previous
Fever: No Malaria
• First line: Cotrimoxazole (2x a day for 5 days)

• Second line: Amoxicillin (3x a day for 5 days)

Measles:

Severe Complicated Measles

Updated
Measles with Eye or Mouth Complications
• First line: Amoxicillin (2x a day for 3 days)

• Second line: Cotrimoxazole (2x a day for 3 days)

Dengue:

Severe DHF
B. Dysentery: For Shigella (5 days)
Fever: DHF unlikely Previous

• First line: Cotrimoxazole (2x a day for 5 days)

Ear Problem: • Second line: Nalidixic Acid (3x a day for 5 days)

Mastoiditis Updated

Acute Ear Infection • First line: Ciprofloxacin (2x a day for 3 days)

Chronic Ear Infection

No Ear Infection C. Cholera: (3 days)

1st line: Tetracycline/Erythromycin

Malnutrition and Anemia;
2nd line: Cotrimoxazole
Severe Malnutrition or Severe Anemia

Anemia or Very Low Weight

High Fever (38.5C and above) or Ear Pain: Paracetamol
No Anemia and No Very Low Weight
Supplementation: Vitamin A. Given at 6 months or
more if not given in the past 6 months
TREAT / REFER Iron: Daily for 14 days

Intramuscular Antibiotics: Gentamicin and Benzyl

Take Note: penicillin and Quinine (for severe malaria)

• If with General Danger Signs: Referred after the Updated

first dose of an appropriate antibiotic and other First line:
urgent treatment.
• Except for severe dehydration, rehydration Gentamicin plus
according to Plan C may resolve the danger signs Benylpenicillin
so that referral is no longer needed.
Second line: Chloramphenicol
ORAL ANTIBIOTICS
Low Blood Sugar: Sugar Water: 4tsps of sugar in 200 ml 115 mm (MUAC- Mild Upper Arm
of clean water Circumference)

COUNSEL
EAR PROBLEM (TREATMENT OF CHRONIC EAR
INFECTION) FOLLOW-UP

Previous

• Chronic Ear Infection Treatment TUBERCULOSIS

1. dry the ear by wicking
- Is one of the oldest and deadly diseases
2. follow up for 5 days
worldwide
Updated
- Global Tuberculosis Report 2019 by WHO
• Chronic Ear Infection Treatment - reported that an estimated 10 million people
1. instill otic drops (quinolone) (2-3 drops, 3x daily worldwide had TB in 2018.
for 2 weeks Key facts (Sept 18, 2018)
2. dry the ear by wicking
 Deaths due to TB among HIV-negative individuals
3. follow up for 5 days
is 1.2million and 251,000 among HIV-positive
individuals.
DIARRHEAL DISEASES TREATMENT  In the Phils, TB ranks as the 8th leading cause of
morbidity and mortality and accounts 84.3 per
Previous
1000 of the population (DOH, 2018)
Persistent diarrhea treatment  TB is a leading killer of HIV-positive people
 + Ending the TB epidemic by 2030 is among the
1. give vit. A 1 dose only
health targets of the Sustainable Development
2. advise recommended feeding
Goals
3. follow up for 5 days
Vision:

 TB -free Philippines
Updated
Mission:
Persistent diarrhea treatment
 + To reduce TB burden (TB incidence and TB
1. give multivitamins and minerals with zinc mortality)
supplement for 14 days  + To achieve catastrophic cost of TB-affected
2. advise recommended feeding households
3. follow up for 5 days  To responsively deliver TB service

NUTRITIONAL STATUS (MALNUTRITION AND ANEMIA) Policies and Laws

Previous  RA 10767: Comprehensive TB Elimination Plan Act

of 2016
Severe Malnutrition: PINK  March 24 - World TB Day Commemoration
1. visible severe wasting or edema on both feet  August - Lung Month Celebration

Updated TUBERCULOSIS

Severe Malnutrition: PINK  is a disease caused by a bacterium called

Mycobacterium tuberculosis.
1. visible severe wasting or edema on both feet or
if age 6mos. and above with MUAC less than
  attack the lungs, but TB bacteria can attack any  When someone with active TB disease in the lungs
part of the body such as the kidney, spine, and or throat coughs, sings, spits, sneeze, laugh or even
brain. speaks,
 The bacteria can cause two types of illness,  TB bacteria can be released into the air where it can
LATENT OR ACTIVE stay in the air for hours.
 TB is latent when the body's immune system
forms a wall around the TB bacteria so they Incubation Period:
cannot multiple or spread. A person with latent  4 to 6 weeks
TB has no symptoms
 TB bacteria can "activate" and cause disease, Symptoms of TB
often if the person's health declines due to  Low grade Late Afternoon Fever
sickness, stress, or aging. Active TB is when the  Weakness or fatigue
body cannot adequately fight the TB bacteria and  Unexpected weight loss (i.e. not from dieting)
the person has symptoms.  Loss of appetite
 Night sweats
People at high risk for Tuberculosis (TB) exposure and  Persistent coughing (2 weeks or more)
infection include:  Coughing up blood (if disease in lungs or throat)
 Chest pain (if disease in lungs)
 Close contacts of persons exposed to contagious
cases of TB
DIAGNOSTIC TEST
 Residents and employees of high-risk congregate
settings (prisons, nursing homes, homeless  Direct sputum smear microscopy (DSSM)
shelters, drug treatment facilities, and healthcare  Xpert MTB/RIF (detects TB and resistance to
facilities) rifampicin)
 Health workers who serve high-risk clients  X-ray
 Some medically under-served, low-income  Purified Protein Derivative
populations  (tuberculin test)
 Infants, children, and adolescents exposed to
adults in high-risk categories
HIV and TB
 Persons who inject illicit drugs or any other locally
identified high-risk substance users  Infection with HIV suppresses the immune
system, making it difficult for the body to
People at high risk for progression to TB disease once control TB bacteria.
infected include:  people with HIV are many times more likely to
get TB and to progress from latent to active
 Persons with human immunodeficiency virus HIV
disease than are people who aren't HIV positive.
infection
 Persons who were infected with M. tuberculosis
within the past 2 years, particularly infants and
very young children
Drug-resistant TB
 Persons who inject illicit drugs
 Persons with a past history of inadequately treated  Drug-resistant strains of tuberculosis emerge
TB when an antibiotic fails to kill all of the bacteria
it targets.
 The surviving bacteria become resistant to that
Mode of transmission particular drug and frequently other antibiotics
as well.
 TB is spread from one person to another through
 Some TB bacteria have developed resistance to
the air. -AIRBORNE
the most commonly used treatments, such as
isoniazid and rifampin.
Risk factors
 Weakened immune system
 Poverty and substance use
 Where you work or live

Prevention
 Ventilate the room
 Cover your mouth
 Wear a mask
 Finish your entire course of medication
 Vaccinations

RECOMMENDED CATEGORY OF TREATMENT REGIMEN

FOR TB

 H Isoniazid
 P Rifampicin
 Z Pyrazinamide
 E Ethambutol
 S Streptomycin

CA2 (CHNN)

Demography – the study of population size,

composition and distribution

I. SOURCES OF DEMOGRAPHIC DATA;

1. Census – De jure (resident); De facto (nasaan
yung tao that time during census), Nat’l Govt,
PhP, Time
2. Sample Survey – small # of people
proportionate to general population
 3. Registration System – records of vital events  Help government in decision making
(NSO/CRO)
Doctor is responsible for registration of birth III. POPULATION COMPOSITION
certificate. It should be register within 30 days A. Sex Composition
Death certificate should administer where - Compares the number of females in the
she/he died community

II. POPULATION SIZE Formula Sex Ratio = No. of Males x 100

A. Measure population size by increase in No. of Females
`population due to difference of birth and death - The resulting figure represents the number
a. Natural Increase = # of b - # of d of males for every 100 females in the
b. Rate of Natural Increase = CBR – CDR population

Rate of Natural Increase = Crude Birth Rate – Crude Death Rate B. Age Composition
(specified year) (specified year) (specified year)  Median Age – Divides population into
two equal parts
B. Increase due to birth & Migration  Dependency Ratio – Compares
a. Absolute Increase – increase/yr Pt-Po economically dependent &
Independent portion of community
Formula: Absolute Increase per year = Pt – Po
T Where:
Pt = population size at a latter time 0-14 year of age & 65 above are
Po = Population size in an earlier time dependent
t = number of years between time o and time t 15-64 as independent

Example: Formula:
Given: Earlier time – Po – 2018: 26,000 Dependency ratio = total pop. Of the 0 to 14 and 65 and above age group X 100
Total population of 15 – 64 age group
Latter time – Pt – 2021: 20,000
26,000 – 20,000
3 Example: 14 & below: 96 individual
AI = 2,000 65 years: 12 individual
15 – 64 years: 140 individual
b. Relative increase - % Total population: 248 individuals
- Known as population growth rate

Formula: Pt – Po  Age and Sex Composition – presented

Po with the use of population pyramid

Pt = Population size at a latter time

Po = population size in an earlier time
Example: Po ---(earlier time) year 2002 Pop.: 10,000
Pt ---(latter time) year 2005 Pop.: 12,300

Relative increase = 12,300 – 10,000

10,000
RI = 0.23

Population Projection
 A demographic tool
 Basis for statistical projections
PATTERNS POPULATION PYRAMID