COMMUNITY HEALTH NURSING (PART 1) COMMUNITY PARTICIPATION

➢ Citizens and communities have a right and

PRIMARY HEALTH CARE responsibility to be active partners in
making decisions about their own health
ALMA ATA DECLARATION and the health of their communities.
➢ September 6-12, 1978 ➢ Heart and Soul of PHC
➢ First International Conference on PHC ➢ The ideal word for COMMUNITY
➢ PHC goal: HEALTH FOR ALL BY THE YEAR PARTICIPATION is “The nurse is working
2000 WITH THE PEOPLE”
➢ ALMA-ATA, Kazakhstan, RUSSIA (USSR)
➢ Sponsored by WHO and UNICEF HEALTH PROMOTION
➢ Focus or enabling citizens to increase control
ASTANA DECLARATION over and improve their health and well-
➢ October 25-26, 2018 being
➢ Marks by 40 years since the first Global ➢ BASIC PRINCIPLE: PREVENTION IS BETTER
Conference on PHC THAN CURE
➢ Declaration of Astana took place in Astana,
Kazakhstan
➢ Hosted by WHO, UNICEF and the Government APPROPIRATE TECHNOLOGY
of Kazakhstan ➢ The people, procedures, equipment, drugs,
and resources used are EFFECTIVE and
CULTURALLY ACCEPTABLE to individuals
LETTER OF INSTRUCTION (LOI) 949 and the community
➢ Philippines First Asian country to have ➢ Use of cheaper, scientifically valid tools and
adopted PHC as a national strategy methods that are all suitable and
➢ The legal basis of PHC was signed by Pres. acceptable to the families and communities
Ferdinand Marcos ➢ E.g. use of herbal medicines, acupuncture,
➢ Signed by October 19, 1979 acupressure
➢ HEALTH FOR ALL FILIPINOS (by the year
2000) AND HEALTH IN THE HANDS OF THE INTERSECTORAL COLLABORATION
PEOPLE (by the year 2020) ➢ Partnership between community and health
➢ END GOAL of PHC approach is for people to be agencies
SELF-RELIANT ➢ E.g.
a) Referral system among the RHU
PRINCIPLES OF PHC: 4 A’s of PHC b) NGOs
1) ACCESSIBILITY c) Local social welfare and Development
➢ Essential and appropriate health services Office
are available to citizens within a
reasonable geographical distance by an SOCIAL MOBILIZATION
appropriate provider and within a time ➢ Enhancing people participation
frame that is appropriate (Not more than ➢ Process of BRINGING TOGETHER ALL
5 km away and 30 minutes to travel) SOCIETAL AD PERSONAL INFLUENCES TO
2) AVAILABILITY RAISE AWARENESS of and demand for
➢ Care can be obtained whenever people healthcare, assist in the delivery of resource
need it (24/7) and services, and cultivate sustainable
3) AFFORDABILITY individual and community involvement.
➢ The cost should be within the means and
resources of the individual and the DECENTRALIZATION
country (not totally free SERVICES) ➢ Transfer of authority, functions and/or
4) ACCEPTABILITY resources from the center to the periphery
➢ Health services offered area to be in within a specific sector
accordance to the prevailing beliefs ➢ The Philippines decentralized government
and practices of the intended clients of health services in 1992 through devolution
care. with the Implementation of the Local
Government Code (RA 7160)
4 MAJOR PILLARS OF PHC (CORNERSTONES) 2) INTERMEDIATE LEVEL
1) INTERSECTORAL LINKAGES (Multisectoral) ➢ First source of professional health care
2) USE OF APPROPRIATE TECHNOLOGY ➢ Attends health problems beyond the
3) SUPPORT MECHANISM MADE AVAILABLE competence of grassroots workers
4) ACTIVE COMMUNITY PARTICIPATION a) Rural Sanitary Inspectors
(sustained by social mobilization) b) Medical Practitioners and their
Assistants
COMPONENTS OF PHC: “MAD ELEMENTS” OF PHC c) Registered Midwives
1) Mental Health d) Nurse in Public Health (PHN)
2) Access to Sentrong Sigla 3) FIRST LINE HOSPITAL PERSONNEL
3) Dental Health ➢ Provide backup health services for
4) Education In Concerning Prevailing Health cases that needs hospitalization
Problems a) Doctors with Specialties:
5) Locally Endemic Disease Preventions And 1. OB
Control 2. Pediatrician
6) Expanded Program Of Immunization Against 3. Cardiologist
Major Infectious Diseases (RA 10152) 4. Dentist
7) Maternal And Child Healthcare Including b) Other Healthcare
Family Planning Professionals
8) Essential Drugs Arrangement c) Nurse Specialist
9) Nutritional Food Supplement, And Adequate d) Anesthesiologist and Surgeon
Supply Of Safe And Basic Nutrition
10) Treatment Of Communicable And Non- LEVELS OF HEALTHCARE DELIVERY SYSTEM
Communicable Diseases And Promotion Of 1) PRIMARY
Mental Health ➢ Basic health procedures
11) Safe Water And Sanitation ➢ 25-75 beds capacity
➢ Puericulture centers/Birthing in or
DOH STANDARD RATIO OF HEALTHCARE WORKERS Lying in
➢ Rural Health Unit (RHU) (RA 1082)
BARANGAY HEALTH 1:20 HOUSEHOLDS ➢ Community Health Centers Or
WORKERS Barangay Health Station (BHS)
MIDWIFE 1:5,000 2) SECONDARY
NURSE 1:20,000 ➢ Referral system of primary level
MD/PHYSICIAN 1:20,000 ➢ Minor operations and laboratory
SANITARY INSPECTOR 1:20,000 examinations
DENTIST 1:50,000 ➢ 100-200 beds capacity
CONTACT TRACERS 1:800 ➢ Outpatient Department Hospitals
➢ Provincial Hospitals
LEVELS OF PHC WORKERS ➢ District Hospitals/Emergency District
1) GRASSROOTS/VILLAGERS Hospital
➢ First contact of the community 3) TERTIARY
➢ Initial link to healthcare ➢ Referral system of secondary level
➢ Renders simple curative/preventive ➢ Highly specialized staff and technical
health measures equipment
➢ Serves as the foundation of healthcare ➢ Complex medical and surgical
➢ Trained local individuals in the interventions
community provides ➢ Major operations and invasive
➢ BATA: procedures
a) BHWs ➢ Medical Centers & National Hospitals
b) Auxiliary Volunteers ➢ Regional Hospitals
c) Traditional Birth Attendants/ ➢ Training and Teaching Hospitals
TBA (Trained hilots)
d) Albularyos
3 LEVELS OF PREVENTION
1) PRIMARY LEVEL b) Blood tests
➢ Target: HEALTHY individuals 1. CBC for blood
➢ GOAL: To prevent/delay the actual disorders
occurrence of disease (Pancytopenia)
➢ INTERVENTION: Health Promotion 2. ELISA (Confirmatory
and Disease Prevention for Dengue)
➢ HEALTH EDUCATION 3. Western Blot for HIV
✓ Basic health service that aims (Confirmatory)
to modify harmful practices of 4. CD4 T cell Count
people and their unscientific (Confirmatory for
knowledge and attitude AIDS)
➢ ACTIVITIES: c) Contact tracing
a) Health Education d) Quarantine (separation of
1. Family Planning contact to well individuals)
2. Genetic Counseling e) Disease surveillance
b) Healthy Lifestyle Habits f) Diagnostic Tests
1. Health Diet 1. Ultrasound
2. Rest 2. CXR
3. Exercise 3. MRI
4. Not Smoking 4. CT Scan
c) Hygiene (HANDWASHING) 5. Mammography
d) Immunization/Inoculation g) Treatment/Cure of disease
e) Isolation of the diagnosed sick h) Examination of breast (BSE)
child to pregnant mother i) Examination of Testes (TSE)
f) Intake or use of Prophylactic j) OPLAN Timbang
drugs k) Screening Test & Selective
1. Antiretroviral drugs Examinations
2. Chloroquine tablets 1. Newborn Screening
(Prophylaxis of malaria) 2. Screening for
3. Doxycycline (Prophylaxis hypertension
of leptospirosis) l) Trauma & CRISIS
4. Crede’s Prophylaxis PREVENTION (stress
(prevent debriefing)
gonorrheal/chlamydial eye 3) TERTIARY LEVEL
infection) ➢ Target: Individuals with diagnosed
g) Vector Control illness and advance disease
1. Destroy breeding sites (for ➢ GOAL: Reduce impact/limit disability,
Dengue, Zika prevention) prevent sequelae and prevent death
2. Clear hanging trees in the ➢ INTERVENTION: Rehabilitation
riverbanks (for Malaria ➢ ACTIVITIES:
prevention) a) Therapies
2) SECONDARY LEVEL 1. Physical therapy
➢ Target: Sick or at risk individuals 2. Occupation therapy
➢ GOAL: SCREENS clients for early (Prostheses use)
detection and prompt treatment of the b) Health care and treatment for
disease those infected by COVID-19
➢ INTERVENTION: Early diagnosis and c) Use of assistive devices
treatment d) Maintenance drugs among
➢ ACTIVITIES: patient with hypertension
a) Case finding tools e) Blood pressure and Blood
1. Skin Slit Smears for sugar monitoring
leprosy f) Self-Management Education
2. Sputum smear for TB for patient with diabetes
3. Swab Test for COVID- g) Use of chemotherapeutic
19 drugs and radiation for cancer
 h) Provide family therapy for  Specific hospitals are funded are from
abusive families; remove DOH
children from home  E.g. Philippine General Hospital
 Specialized Hospitals = Specific cases
DEPARTMENT OF HEALTH (e.g. National Kidney Institute,
➢ Dr. Francisco Duque III (DOH Secretary) Philippine Heart Centre)
➢ VISION: Filipinos are among the healthiest ✓ ADMINISTER BASIC SERVICES
people in Southeast Asia by 2022, and Asia by − To provide basic health services
2040
➢ MISSION: To lead country in the development UNIVERSAL HEALTH CARE (RA 11223)
of a productive, resilient, equitable and people ➢ KALUSUGAN PANGKALAHATAN (KP)
centered health system ➢ Highest possible quality of healthcare for
EVERY Filipino
ROLES AND FUNCTIONS OF DOH ➢ Care that is accessible, efficient, equitably
3 BASIC FUNCTIONS “LEA” distributed, adequately funded, fairly
1) LEADERSHIP IN HEALTH financed, and appropriately used by an
✓ Serve as the national policy and regulatory informed and empowered public
institution
✓ Provide leadership in formulation, UHC’S 3 THRUSTS
monitoring and evaluation of national ➢ KEY PLAYERS IN UHC: DOH, LGU & PhilHealth
health policies 1) FINANCIAL RISK PROTECTION
✓ Serve as advocate in the adoption of health ✓ Through expansion in enrollment and
policies, plans and programs to address benefit delivery of the National Health
national and sectoral concerns Insurance Program (NHIP) or PhilHealth
✓ FORMULATE 2) IMPORVED ACCESS TO QUALITY HOSPITALS
 Creates the policies, protocols, rules AND HEALTHCARE FACILITIES
and regulations of health in the ✓ Upgrading government-owned and
Philippines. operated hospitals and health facilities
✓ ADVOCATE ✓ Rehabilitation and Construction of Critical
 Protect the right of the people Health Facilities
✓ REGULATE ✓ Treatment Packs for HTN and DM
 All hospitals must have certification of ✓ Obtained and distributed to RHUs
cooperation from DOH 3) ATTAINMENT OF HEALTH-REALTED MDGs
 Make sure affordable and safe health ✓ MDG signed: September 2000
services in the country ✓ Target: 2015
2) ENABLER & CAPACITY BUILDER “IME” ✓ Goals: 8 MDGs
✓ INNOVATE ✓ To reduce maternal and child mortality
 Update of health practices in the ✓ TO reduce morbidity and mortality from
country. TB, Malaria and incidence of HIV/AIDS
✓ MONITOR ➢ 8 MDGs
 All hospitals in the country have 1) Eliminate Extreme Poverty And Hunger
license from DOH 2) Achieve Global Primary Education
 All hospitals in the country are 3) Promote Gender Equality And Empower
checked by the DOH Women
✓ ENSURE 4) Reduce Child Mortality (reduce the under-
 Must have safe and quality health five mortally rate by 2/3 in year 2015)
services ✓ Pneumonia = single largest
3) Administrator of specific services infectious cause of death in
✓ EMERGENCY SERVICES “EMA” children worldwide (under-five)
 In case of emergencies, the DOH must ✓ Diarrhea =
ensure safe and quality healthcare ✓ Asphyxia = Common cause of
services newborn deaths
5) Improve Maternal Health (reduce
✓ MANAGE SELECTED HOSPITAL maternal mortality by 3 quarters (3/4) in
2015)
 ✓ Direct Maternal Deaths (HOUSE) c) Service delivery monitoring
a) Hemorrhage d) It monitors health status of the community
b) Obstructed Labor e) Source of data to detect any unusual
c) Unsafe Abortion occurrence of a disease
d) Sepsis
e) Eclampsia COMPONENTS OF FHSIS
6) Combat Malaria, HIV/AIDS, And Other 1) INDIVIDUAL TREATMENT RECORD (ITR)
Diseases (Including neglected tropical ➢ Use to record patient address, full
diseases) name, age, symptoms and diagnosis
7) Ensure Environmental Sustainability (piece of paper/patient consultation
8) Develop A Universal/Global Partnership record)
For Development ➢ Individual treatment record or
FAMILY TREATMENT RECORD is the
SUSTAINABLE DEVELOPMENT GOALS fundamental block or foundation of
1) No Poverty FHSIS
2) 0 (Zero) Hunger 2) TARGET CLIENT LIST (TCL)
3) Good Health & Well-Being ➢ Primary Advantage: Lets nurses and
4) Education (Quality) midwives save time and effort in
5) Equality (Gender) monitoring treatment and services to
6) Clean Water And Sanitation beneficiaries
7) Affordable And Clean Energy ➢ TCL will be transmitted to the next
8) Decent Work And Economic Growth facility in the form form of
9) Industry, Integration And Infrastructure REPORTING FORMS
10) Reduced Inequalities ➢ TCLS TO BE MAINTAINED ARE:
11) Cities And Communities (Sustainable) a) TCL for Prenatal
12) Consumption And Production b) TCL for Postpartum Care
13) Climate Change Action c) TCL for Family Planning
14) Life Below Water d) TCL for Under One year old
15) Life On Land children
16) Peace, Justice & Strong Institution e) TCL for Sick Children
17) Partnership For Goals f) NTP TB Register (National
Leprosy Control Program)
IMPORTANT NOTES: 3) TALLY/REPORTING FORMS
a) MDGs 4 & 5 is the priority of the DOH ➢ Reporting forms is the ONLY
b) Reduce Child Mortality And Improve Maternal mechanism through which date are
Health are 2 goals which are VERY specific to routinely transmitted from one facility
Maternal Child Health (MCH) to another
✓ Infant Mortality Rate = most sensitive ➢ Reports are submitted directly to the
indicator for mortality and morbidity PROVINCIAL HEALTH OFFICE (PHO)
c) Reduction of maternal mortality of 75% by ➢ E-2 is the Maternal Death Form
year 2015 ➢ Reporting forms from BHU Facility to
d) NATIONAL PRIORITY: MDG 1 (Eradicate the PHO
Extreme Poverty) ➢ Output Reports are solely produced by
the PHO
FILED HEALTH SERVICE INFORMATION SYSTEM ➢ Data submitted to the PHO is
(FHSIS) processed using MICROCOMPUTER
➢ Provides a summary of data on health service ➢ The recommended frequency in
delivery and selected programs from the tallying activities and services using
barangay level up to the national level tally sheets is DAILY
➢ FHSIS Importance: ➢ Counting of the tally sheet is done at
a) Facilitates information for monitoring and the END OF THE MONTH
evaluating health program
implementation RA 7160 (Devolution Code or Local Government Code)
b) Help local government determine public
health priorities
 ➢ Aims to transform local government units into a) ½ cup of leaves boiled in a glasses
self-reliant communities and active for water
partners b) Divide into 3 parts and drink one
part 3x a day
LOCAL HEALTH BOARD (LHB) 3) BAWANG (Allium Sativum)
1) PROVINCIAL HEALTH BOARD a) Hypertension
a) Chairman: GOVERNOR b) Toothache
b) Vice Chairman: Provincial Health Officer c) Neutralize free radicals & lowers
c) MEMBERS: cholesterol level
1. Chairman, Committee on Health ✓ PREPARATION:
of Sangguniang Panlalawigan a) Fried, roasted soaked in vinegar
2. DOH Representative (PHN) for 30 minutes
3. NGO Representative (Private b) Blanched in boiled water for 15
Sector) minutes
2) CITY & MUNICIPAL HEALTH BOARD c) Take 2 pieces 3x a day AFTER
a) Chairman: MAYOR MEALS
b) Vice Chairman: Municipal Health Officer 4) BAYABAS (Psidium Guajava)
c) MEMBERS: a) Stomach Flu/Diarrhea
1. Chairman, Committee on Health b) Use for Wound Washing
of Sangguniang Panlungsod c) Gets rid of fungi, amoeba, and bacteria
2. DOH Representative (PHN) d) Antiseptic activity
3. NGO Representative (Private e) Toothache
Sector) ✓ PREPARATION:
 TAKE NOTE: a) Young leaves can be boiled taken
a) MIDWIFE is NOT a member of the 3-4x a day for diarrhea
Health Board b) Warm decoction for gargle in
b) Midwives are the FRONTLINE toothache
WORKERS in COMMUNITY and RHU 5) YERBA BUENA (Mentha Cordifolia)
c) Midwives links the community to RHU a) ANALGESIC
b) Pruritus or itchiness
RA 8423 – TRADITIONAL AND ALTERNATIVE c) Arthritis/Rheumatism
MEDICINAL ACT (TAMA) of 1997 d) Insect bites and swollen gums
➢ By Juan Flavier e) Nausea & Vomiting
1) LAGUNDI (Vitex Negundo) f) Flatulence or Gas pain
a) Sprain and Skin Diseases g) Loss of consciousness temporarily
b) Headache & Fever (syncope) – alternative of spirit of
c) Rheumatism ammonia
d) Eczema h) Menstrual pain
e) Dysentery ✓ PREPARATION:
✓ PREPARATION: a) For PAIN: boil leaves in 2 glasses
a) Decoction: Boil ½ cup of chopped for 15 minutes
fresh or dried leaves in 2 cups of b) Divide
water for 10-15 minutes c) Decoction in 2 parts and drink
b) Drink half cup 3 times a day one
c) Pounded leaves for headache and 6) SAMBONG (Blumea Balsamifera)
rheumatism a) Antiurolithiasis
2) ULASIMANG BATO/PANSIT-PANSITAN b) Diuretic
(Peperonia Pellucida) c) Anti-edema
a) Gouty arthritis (Great Toe pain) d) NOT used for kidney infections
b) Others: Boils and abscesses
c) Uric Acid lowering Agent
d) Tophi prevention ✓ PREPARATION:
e) YES you can boil it or eat like a salad a) Decoction of leaves – boil
✓ PREPARATION: chopped leaves in a glass of water
b) Divide into 3 parts
 c) Drink one part every 3 hours ➢ Botika ng Barangay (BnB), a government-
7) AKAPULKO (Cassia Alata L.) initiated poverty alleviation program to
a) Antifungal parasites herb increase access of community people to
b) Ringworm (Fungal) affordable medicines
c) Athlete’s Foot ➢ VENDOR: At least 2 BHW
d) Tinea flava ➢ MANAGED BY: legitimate community
e) Scabies (Parasite) organization. NGOs and/or LGUs
✓ PREPARATION:
a) Pounded fresh matured leaves DRUGS SOLD IN BnB
b) Can be made into a soap, cream or 1) RIPES (TB drugs)
paste applied to affected area 1- 2) NIFEDIPINE
2x a day 3) AMOXICILLIN (1st line antibiotic of pneumonia)
c) Apply cream all over the body for 4) ALBENDAZOLE
scabies 5) PARACETAMOL
8) NIYOG NIYOGAN (Quisqualis Indica) 6) COTRIMOXAZOLE (2nd line antibiotic of
a) Anti-helminthic pneumonia)
b) Expel worms or parasite like 7) ORS (Oresol)
roundworms, tapeworms, hookworms. 8) QUININE
✓ PREPARATION:  ASPIRIN is NOT BEING SOLD in BnB
a) Take seeds 2 hours AFTER dinner
b) CHILDREN: at least 4-7 seeds IMMUNIZATION PROGRAM
c) ADULTS: at least 8-10 seeds ➢ VACCINE HISTORY:
d) CONTRAINDICATED to less than 1) EDWARD JENNER
4 years old ✓ Founder of Vaccinology in the West
9) TSAANG GUBAT (Carmona Retusa)= Wild Tea (1796)
a) Antispasmodic (Cramps) ✓ After he inoculated a 13 y/o boy with
b) Body cleanser/wash vaccinia virus (cowpox) which
c) Diarrhea demonstrated immunity to smallpox
d) Oral Hygiene or canker sores ✓ In 1798, the FIRST smallpox vaccine
e) Mouth wash used in “SAGIPIN: UNANG was developed
NGIPIN” (fluoridation of teeth) ✓ Smallpox vaccine was the FIRST
f) Eczema SUCCESSFUL VACCINE to be
g) Natural remedy for biliary colic developed
10) AMPALAYA (Momordica Charantia) ✓ WHO declares GLOBAL eradication
a) DM Type 2 of Smallpox (May 1980)
✓ PREPARATION: ✓ LAST WILD CASE of small pox –
a) Chopped leaves Somalia (1977)
b) Boil in a glass of water for 15
minutes EXPANDED PROGRAM ON IMMUNZATION
c) Take 1/3 cup 3x a day AFTER (established in 1976)
MEALS ➢ IMMUNIZATION
✓ Process of introducing vaccine into
REMINDERS ON THE USE OF HERBAL MEDICINE the body before infection sets in
1) Boil using a clay pot and remove cover while providing ARTIFICIAL ACTIVE
boiling at low heat IMMUNITY
2) Only one kind of herbal plant for each type of ➢ WHO stated that as many as 2-3 million deaths
symptoms among children per year could have been
3) No use of insecticides as these may leave prevented by ACCESS TO IMMUNIZATION
poison on plants ➢ SCHEDULE: WEDNESDAY
4) Use only part of the plant being advocated ✓ Designated NATIONAL
5) Symptoms persist after 2-3 doses – CONSULT IMMUNIZATION DAY or “Patak
physician Day”
➢ WEEKLY: Rural Health Units
BOTIKA NG BARANGAY/BOTIKA NG BAYAN (BnB) ➢ MONTHLY: Barangay Health Stations
➢ QUARTERLY: Remote areas (Far-flung)
 ➢ Philippines was certified POLIO-FREE
VACCINE PREVENTABLE DISEASES country on October 29,2000 in Kyoto,
1) Tuberculosis – BCG Japan
2) Diphtheria & Pertussis – DPT/Pentavalent ➢ 19 years after, On September 19,2019,
3) Measles – Measles Vaccine a new polio outbreak was reported by
4) Poliomyelitis – OPV and IPV POLIO VIRUS 2
a) OPV – Albert Sabin ➢ 3 Viral Strains of Polio
b) IPV – Jonas Salk a) Brunhilde Type 1
5) Tetanus b) Lansing type 2
a) CHILDREN = DPT c) Leon type 3
b) Mothers = Tetanus Toxoid 3) PROCLAMATION NO. 4, s. 1998
6) Hepatitis B – HepB vaccine ➢ LIGTAS TIGDAS MONTH
7) Diarrhea caused by Rotavirus – Rotavirus ➢ September 16 – October 14, 1998
vaccine ➢ Free measles vaccines between the
8) Meningitis – PentaHIB vaccine ages of 9 months – less than 15 years
4) PRESIDENTIAL DECREE 996
FALSE TRUE/ABSOLUTE ➢ COMPULSORY basic immunization for
CONTRAINDICATIONS CONTRAINDICATIONS infants and children below 8 years of
Fever NOT more than Convulsions within 7 age
38.5 degrees C days after DPT vaccine 5) REPUBLIC ACT NO. 7846
Seizures 4 days before ➢ COMPULSORY Hepatitis B
DPT 1 immunization among infants &
Vomiting Anaphylaxis to any children less than 8 years old
components of vaccine ➢ Newborn infants of women with
Respiratory Conditions HIV/AIDS with signs Hepatitis B shall be given
(Cough & Colds) and symptoms immunization against Hepatitis B
within 24 hours after birth
Like BROMA vaccines 6) RA No. 10152
a) BCG ➢ MANDATORY infants and Children
b) Rotavirus Health Immunization Act of 2011
c) OPV ➢ TAKE NOTE:
d) Measles a) If the infant is sick, and the
e) parent strongly objects for the
Malnutrition immunization, DO NOT GIVE
IT
Anaphylaxis after a b) Ask the mother to comeback
Diarrhea previous dose when child is well
Hepatitis
Neural Problems FULLY IMMUNIZED CHILD (FIC)
1) Before 12 months
REGULATORY LAWS 2) Before 1st birthday of child he/she must have
1) PROCLAMATION NO. 773, s. 1996 completed:
➢ Declaring April 17 and May 15, 1996 a) 1 dose of BCG
and every third Wednesday of April b) 3 doses of DPT
and May from 1996 to 2000 as c) 3 doses of OPV
“KNOCKOUT POLIO DAYS” d) 3 doses of HepB
➢ ONLY OPV doses can lead to polio e) 1 dose of Measles
eradication
➢ OPV given simultaneously to all FREEZE DRIED:
children younger than 5 y/o 1) BCG
2) PROCLAMATION NO. 135, s. 2001 2) Others: Yellow Fever and HIB
➢ POLIO-FREE MAINTENANCE
IMMUNIZATION CAMPAIGN MOST SENSITIVE TO HEAT/SUNLIGHT:
➢ Last wild Poliomyelitis case in the 1) OPV
Philippines was in 1993 2) Measles
 3) MMR 4) Do not give more than 1 dose of the SAME
VACCINE to a child in one session
MOST SENSITIVE TO COLD/FREEZING 5) If the vaccination schedule is interrupted, it is
1) DPT NOT NECESSARY to RESTART.
2) DT 6) Minimal intervals between doses to catch up
3) TT as quickly as possible if it is interrupted
4) HepB 7) Immunity provided by vaccines is ARTIFICIAL
5) Pentavalent Vaccine ACTIVE:
6) PCV vaccine a) More than 1 vaccine is to be
administered, inject it at different sites
NEW MANDATED VACCINES of body
1) ROTAVIRUS b) Mild asthma, stable cerebral palsy or
✓ Prevents diarrhea down syndrome is NOT a
2) PNEUMOCOCCAL CONJUGATE VACCINES ( contraindication
PCV13) c) Use single syringe (1 syringe per
✓ Prevents pneumonia vaccine) when giving more than 1
3) INACTIVATED POLIO VACCINE (IPV) vaccine
✓ Given to infant at 3 ½ months (14 d) NEVER reconstitute freeze dried
weeks) vaccine anything other than the diluent
 TAKE NOTE: supplied with them
a) Give PCV to infants as a series of 3 e) Effective and still safe if more than 1
doses, 1 dose at each of these ages: vaccine is given on the same day
o 1 ½ months (6 weeks) f) DO NOT ADMINSTER live vaccines to
o 2 ½ months (10 weeks) persons who are significantly immune
o 3 ½ months (14 weeks) compromised
b) Children who miss their shots or start
the series later should still get the COLD CHAIN
vaccine ➢ SYSTEM of storing and transporting vaccines
at recommended temperatures from the point
PENTALENT VACCINE of manufacture to the point of use
➢ Vaccine (5 in 1) that contains Five antigens: ➢ Primary PURPOSE: MAINTAIN POTENCY of
1) Diphtheria vaccine
2) Pertussis
3) Tetanus VACCINE STORAGE
4) HepB 1) Store VARICELLA at freezing temperatures
5) Haemophilus influenzae type B 2) Temperature should be checked TWICE A DAY
3) One in the morning and one in the late
“BACK TO BAKUNA” Program afternoon
➢ School based immunization program provides 4) Refrigerator: Stand-alone refrigerator and
free measles and rubella vaccines including freezer
booster doses of tetanus-diphtheria vaccines 5) Avoid direct contact of vaccine to ice
to public school children from kindergarten to 6) Goodies, foods and drinks should NEVER be
Grade 7 (ages 5-13 y/o) stored
➢ For Grade 4 females: HPV immunization, a 7) Ensure to keep refrigerator away from
protection against cervical cancer sunlight and at least (10cm) distance from the
wall

COLD CHAIN REMINDERS:

GENERAL PRINCIPLES IN VACCINATING CHILDREN 1) NEVER store any vaccine in a dormitory style
1) Give doses less than 4 weeks interval may or bar style combined unit
lessen the antibody response 2) NEVER place vaccines and diluents in the
2) Lengthening the interval between doses of DOOR shelves (Temperature is not stable)
vaccine leads to a higher antibody levels 3) AVOID frequent opening and closing of doors
3) Avoid using the same arm or leg for more than
1 injection
 4) Place vaccines and diluents in the center of the 2) FREEZER
unit 2 or 3 inches away from walls, ceiling, ➢ Kept between -15 degrees C to -25
floor. And door degrees C
5) AVOID freezing of diluents as the vial may ➢ Average of 20 degrees C
burst when frozen ➢ Used for freezing ice packs
6) DO NOT STORE vaccines in deli, fruit or ➢ For heat sensitive vaccines (OPV &
vegetable drawers or in the door Measles)
7) Place vaccines and diluents with the earliest ➢ OPV is the MOST sensitive to heat and
expiration dates in front of those with later fragile vaccine
expiration dates
8) Do not return reconstituted vaccines (BCG, STORING:
Measles) or opened PCV 10 vials to the 1) FREEZING COMPARTMENTS
refrigerator. They should be discarded at the a) Ice cubes
end of the immunization session or after 6 b) Ice packs
hours, whichever comes first, 2) MAIN COMPARTMENT
9) The refrigerator should not be packed too full a) TOP
(to allow air to circulate) 1. OPV
10) Vaccines should be stored carefully between 2. Measles
+2 degrees C and +8 degrees C at all times b) MIDDLE
11) Freeze-sensitive vaccines (Pentavalent, PCV10, 1. DPT
TT & HepB) should be kept away from the 2. TT
freezing compartment, refrigeration plates, side 3. Diluent
linings or bottom lining of refrigerators and c) LOWER
frozen ice packs 1. Water bottles

WATER BOTTLES STORAGE TIME FRAMES

1) Place water bottles on the top shelf, floor and 1) 6 MONTHS – Regional Level
in the door racks 2) 3 MONTHS – Provincial Level/District Level
2) Putting water bottles in the unit can help 3) 1 MONTH – Main Health Centers with
maintain stable temperatures cause by refrigerator
frequently opening and closing unit doors or a 4) NOT MORE THAN 5 DAYS – Health centers
power failure using transport boxes
3) Label all water bottles DO NOT DRINK
ESSENTIAL ELEMENTS:
REFRIGERATOR 1) Personnel to manage vaccine distribution
1) NO foods, drinks or other drugs are to be kept 2) Equipment for vaccine storage & transport
in a refrigerator 3) Maintenance of equipment
2) Check and record temperature 2x a day in 4) Monitoring
temperature log for 2-7 days 5) COLD CHAIN MANAGER: PHN
3) DEFROST the refrigerator when ice becomes
more than 0,5 cm thick, or once a month, VACCINES:
whichever comes first 1) BCG (Bacillus Chalmette Guerin)
4) Record temperature, date, time and initials of ➢ CONTENT: Live Attenuated Bacteria
the person in monitoring log sheet ➢ TYPE: Freeze Dried
➢ DOSAGE:
2 COMPARTMENTS: a) Infant/birth: 0.05 mL
1) REFRIGERATOR (Main Compartment) b) Preschool: 0.1 mL
➢ Kept between +2 degrees C and +8 ➢ NUMBER OF DOSES: 1dose
degrees C ➢ ROUTE: ID using 26G needle syringe
➢ Used for storing vaccines and diluents 2) Hepatitis B
➢ E.g. ➢ CONTENT: Plasma Derivative (HbsAg)/
a) BCG RNA Recombinant
b) DPT ➢ TYPE: Liquid
c) HepB ➢ DOSAGE:
d) TT a) Infant/birth: 0.5 mL
 ➢ NUMBER OF DOSES:3 doses ➢ ABNORMAL ADVERSE EFFECTS
➢ ROUTE: IM a) INDOLENT ULCERATION
3) DPT (Diphtheria-Pertussis-Tetanus) ✓ WATCH OUT FOR: Signs of
➢ CONTENT: DT weakened toxin/ P-killed Infection
bacteria ✓ Abscess formation and swelling
➢ TYPE: Liquid of glands in armpits
➢ DOSAGE: 0.5 mL (lymphadenopathy)
➢ NUMBER OF DOSES: 3 doses ✓ Abscess may be due to:
➢ ROUTE: IM 1. UNSTERILE needle/syringe
4) OPV (Oral Polio Virus) was used (#1 cause)
➢ CONTENT: Live Attenuated Virus 2. Too much vaccine was
(weakened) injected
➢ TYPE: Liquid 3. Wrong technique of
➢ DOSAGE: 2 drops (0.1 mL) administration
➢ NUMBER OF DOSES: 3 doses ✓ MANAGEMENT:
➢ ROUTE: PO 1. Do not incise and Drain
5) Rotavirus Vaccine 2. Use warm water
➢ CONTENT: Live Attenuated Virus compresses over the
(weakened) injection site or
➢ TYPE: Liquid suppurating lymph node/s
➢ DOSAGE: 5 drops (0.5 mL) 4-5 times a day
➢ NUMBER OF DOSES: 5 doses
➢ ROUTE: PO HEPATITIS B
6) MEASLES ➢ Transmission at birth is possible give:
➢ CONTENT: Live Attenuated Virus a) HepB 1 – At Birth
(weakened) b) HepB 2 – 6 weeks
➢ TYPE: Freeze dried c) HepB 3 – 14 weeks
➢ DOSAGE: 0.5 mL ➢ When transmission at birth is less likely, the
➢ NUMBER OF DOSES: 1 dose recommended schedule is:
➢ ROUTE: SQ a) HepB 1 – 6 weeks
b) HepB 2 – 10 weeks
BCG c) HepB 3 – 14 weeks
➢ At birth or Any time after birth ➢ COMMON SIDE EFFECTS:
➢ NORMAL SIDE EFFECTS a) MILD FEVER (1-2 days)
a) KOCH’S PHENOMENON ✓ Teach mother to perform TSB
✓ Acute inflammatory process ✓ Advise to give Paracetamol every
starting 24 hours after injection and 4 hours if temperature is above
may last 2-4 days 38.5 degrees C
✓ Wheal formation (small raised ✓ REFER if fever last for 4 days
lump of 10 mm of diameter) b) SORENESS, REDNESS OR SWELLING IN
✓ Disappears within 30 minutes THE INJECTION SITE
b) ULCER/RED SORE FORMATION ✓ Teach mother to perform COLD
✓ May appear 2 weeks after injection compress FIRST before HOT
and may persist for another 2 compress
weeks to heal
✓ Keep dry and clean (Do not put any
ointment on the sore or give the
child any medicine)

c) SCAR FORMATION DPT

✓ About 5 mm ➢ The recommended schedule is: 4 weeks
✓ Scar at 12 weeks after injection interval between doses
(2-5 months) a) DPT 1 – 6 weeks
✓ Sign that the child has been b) DPT 2 – 10 weeks
effectively immunized c) DPT 3 – 14 weeks
 ➢ MILD REACTIONS: ➢ LATE dose: 15 months
a) FEVER ➢ Catch up dose: 4-5 y/o
✓ Child may have fever in the
evening AFTER receiving DPT IMPORTANT NOTES:
vaccine 1) It is safe to vaccinate a sick child who is
✓ Fever should disappear within a suffering from a minor illness
day 2) When handling vaccines, the FIRST step is to
✓ NOTE: FEVER that begins more CHECK the vial for EXPIRATION DATE
than 25 hours after a DPT 3) Use standard refrigerator with separate
injection is UNLIKELY to be a freezer door and seal for vaccines
reaction to the vaccine 4) Vaccines can be mixed in a single syringe
b) SORENESS when:
c) PAIN a) Vaccines are licenses and labeled to be
d) REDNESS OR SWELLING AT INJECTION mixed
SITE 5) BCG vaccine protects against TB in infants
➢ WATCH OUT FOR: ABSCESS FORMATION 6) BCG vaccine amber glass ampules is to protect
✓ An abscess may develop a week or from ultraviolet and fluorescent light to
more after a DPT infection due to: MAINTAIN POTENCY
1. Unsterile needle or syringe 7) BCG also should be discarded AFTER 6 HOURS
was used of reconstitution because of risk of
2. Wrong technique contamination d/t lack of preservative and
3. Vaccine was note injected into loss of potency
the muscle 8) BCG vaccine is NOT damaged by freezing
➢ DPT vaccine should NOT be given: 9) Store BCG Vaccine and its diluent side-by-side
a) Children over 5 years of age in a refrigerator or vaccine carrier
b) Children who have suffered a severe 10) BCG is administered via ID route at (R) deltoid
reaction to a previous dose of DPT 11) NEVER immunize in buttocks, IM vaccines like
vaccine HepB, DPT, IPV, Pentavalent and PCV should
➢ Instead, a COMBINATION OF DIPHTHERIA be administered muscle of the upper outer of
AND TETANUS TOXOIDS (DT) should be given the thigh
12) Measles is given ONCE, SQ injection in the
OPV OUTER UPPER (R) arm
➢ The recommended schedule is: 4 weeks 13) The Measles, Mumps, Rubella, Vaccine (MMR)
interval between doses can be stored either in the freezer or the
a) OPV 1 – 6 weeks refrigerator
b) OPV 2 – 10 weeks 14) Protect reconstituted measles vaccine from
c) OPV 3 – 14 weeks sunlight. WRAP IT WITH FOIL
➢ NO SIDE EFFECT 15) If a child has diarrhea, give OPV as usual but
administer an extra dose
ROTAVAC ✓ 5th dose, at least 4 weeks after he or
➢ The recommended schedule is: she has received the last dose in the
d) ROTAVAC 1 – 6 weeks schedule
e) ROTAVAC 2 – 10 weeks to a maximum of 16) Diphtheria and Tetanus toxoid parts re
32 weeks damaged by freezing
➢ Rare and mild side effects
➢ Fussiness, mild diarrhea, and vomiting
17) For outreach session using vaccine carriers or
old box:
MEASLES a) Do not let DPT, TT or HepB vaccine
➢ Regular schedule: 9 months vials touch the cold dogs/ice packs.
➢ NOTE: if the child aged 6-9 months when b) Put or wrap newspaper or cardboard
hospitalized should receive measles vaccine around DPT, TT, or HepB to protect
apart from the scheduled vaccine at 9 months them from freezing
➢ In case of outbreak: may be given at 6 months 18) PERTUSSIS vaccine is damaged by heat
(EARLIEST dose) 19) Pertussis causes the fever after DPT shot
 20) If a child spits out, regurgitates the vaccine b) Total number of mothers for
drops, or vomits immediately after a dose of immunization = 3.5% or 0.035
OPV, it is safe to repeat the doe (DO NOT BF ➢ EXAMPLE: Midwife Lorna was assigned to Bgy.
immediately) San Roque with 20 000 population. How many
infants are expected to receive measles
VACCINATION CARD injection
a) Date of administration ✓ TP = 20 000
b) Vaccine manufacturer ✓ EP = 3% (Infants)
c) Vaccine lot number ✓ 20 000 x 0.03 = 600 infants
d) Name and title of the person who
administered the vaccine STEP 2: DETERMINE THE TOTAL VACCINE
REQUIRED (TVR)
HERD IMMUNITY ➢ FORMULA: Eligible Population x Number of
➢ Occurs when a high percentage of the doses to complete immunization = TVR
community is immune to a disease (through a ➢ 600 infants x 1 dose of measles = 600 TVR
vaccination and/or prior illness) making the
spread of the disease from person to person is STEP 3: DETERMINE THE ANNUAL VACCINE DOSES
unlikely. REQUIRED (AVR)
➢ FORMULA: Total Vaccine dose Required x
TARGET SETTING Wastage Factor of the vaccine (refer to table
1) BCG above)
➢ Number of Doses: 1 ➢ 600 (TVR) x 2 (constant wastage factor of
➢ Number of Doses per ampule: 20 measles) = 1200 AVR
➢ Wastage factor: 2.5
2) HepB EXAMPLE 1: Lorna has an eligible target of 600 (0-1
➢ Number of Doses: 3 y/o) for the current year. If she computes her EPI
➢ Number of Doses per ampule: 10 target on anti-measles. How many vials of 10 doses
➢ Wastage factor: 1.10 will she need?
3) DPT ✓ ANSWER: 120 vials
➢ Number of Doses: 3 ✓ 600 x1 = 600
➢ Number of Doses per ampule: 20 ✓ 600 x 2 = 1200
➢ Wastage factor: 1.67 ✓ 1200/10 = 120 vials
4) OPV
➢ Number of Doses: 3 STEP 4: DETERMINE ANNUAL VACCINE AMPULE OR
➢ Number of Doses per ampule: 20 VIAL (AVA)
➢ Wastage factor: 1.67 ➢ FORMULA: Annual Vaccine Doses Required
5) MEASLES (AVR)/number of doses per ampule
➢ Number of Doses: 1 ➢ 1200 (AVR)/ 10 doses per ampule of measles
➢ Number of Doses per ampule: 10 = 120 ampules of measles
➢ Wastage factor: 2
6) TETANUS TOXOID EXAMPLE 2: Nurse Ling Ling has a total eligible target
➢ Number of Doses: 5 of 205 (mothers), If she computes her EPI target on
➢ Number of Doses per ampule: 10 Tetanus Toxoid, how many vials of 20 doses will she
➢ Wastage factor: 1.67 need?
✓ 205 x 5 (doses of TT) = 1025

STEP 1: DETERMINE THE ELIGIBLE POPULATION MATERNAL HEALTH PROGRAM

OUT OF THE GIVEN TOTAL POPULATION
MCHP
COMPUTE FOR ELIGIBLE POPULATION ➢ The Philippines is tasked to reduce the
➢ FORMULA: TOTAL POPULATION x Target Maternal Mortality Ratio (MMR) by three
Setting = Eligible Population quarters or 75% by 2015 to achieve its MDG
➢ For Target Setting of Eligible Population: ➢ This means a MMR of 112/100, 000 live births
a) Total number of children & infants for in 2010
immunization = 3% or 0.03 ➢ 80/100,000 live births by 2015
 DAILY IRON & FOLIC ACID SUPPLEMENTATION
HOME BASED MOTHER’S RECORD (HBMR) DURING PREGNANCY
➢ Tool used when rendering prenatal care ➢ WHO & National Guidelines recommended all
containing risk factors and danger signs pregnant women should receive a daily Oral
➢ A system for recording risk factors, early sings Fe and Folic Acid supplementation dose of
of complications, referrals and treatment of DAILY 60 mg of Fe + 400mcg (0.4 mg) Folic
the mother Acid for 6 months (125 days)
➢ PANEL 1: Maternal Information ✓ To prevent maternal anemia, puerperal
(demographics) sepsis, LBWs and Preterm birth
➢ PANEL 2: Danger signs/Risk factors/Present ➢ Folic Acid is the chief
pregnant condition ➢ TAKE NOTE: Folic acid should be commenced
➢ PANEL 3: Actions by referral as early as possible (ideally before conception)
➢ PANEL 4: Family planning/Postpartum Care to prevent NTDs

RISK FACTORS PRENATAL CONTACT/VISIT

a) Height 145 cm tall (4 ft & 9 in) ➢ 8 or more Prenatal contacts for antenatal
b) Age below 18 y/o (PIH) ; above 35 y/o (H- care can reduce perinatal deaths by up to 8 per
mole, Placental Previa) 1000 births when compared to 4 visits
c) Recent pregnancy was C/S delivery ➢ It recommends pregnant women to have their
d) Multiparity and last baby born was less than a first contact in the FIRST 12 weeks AOG with
years ago subsequent contacts taking place at:
e) Family history of DM, Hypertension, and Heart a) 20 weeks AOG
disease b) 26 weeks AOG
f) Underlying condition like TB, Goiter, c) 30 weeks AOG
Bronchial Asthma, Severe Anemia d) 34 weeks AOG
g) Less than 45 kg or more than 80 kg weight e) 36 weeks AOG
f) 38 weeks AOG
DANGER SIGNS g) 40 weeks AOG
1) Any type of vaginal bleeding
2) Headache, Dizziness, Blurred Vision (Pre- NUTRITION
Eclampsia/Gestational HTN) ➢ Emphasize the importance of nutrition during
3) Puffiness of the face and hands (Facial each prenatal contacts
Edema/Peripheral Edema) 1) Eat nutritious foods like fruits &
4) Pale and Anemic vegetables
5) Any watery discharges (PROM) 2) Avoid excessive weight gain
3) Daily oral Fe and Folic Acid (600 mg Fe +
MATERNAL DEATHS 400 mcg Folic Acid)
➢ Maternal Mortality: 10-11 mothers die each 4) Daily calcium supplementation (1.5-2 g)
day d/t pregnancy and delivery complication ✓ Prevents eclampsia
➢ MATERNAL DEATH: 5) NO SMOKING and NO DRINKING
✓ Death of a woman while pregnant or ALCOHOL
within 42 days of termination of
pregnancy

TETANUS TOXOID IMMUNIZATION

DIRECT MATERNAL DEATHS (HOUSE) ➢ Both mother & child are protected against
a) Hemorrhage tetanus & neonatal tetanus
b) Obstructed Labor ➢ A series of 2 doses of TT vaccination must be
c) Unsafe Abortion received by a women 1month before delivery
d) Sepsis to protect baby from neonatal tetanus
✓ Endometriosis (most common ➢ And the 3 booster dose shots to complete the
puerperal sepsis) 5 doses following the recommended schedule
e) Eclampsia and PIH provide full protection for both mother &
child.
 ➢ The mother is then called a “FULY ➢ 4th Pregnancy (G4) 0 give TT5 (3rd booster dose)
IMMUNIZED MOTHER” (FIM)
➢ There are many kinds of vaccines used to TAKE NOTE:
protect against tetanus, all of which are 1) If a pregnant mother received TT injection, she
combined with vaccines for other diseases: is protected from tetanus infection through
DT, DTaP, TD, Tdap ARTIFICIAL ACTIVE IMMUNITY
2) 2 TT doses (TT2) protects for 1-3 years
VACCINE MAXIMUM PERCENT DURATION although some studies indicate even longer
AGE PROTECTED PROTECTED protection
INTERVAL 3) TT is SAFE during pregnancy
4) If a pregnant mother has received 2 doses of TT.
TT1 (0.5 As early as None None The baby is protected from tetanus
mL IM) possible neonatorum through NATURAL PASSIVE
during IMMUNITY
pregnancy 5) TT3 is administered 6 months after TT2
6) The nurse understands that the client can be
During 6 considered fully immunized against tetanus if
months of she received how many booster doses of TT?
pregnancy ANSWER: THREE
7) Which of the following dose of TT is given to the
TT2 At least 4 80% Gives 1-3 mother to protect her infant from neonatal
weeks after years tetanus and likewise provide 10 years
TT1 protection protection for the mother? ANSWER: TT4
8) Of the mother receives TT4 vaccine: this will
give her protection that lasts up to 10 years
TT3 At least 6 95% Gives at least
months after 5 years 9) A pregnant woman had just receive 4th dose of
TT, subsequently her baby will have protection
TT2 protection
against tetanus for how long? ANSWER: 1 year

TT4 At least 1 99% Gives at least INTRAPARTAL CARE:

year after 10 years ➢ Deliver at the Health Facility
TT3 or protection ➢ FOLLOW UNANG YAKAP PROTOCOL
during 1) Dry thoroughly (first 30 seconds)
subsequent 2) Skin to skin contact (after 30 minutes)
pregnancy 3) Properly timed cord clamping (within 1-
3 minutes)
4) Early Breastfeeding and Rooming In
(within 90 minutes)
TT5 At least 1 99% Gives lifetime
year after protection
TT4 or
during
subsequent
pregnancy
IMMINENT HOME DELIVERY
TETANUS TOXOID ➢ In case of imminent delivery at home, birth
➢ To protect mother and her baby against attendants must be aware of the CLEAN
Clostridium-borne infection; injected TWICE principles of HOME DELIVERY
during pregnancy ➢ 5 CLEANS:
➢ Dose: 0.5 mL 1) CLEAN hands of attendant
➢ Route: IM 2) CLEAN surface
➢ Site: (R) & (L) Deltoid/Buttocks 3) CLEAN cord
➢ 1st Pregnancy (G1) – give TT1 and TT2 (CBQ) 4) CLEAN cord tie without dressing
➢ 2nd Pregnancy (G2) – give TT3 (1st booster dose) 5) CLEAN and dry wrapping of baby
➢ 3rd Pregnancy (G3) – give TT4 (2nd booster dose)
POSTPARTUM CARE 3) REFINED SUGAR – with vitamin A
➢ Delay facility discharge for at least 24 hours 4) COOKING OIL – with vitamin A
➢ Visit women and babies with home births 5) Other staple foods:
WITHIN THE FIRST 24 hours a) STAR Margarine (1992)
➢ FIRST 24 hours assess for vaginal bleeding, ✓ FIRST ever product to partner
uterine contractions, vital signs and voiding with DOH and the FIRST to
within 6 hours reserve the Sangkap Pinoy Seal

POSTPARTUM VISIT GOVERNMENT SUPPORT PROGRAMS

➢ Provide every mother and baby a total of 4 1) Sustansya Para Sa Masa
POSTPARTAL VISITS on: 2) Pan De Bida (Pandesal with Vitamin A)
a) 1st visit: 1st day (within first 24 hours) 3) NUTRI BAN
b) 2nd visit: Day 3 (48-72 hours) 4) SALT FORTIFICATION
c) 3rd visit: Between 7-14 days a) RA 8172 (Act for Salt Iodization
d) 4th visit: 6 weeks Nationwide –ASIN LAW)
➢ For a woman who delivered at the health b) Use salt with “FIDEL” seal
facility: (Fortification for Iodine Deficiency
a) 1st visit: within FIRST week preferably Elimination)
2-3 days after delivery
b) 2,d visit: end of puerperium or 4-6 IODINE
weeks after delivery ➢ For proper functioning of thyroid, growth and
development of the brain
MICRONUTRIENT DEFICIENCY (IVI) ➢ Iodine deficiency is a leading cause of
a) IRON = causing ANEMIA preventable brain damage and reduced IQ
b) VITAMIN A = causing NIGHT BLINDNESS among children worldwide
c) IODINE = causing CRETINISM ➢ Iodine Deficiency Disorder (IDD) during
pregnancy may result in stillbirth,
NUTRITION miscarriage, and congenital abnormalities
➢ Nutrition LAW: PD 491 such as cretinism
➢ Nutrition month: JULY ➢ For iodine supplementation give iodized oil
➢ MOST VULNERABLE TO MALNUTRITION: capsule with 200 mg iodine, 1 cap for 1 year
a) Children
b) Lactating mothers GOITER
c) Infants ➢ Common in mountainous or inlands or
d) Pregnant uplands areas where iodine content in the soil,
➢ RA 8976 – Philippine Food Fortification Act of water and food are different
2000 ➢ Endemic goiter is more common among girls
➢ FOOD FORTIFICATION: than boys and among women than men.
✓ Addition of Sangkap Pinoy or ➢ Effect of iodine deficiency to fetus may be born
Micronutrient such as Vitamin A, Iron mentally and physically retarded
and Iodine to food.

SANGKAP PINOY SEAL PROGRAM (SPSP) OBESITY

➢ A strategy to encourage food manufacturers to ➢ A risk factor for many chronic diseases
fortify processed foods or food products with including heart disease, cancer, hypertension
essential nutrients at levels approved by DOH and DM.
and use its seal ➢ ABC for healthy nutrition:
➢ The seal is a guide used by consumers in 1) Aim for fitness
selecting nutrition’s foods 2) Build a healthy base
3) Choose sensibly
MANDATORY FOOD FORTIFICATION
1) RICE – with Iron 3 SOMATOTYPES OR BODY TYPES
2) WHEAT FLOUR – with vitamin A and Iron
 1) ECTOMORPH = Skinny; Difficulty in gaining c) Legumes
weight d) Leafy green vegetables
✓ Narrow hips and clavicles 1. Camote (Sweet Potatoes)
✓ Small joints (wrist/ankles) 2. Kangkong
✓ Thin build 3. Malunggay
✓ Stringy muscle bellies ➢ TREATMENT of IDA: FeSO4
✓ Long limbs a) Mainstay treatment
2) MESOMORPH = Naturally muscular; easy b) Continued for about 2 months after
gain and loses weight correction of the anemia
✓ Wide clavicles c) Ferrous sulfate is the most common
✓ Narrow waist and CHEAPEST form of iron utilized
✓ Thinner joints ➢ MOST COMMON SIDE EFFECTS OF IRON
✓ Long and round muscle bellies a) Constipation
3) ENDOMORPH = Round; Difficulty in losing b) Unpleasant taste
weight; slower metabolism c) Nausea & Vomiting
✓ Blocky d) Tarry stool (Dark discolored stool)
✓ Thick rib cage ✓ NORMAL side effect
✓ Wide/thicker joints
✓ Hips as wide (or wider) than clavicles VITAMIN A DEFICIENCY (VAD)
✓ Shorter limbs ➢ VAD Causes:
✓ High body fat (Central Obesity) a) Inadequate nutritional intake of
✓ Pear-shaped Vitamin A rich foods
✓ High tendency to store body fat b) Lack of fats/oils in diet
c) Rapid utilization of Vitamin A during
IRON DEFICIENCY ANEMIA (IDA) course of illness
➢ Normal Hgb Level: d) Liver disorders = 80-90% of Vitamin A
a) MALES: 14-18 g/dL is stored in liver
b) FEMALES: 12-16 g/dL e) Long term drinking alcohol lowers
➢ According WHO, anemia is defined as: Vitamin A levels in the liver
a) Hgb levels <12 g/dL in women ➢ VULNERABLE GROUPS
b) Hgb levels <13 g/dL in men a) Infants
➢ In children above 2 years old b) Preschoolers
➢ Anemia is worsened by hookworm and c) Pregnant
whipworm ➢ VAD S/Sx:
➢ Give Mebendazole + Iron supplement a) NIGHT BLINDNESS (EARLIST SIGN)
➢ RISK INDIVIDUALS: WOMEN ✓ Impaired dark adaptation d/t
a) Women at childbearing age lack of rhodopsin
b) Old age/elderly (NYCTALOPIA)
c) Menstrual and GI bleeding (heavy) b) XEROPHTHALMIA
d) Enteric parasitism (hookworm, ascaris ✓ Dry, thickened conjunctiva and
& trichuris) cornea
e) Not enough iron intake c) BITOT’S SPOTS
➢ CLINICAL MANIFESTATIONS: PALENESS ✓ Foamy soapsuds-like spots on
a) Pallor white part of the eye
b) Anorexia
c) Lightheadedness d) KERATOMALACIA
d) Easy fatigability ✓ Corneal erosions and
e) Nail brittleness (koilonychia) ulcerations
f) Enlargement of spleen e) BLINDNESS (END STAGE)
g) SOB ✓ Irreversible eye blindness
h) Sore/cramps of muscles (restless legs
syndrome) VITAMIN A SUPPLEMENTATION
➢ PREVENTION & MANAGEMENT: ➢ Provides PROTECTION UP TO 6 MONTHS
a) Liver products
b) Lean & Red meats SCHEDULE INFANTS PRESCHOOLERS
 (6-11 (12-59 months) b) MARASMUS
months) ✓ CALORIE deficiency intake
TODAY 100,000 IU 200,000 IU c) MARASMIC KWASHIORKOR
(Blue (Red capsule) ✓ Marked protein deficiency and
capsule) marked calorie insufficiency
AFTER 6 100,000 IU 200,000 IU signs present, sometimes
MONTHS (Blue (Red capsule) referred to as the MOST
capsule) SEVERE FORM OF
Given 100,000 IU 200,000 IU MALNUTRITION
immediately (Blue (Red capsule)
upon capsule) NUTRITIONAL INDICATORS
diagnosis 1) Arm Circumference (MUAC) – GOLD Standard
2) Low Height for Age (STUNTING)
(GIVE ONE 3) Low Weight for Age (Underweight)
CAPSULE) 4) Low Weight for Height (Wasting)
Given the 100,000 IU 200,000 IU  TAKE NOTE: classical indicator used by
next day (Blue (Red capsule) experts to diagnose MARASMUS:
capsule) a) Weight for Height (WFH) Z score of
Given after 2 100,000 IU 200,000 IU less than -3
weeks (Blue (Red capsule) ✓ BEST INDICATOR OF
capsule) MORTALITY

VITAMIN A SUPPLEMENTATION FOR PREGNANT MUAC INDICATORS (Mid-Upper Arm Circumference)

AND POSTPARTUM MOTHERS <110 mm RED SEVERE ACUTE Child should
TARGETS SCHEDULE DURATION REMARKS (11.0 cm) COLOUR MALNUTRITION be
PREGNANT 1 capsule of Start from 4th NEVER give (SAM) immediately
10,000 IU month of more than referred for
pregnancy 10,000 IU treatment
TWICE a because it is
week TERATOGENIC
Between RED MODERATE ACUTE
110-125 mm COLOUR MALNUTRITION (MAM)
(Colorless (3-color
capsule) (11.0-12.5 tape)
POSTPARTUM 1 capsule of 1 dose only Lactating cm)
200,000 IU within 1 mothers
month after should receive Or
(Red capsule) delivery up to 200,000 IU
4 deliveries once within ORANGE
the 1st month COLOUR
after delivery
in order to
(4-color
supplement tape)
breast milk Between YELLOW Child is at RISK FOR ACUTE
125-135 mm COLOUR MALNUTRITION and should be
TREATMENT SCHEDULE FOR XERPOHTHALMIA FOR counseled
PREGNANT WOMEN (12.5-13.5
a) Pregnant women with night-blindness cm) Followed up for Growth
b) 1 capsule of 10,000 IU (Colorless capsule) Promotion and Monitoring
c) 1 capsule, once a day regardless of the AOG (GPM)

>135 mm GREEN WELL-NOURISHED CHILD

(>13.5 cm) COLOUR

PROTEIN ENERGY MALNUTRITION (PEM) SERUM ALBUMIN

➢ TYPES INCLUDE: ➢ Found to be a better predictor of underlying
a) KWASHIORKOR malnutrition than BMI
✓ PROTEIN malnutrition ➢ Most widely used laboratory measures of
predominant nutritional status
 ➢ Good marker of nutritional status d) Skin lesions
1. Hyperkeratosis
MARASMUS 2. Dermatoses
➢ Wasting/Withering Malnutrition 3. Dyspigmentation
➢ Cause by TOTAL CALORIC DEFICIENCY
➢ HALLMARK SIGN:
a) Visible generalized muscle
wasting/withering
➢ CLINICAL MANIFESTATIONS: CALORIES
a) Caloric deficiency (deficiency of ALL
NUTRIENTS)
b) Active & Irritable
c) Liver is NOT enlarged (NO FATTY
LIVER)
d) Old man look/Chipmunk face or
Monkey face with Lanugo
e) Retarded growth (Severe)
f) Infants under 1 year old are commonly
affected
g) Eager or Voracious appetite
h) Severe Muscle Wasting
➢ TAKE NOTE: MARASMUS may also have:
a) Baggy pants appearance (REFER
IMMEDIATELY!)
b) No hair color changes (appears
normal)
c) Loose wrinkled skin/Emaciated look
d) Weight loss
e) Child is like skin & bones (RIBS ARE
VERY PROMINENT)
f) Child may also have diarrhea &
dehydration

KWASHIORKOR
➢ Edematous Malnutrition
➢ Caused by PROTEIN DEFICIENCY
➢ HALLMARK SIGN: Edema of both feet
➢ CLINICAL MANIFESTATIONS: PROTEINS
a) Pot belly/Large swollen protruding
belly (ENLARGED FATTY LIVER)
b) Ribs are NOT PROMINENT
c) Occurs in children older than 18
months to 2 y/o
d) Thin muscles & small MUAC
e) EDEMATOUS “Moon face” appearance
f) Increased risk of infection
g) No or lack of appetite (anorexia)
h) Sluggish, apathetic, lethargic,
unresponsive

➢ TAKE NOTE: KWASHIORKOR may also have:

a) Dry sparse discolored hair (FLAG
SIGN)
b) Growth retardation
c) Anemia