(DOH Programs)

A. EXPANDED PROGRAM ON IMMUNIZATION

Legal basis

PD 996 (Sept. 16, 1976) providing compulsory basic immunization for infants and
children below 8 years
old (Marcos)
PD no. 6 (April 3, 1986) implementing a United nations goal on universal child
immunization by 1990 (Cory Aquino)
PD no. 147 (March 3, 1993) declaring April 21 and may 17 and every 3 rd Wednesday
thereafter for 2 years as National Immunization Days (Ramos)
PD no. 46 (Sept. 16, 1992) reaffirming the commitment to the universal child and
mother immunization goal by launching the polio eradication project (FVR)
RA 7846 (Dec. 30, 1944) an act requiring compulsory immunization against hepatitis B
for infants and children below 8 years old.
PP no. 773 (March 28, 1996) declaring April 17 and May from 1996 to 2000 as knock
out polio days.
PP no. 1066 (Aug. 26, 1997) declaring a national neonatal elimination campaign for
1997.
PP no. 1064 (Aug. 27, 1997) enjoining all sectors of society to participate in the acute
flaccid paralysis surveillance component of polio eradication campaign of the Philippines.
PP no. 4 (July 29, 1998) declaring Sept. 16 to Oct. 14, 1998 as the Ligtas Tigdas Month
and launching of Phil. Measles elimination campaign.

7 immunizable diseases in
children

Measles
Poliomyelitis
Pertussis / whooping cough
Tetanus
Tuberculosis
Hepatitis B
Diptheria

Measles (RUBEOLA)

Agent measles virus

Reservoir- man, mostly children
Incubation period about 10 days (8 13 days from
exposure to onset of fever)
Mode of transmission droplet infection, direct contact
(nasal, throat, urine, secretions of infected individuals)
Period of communicability from 1- 3 days before beginning
of fever and cough. Decreases rapidly after onset of rash.
A typical illness
Day 1 3 = colds, cough and high fever, eyes are pink, watery
and sensitive to light. (catarrhal symptoms)
Day 2 4 = rash spreads over the face and body, over 8 hours,
slightly raised. After a week, rash disappear and skin may peel.
Pathognomonic sign kopliks spot. (sign or symptoms
specific to a disease)
Rash appears first behind the ears, then the chest and
extremities (cephalocaudal)
Causes of death bronchopneumonia

Pertussis (whooping cough)

Causative agent bordetella pertussis

Reservoir: man
Incubation period 7 days ( 5-15 days)
Mode of transmission direct contact with dialysis from
resp. mucous membrane, droplet / airborne, indirect
contact with articles freshly soiled with discharges.
1st Week symptoms of colds
2nd week cough gets worse and doesnt stop
In china it is called the 100 days cough
The characteristic struggle to breathe and whoops in a
breath, vomits and the cycle repeats, cough whoop
vomit
3rd week cough slowly subsides
Method of prevention:
Immunization, isolation, handle secretion carefully

Tetanus (tetanus neonatorum)

Causative agent clostridium tetani (anaerobic)
Reservoir: soil, feces of fowls, man
Mode of transmission unhygienic cutting of umbilical cord
and improper handling of umbilical cord.
Incubation period 6 days (3-21 days)
At birth: normal sucking
5 7 days = lock jaw (trismus), stop sucking
7-10 days = episthotonus
Method of prevention and control:
Immunization of mothers
Health education:
> PHN should report cases immediately including case
history.
> Employ measures to decrease frequency of and severity of
convulsion and spasm (noise, lights)

Tuberculosis:
Causative agent mycobacterium
tuberculosis
Reservoir: man, diseased cattle
Mode of transmission droplet
infection and direct contact
Incubation period 4 12 weeks
Prevention: immunization

Diphtheria

Causative agent: Corynebacterium Diphtherae

Reservoir: man
Mode of transmission droplet infection
Incubation period 2-5 days
Pathoneumonic sign pseudomembrane
1 3 days = sore throat, unwell
4 6 days = ill, neck swelling/swollen neck,
pseudomembrane, difficulty in breathing.
After 2 weeks toxin may cause heart failure,
paralysis of breathing then DEATH.

Hepatitis B:
Causative agent: Hepa B virus
Reservoir: man
Mode of transmission child to child,
mother to child, blood transfusion,
unsterilized needles sharing, knives and
razors, sexual contact.
Incubation period 45 to 180 days (60
90 days)
Could be around 2 weeks

Target Setting
1. To achieve universal child
immunization
goal.
2. Target population
3. Eligible infants and children (3%)
=.03
4. Eligible pregnant women (3.5%) = .
035
Example: population is 20,000
Eligible infants = 20,000 x .03 ans. is 600

Vaccines
1. BCG

live attenuated (bacillus calmette and guerin)

freeze dried
20 doses / ampoule
destroyed by heat / sunlight
+ 20C to + 80C

2. DPT

toxoids (weakened toxin /killed)

liquid bacteria
10 doses / vial
destroyed by freezing / heat
+ 20C to + 80C

3. Polio Vaccine (live attenuated )

liquid
20 doses / vial
damaged by heat but not freezing
-150C to 250C

4. Measles

live attenuated
freeze dried
10 doses / vial
damaged by heat but not freezing
- 250C to 250C

5. Tetanus toxoid

weakened toxin
liquid
20 doses / vial
damaged by heat / freezing
+ 20C to + 80C

6. Hepatitis B vaccine

plasma derived, RNA recombinant

liquid
1 dose / vial
10 doses / vial
damaged by heat / freezing
+ 20C to + 80C

Cold Chain
A system for ensuring the patency of a
vaccine from the time of manufacture to the
time it is given to an eligible child or woman.
Supplies / manufacture airplane
central cold room of the national service
plane or by track regional cold room /
freezers truck / plane IPHO cold rooms /
freezers cars/other transportation
district hospital cars / other transportation
RHU Brgy. Health center community.

Calculation of supplies needed

BCG1 = EP x 40% (1.67)
BCG2 = EP x 25% (1.34)
DPT = EP x 3 x 40% (1.67)
HepBV= EP x 40% (ST) X 3 X 10%
(1.10)
MEASLES = EP x 5-0% (2)
TETANUS = EP x 5 X 40% (1.67)
SYRINGES = EP x doses x 25% (1.34)
NEEDLES
= EP x doses x 2

B. MATERNAL CHILD HEALTH/ SAFE

MOTHER HOOD
COMPREHENSIVE MATERNAL AND CHILD HEALTH
PROGRAMS

EPI (Expanded Program on Immunization)

CDD (Control of Diarrheal Diseases)
CARI (Control of Acute Respiratory Infections)
UFC (Under-Five Clinics)
MC (Maternal Care)
BF (Breastfeeding)
MRP (Malnutrition Rehabilitation Program)
VAD ( Vitamin A Deficiency)
IDD/IDA (Iodine Deficiency Disorders/ Iron Deficiency
Anemia)
FP (Family Planning)

EPI (EXPANDED PROGRAM ON IMMUNIZATION

TARGET SETTING:
INFANTS 0-12 MONTHS
PREGNANT AND POST PARTUM WOMEN
SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD

OBJECTIVES OF EPI:
TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND
CHILDREN FROM SIX CHILDHOOD IMMUNIZABLE DISEASE
ELEMENTS

OF EPI:

> TARGET SETTING

> COLDCHAIN LOGISTIC MANAGEMENT- Vaccine distribution through cold chain is
designed to ensure that the vaccine was maintained under proper environmental
condition
until the time of administration.
> IEC
> Assessment and evaluation of Over-all performance of the program
> Surveillance and research studies.

REPRODUCTIVE HEALTH

- a state of complete physical, mental and

social well-being and not merely the absence
of disease/ infirmity in all matters relating to
the reproductive system and to its functions
and processes.

Basic RH Rights
> Right to RH information and health care services for safe
pregnancy and childbirth
> Right to know different means of regulating fertility to
preserve health and where to obtain them
> Freedom to decide the number and timing of birth of children
> Right to exercise satisfying sex life

 Factors/ determinants of RH

Socioeconomic conditions
education, employment, poverty, nutrition, living condition/ environment, family
environment
Status of women
equal right in education and in making decisions about her own RH; right to be
free from torture and ill treatment and to participate in politics
Social and Gender Issues
Biological (individual knowledge of reproductive organs and their functions),
cultural (countrys norms, RH practices) and psychosocial factors.

Elements

Maternal and Child Health Nutrition

Family Planning
Prevention and Management of Abortion Complications
Prevention and Treatment of Reproductive Tract Infections, including STDs, HIV
and AIDS
Education and Counseling on Sexuality and Sexual Health
Breast and Reproductive Tract Cancers and other Gynecological Conditions
Mens Reproductive Health
Adolescent Reproductive Health
Violence Against Women
Prevention and Treatment of Infertility and Sexual Disorders

 Selected Concepts
RH is the exercise of reproductive right with
responsibility
It means safe pregnancy and delivery, the right
of access to appropriate health information and
services
It includes protection from unwanted pregnancy
by having access to safe and acceptable methods
of family planning of their choice
It includes protection from harmful reproductive
practices and violence
It ensure sexual health for the purpose of
enhancement of life and personal relations and
assures access to information on sexuality to
achieve sexual enjoyment

 Goal
To achieve healthy sexual development and maturation
To achieve their reproductive intention
To avoid diseases, injuries and disabilities related to sexuality and
reproduction
To receive appropriate counseling and care of RH problems

Strategies
Increase and improve the use of more effective or modern contraceptive
methods
Provision of care, treatment and rehabilitation for RH
RH care provision should be focused on adolescents, men and unmarried
and other displaced people with RH problems
Strengthen outreach activities and referral system
Prevent specific RH problems through information dissemination and
of clients

Maternal and Child Health Nursing

Philosophy
Pregnancy, labor and delivery and puerperium are part of the
continuum of the total life cycle
Personal, cultural and religious attitudes and beliefs influence
the meaning of pregnancy for individuals and make each
experience unique
MCN is FAMILY CENTERED- the father is as important as the
mother

Goals:
To ensure that expectant mother and nursing mother
maintain good health, learn the art of child care, has a normal
delivery and bear healthy children
That every child lives and grows up in a family unit with love
and security, in healthy surroundings, receives adequate
nourishment, health supervision and efficient medical
attention and is taught the elements of healthy living

Classification of pregnant women

Normal healthy pregnancy
With mild complications- frequent home visits
With serious or potentially serious referred to
most skilled source of medical and hospital care

Prenatal Care

Schedule of Visit
1st as early as pregnancy, 1 st trimester
2nd - 2nd trimester
3rd & subsequent visits - 3 rd trimester
More frequent visits for those at risk client.

Vaccine

Minimum Age Interval

Percent
Protected

Duration of Protection

TT1

As Early As Possible During

Pregnancy

80%

Infants born to the mother will be

protected from neonatal tetanus.

TT2

At Least 4 Weeks Later

80%

Gives 3 years protection for the mother

from tetanus.

TT3

At Least 6 Months

90%

Infants born to the mother will be

protected from neonatal tetanus.

TT4

At Least 1 Year

99%

Gives 5 years protection for the mother.

TT5

At Least 1 Year Later

99%

Gives 100% protection for the mother

Gives lifetime protection for the mother.
All infants born to that mother
will be protected

TETANUS IMMUNIZATION SCHEDULE FOR WOMEN

Note: Dose:0.5ml
Route: Intramuscularly
Site: Right or Left Deltoid/Buttocks

Components

of Prenatal Visits

History taking
Determination of obstetrical score- G, P, TPAL,AOG,EDD
U/A for Proteinuria, glycosuria and infection
Dental exam
Wt. Ht. BP taking
Exam of conjunctiva and palms for pallor
Abdominal exam - fundic height, Leopolds maneuver and FHT
Exam of breasts, face, hands and feet for edema and neck for
thyroid enlargement
Health teachings- nutrition, personal hygiene, common complaints
Tetanus toxoid immunization
Iron supplementation from 5th mo. of pregnancy - 2 mos.
Postpartum
In goiter endemic areas iodized capsule once a year
In malaria infested areas- prophylactic Chloroquine ( 150 mg/tab
2 tabs/ wk for the whole duration of pregnancy

UNDER FIVE CLINIC

The first five years of life form the foundations
of the childs physical and mental growth and
development. Studies have shown the
mortality and morbidity are high among this
age group. The Department of Health
established the Under Five Clinic Program to
address this problem.

PROGRAM OBJECTIVES AND GOALS:

Monitor growth and development of the child
until 5 years of age.
Identify factors that may hinder the growth
and development of the child.

ACTIVITIES AND STRATEGIES:

1. Regular height and weight determination/
monitoring until 5 years old.
> 0-1year old=monthly
> 1 year old and above =quarterly
2. Recording of immunization, vitamins
supplementation, deworming and feeding.
3. Provision of IEC materials (ex. Posters, charts,
toys) that promote and enhance childs
proper
growth and development.
4. Provision of a safe and learning oriented
environment for the child.
5. Monitoring and Evaluation.

BREASTFEEDING/ LACTATION MANAGEMENT

EDUCATION TRAINING

Breastfeeding practices has been proved

to be very beneficial to both mother and
baby thus the creation of the following
laws support the full implementation of
this program:
Executive Order 51
Republic Act 7600
The Rooming-In and Breastfeeding Act of
1992
PROGRAM OBJECTIVES AND GOALS:
Protection and promotion of breastfeeding
and lactation management education training.

 ACTIVITIES AND STRATEGIES:

1.FULL IMPLEMENTATION OF LAW
2. SUPPORTING THE PROGRAM
EO 51 THE MILK CODE protection and promotion of
breastfeeding to ensure the safe and adequate nutrition of
infants through regulation of marketing of infant foods and
related products. (e.g. breast milk substitutes, infant formulas,
feeding bottles, teats etc. )
RA 7600 THE ROOMING IN and BREASTFEEDING ACT of 1992
> An act providing incentives to government and private health
institutions
promoting and practicing rooming-in and breast-feeding.
> Provision for human milk bank.
> Information, education and re-education drive
> Sanction and Regulation

3.CONDUCT ORIENTATION/ADVOCACY
MEETINGS TO HOSPITAL/ COMMUNITY.

ADVANTAGES OF BREASTFEEDING
MOTHER
Oxytocin help the uterus contracts
Uterine involution
Reduce incidence of Breast Cancer
Promote Maternal-Infant Bonding
Form of Family planning Method (Lactational
Amenorrhea)
BABY
Provides Antibodies
Contains Lactoferin (binds with Iron)
Leukocytes
Contains Bifidus factor-promotes growth of the
Lactobacillus-inhibits the growth of pathogenic
bacilli

 POSITIONS IN BF THE BABY:

1. Cradle Hold = head and neck are supported
2. Football Hold
3. Side Lying Position
B- BEST FOR BABIES
R- REDUCE INCIDENCE OF ALLERGENS
E- ECONOMICAL
A- ANTIBODIES PRESENT
S- STOOL INOFFENSIVE (GOLDEN YELLOW)
E-EMPERATURE ALWAYS IDEAL
F- FRESH MILK NEVER GOES OFF
E- EMOTIONALLY BONDING
E- EASY ONCE ESTABLISHED
D- DIGESTED EASILY
I- IMMEDIATELY AVAILABLE
N- NUTRITIONALLY OPTIMAL
G- GASTROENTERITIS GREATLY REDUCED

GARANTISADONG PAMBATA
(GP)
Garantisadong Pambata is a biannual
week long delivery of a package of
health services to children between
the ages of 0-59 months old with the
purpose of reducing morbidity and
mortality among under fives through
the promotion of positive Filipino
values for proper child growth and
development.

Health Service

Dosage

Route of
Administration

Target
Population

Vitamin A capsule

200,000 IU or 1 capsule
100,000 IU or cap or 3
drops

Orally bydrops

12-59 months old,

nationwide
9-12 month old infants
receiving AMV
nationwide

0.3ml(2-6 mos)once a day

0.6ml(6-11mos) once a day

Orally by drops

2-11 months old

infants in area, including
evacuation centers in armed
conflict areas.

0.05ml

Intradermal on right deltoid

0-11 mos

0.5ml

Intramuscularly on anterior
thigh

0-11 mos

2 drops

Orally

0-11 mos

0.5ml

Subcutaneously on deltoid

9-11 mos

0.5ml

Intramuscularly

0-11 mos

1 tablet as single dose

Orally

36-59 mos, nationwide

Ferrous Sulfate
(25 mg. Elemental Iron per
ml; 30 ml. Bottle as taken
home medicine
withinstructions)
Routine Immunization
-BCG*
-DPT*
-OPV*
-AMV*
-Hepa B (if available)

Deworming drug
(if available)

0-59 mos, nationwide

Weighing

Note: The child should not have received megadose of Vit. A above the recommended dosage within the past 4 weeks except if
the child has measles or signs and symptoms of Vit A. deficiency.
** For any child between 12-23 months, who missed any of his routine immunization, the health worker should give the child
the necessary antigen to complete FIC and shall be recorded as such antigen to complete FIC and shall be recorded as such.

GARANTISADONG PAMBATA
Sangkap Pinoy
Vitamin A, Iron and Iodine
-Sources: green leafy and yellow vegetables, fruits, liver,
seafoods, iodized salt, pan de bida and other fortified foods.
These micronutrients are not produced by the body, and must
be taken in the food we eat; essential in the normal process of
growth and development:
Helps the body to regulate itself
Necessary in energy metabolism
Vital in brain cell formation and mental development
Necessary in the body immune system to protect the body
from severe infection.
Eating Sangkap Pinoy-rich foods can prevent and control:
Protein Energy Malnutrition
Vitamin A Deficiency
Iron Deficiency Anemia
Iodine Deficiency Disorder

BREASTFEEDING (BF)
Breast milk is best for babies up to 2
years old. Exclusive breastfeeding is
recommended for the first six
months of life. At about six months,
give carefully selected nutritious
foods as supplements.

Breastfeeding provides physical

and psychological benefits for
children and mothers as well as
economic benefits for families and

BENEFITS :
For infants
Provides a nutritional complete food for the young infant.
Strengthens the infants immune system, preventing many
infections.
Safely rehydrates and provides essential nutrients to a sick child,
especially to those suffering from diarrheal diseases.
Reduces the infants exposure to infection.
For the Mother
Reduces a womans risk of excessive blood loss after birth
Provides a natural method of delaying pregnancies.
Reduces the risk of ovarian and breast cancers and osteoporosis.
For the Family and Community
Conserves funds that otherwise would be spent on breast milk
substitute, supplies and fuel to prepare them.
Saves medical costs to the families and government by preventing
illnesses and by providing immediate postpartum contraception.

COMPLEMENTARY FEEDING FOR BABIES 6-11 MONTHS OLD

What are Complementary Foods?

foods introduced to the child at the age 6 months to
supplement breastmilk.
given progressively until the child is used to three meals
and in-between feedings at the age of one year.

Why is there a Need to Give Complementary Foods?

breastmilk can be a single source of nourishment from
birth up to six months of life.

The childs demands for food increases as he grows

older and breastmilk alone is not enough to meet his
increased nutritional needs for rapid growth and
development
Breastmilk should be supplemented with other foods so
that the child can get additional nutrients

 Introduction of complementary foods will accustom him

to new foods that will also provide additional nutrients to
make him grow well
Breastfeeding, however, should continue for as long as
the mother is able and has milk which could be as long
as two years.
The childs demands for food increases as he grows older
and breastmilk alone is not enough to meet his increased
nutritional needs for rapid growth and development
Breastmilk should be supplemented with other foods so
that the child can get additional nutrients
Introduction of complementary foods will accustom him
to new foods that will also provide additional nutrients to
make him grow well
Breastfeeding, however, should continue for as long as
the mother is able and has milk which could be as long
as two years.

FAMILY PLANNING
The Philippine Family Planning Program is a national
program that systematically provides information and
services needed by women of reproductive age to
plan their families according to their own beliefs and
circumstances.
GOALS AND OBJECTIVES:
Universal access to family planning information,
education and services.
MISSION:
To provide the means and opportunities by which
married couples of reproductive age desirous of
spacing and limiting their pregnancies can realize
their reproductive goals.

TYPES OF METHODS:
A. NATURAL METHODS
1. Calendar or Rhythm Method
2. Basal Body Temperature Method
3. Cervical Mucus Method
4. Sympto-Thermal Method
5. Lactational Amennorhea

B. ARTIFICIAL METHODS
I. CHEMICAL METHODS
1.Ovulation suppressant such as PILLS
2. Depo-Provera
3. Spermicidals
4. Implant

II. MECHANICAL METHODS

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

C. SURGICAL METHODS
1. Vasectomy
2. Tubal Ligation

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

INJECTABLES
Dizziness
Severe headache
Heavy bleeding
BTL
Fever
Weakness
Rapid pulse
Persistent abdominal pain
Vomiting
Dizziness
Pus or tenderness at incision site
Amenorrhea

VASECTOMY
Fever
Scrotal blood clots or excessive swelling

MRP (Malnutrition Rehabilitation Program)

Goal:
To improve the nutritional status, productivity and quality of
life of the population thru adoption of desirable dietary
practices and healthy lifestyle

Objectives:
-Increase food and dietary energy intake of the average
Filipino
-Prevent nutritional deficiency diseases and nutrition-related
chronic degenerative diseases
-Promote a healthy well-balanced diet
-Promote food safety

Nutrition is a state of well-being achieved by eating the

right food in every meal and the proper utilization of the
nutrients by the body.

THE THREE (3) BASIC FOOD GROUPS ARE:

1. Body building food which are rich in protein and needed by the body for:
< normal growth and repair of worn-out body tissues
< supplying additional energy
< fighting infections
< Examples of protein-rich food are: fish; pork; chicken; beef; cheese;
butter; kidney beans; mongo; peanuts; bean curd; shrimp; clams

2. Energy-giving food which are rich in carbohydrates and fats and needed by the
body for:
< providing enough energy to make the body strong
< Examples of energy-giving food are: rice; corn; bread; cassava; sweet
potato; banana; sugar cane; honey; lard; cooking oil; coconut milk;
margarine; butter

3. Body-regulating food which are rich in Vitamins and minerals and needed by
the body for:
< normal development of the eyes, skin, hair, bones, and teeth
< increased protection against diseases
< Examples of body-regulating food are: tisa; ripe papaya; mango; guava;
yellow
corn; banana; orange; squash; car

Important vitamins and minerals

Vitamins

Vitamin A

Thiamine

Riboflavin

Niacin

Biotin

Pantothenic
Folic acid

Vitamin B 12

Functions
Maintain normal vision, skin health, bone and tooth growth
reproduction and immune function; prevents xerophthalmia.
Food sources:
Breastmilk;poultry;eggs; liver; meat;carrots;squash;
papaya;mango;tiesa; malunggay;kangkong; camote tops; ampalaya
tops.

Help release energy from nutrients; support normal appetite and

nerve function, prevent beri-beri.

Helps release energy from nutrients, support skin health, prevent

deficiency manifested by cracks and redness at corners of mouth;
inflammation of the tongue and dermatitis.

Help release energy from nutrients; support skin, nervous and

digestive system, prevents pellagra.

Help energy and amino acid metabolism; help in the synthesis of fat
glycogen.

Help in energy metabolism.

Help in the formation of DNA and new blood cells including red blood
cells; prevent anemia and some amino acids.

VITAMINS
Vitamin C

Vitamin D

Vitamin E

Vitamin K

Calcium

FUNCTIONS
Help in the formation of the new cells; maintain nerve cells, assist in
the metabolism of fatty acids and amino acids.
Help in the formation of protein, collagen, bone, teeth cartilage, skin
and scar tissue; facilitate in the absorption of iron from the
gastrointestinal tract; involve in amino acid metabolism; increase
resistance to infection, prevent scurvy.
Food sources:
Guava;pomelo;lemon;orange; calamansi; tomato; cashew

Help in the mineralization of bones by enhancing absorption of

calcium

Strong anti-oxidant; help prevent arteriosclerosis; protect neuromuscular system; important for normal immune function.

Involve in the synthesis of blood clotting proteins and a bone protein

that regulates blood calcium level.

Mineralization of bones and teeth, regulator of many of the bodys

biochemical processes, involve in blood clotting, muscle contraction
and relaxation, nerve functioning, blood pressure and immune
defenses.

Maintain normal fluid and electrolyte balance.

Work with insulin and is required for release of energy from glucose

MALNUTRITION
- An abnormal condition of the body resulting from the lack or excess of one or
more nutrients like protein, carbohydrates, fats, vitamins and minerals.

PRIMARY CAUSE: POVERTY

Lack of money to buy food Majority of the victims of malnutrition comes from
families of farmers, fisherfolk, and laborers who cannot afford to buy nutritious
foods.
Lack of food supply
Lack of information on proper nutrition and food values

SECONDARY CAUSES

Early weaning of child and improper introduction of supplementary food

Incomplete immunization of babies and children
Bad eating habits
Poor hygiene and environmental sanitation:
lack of potable water
lack of sanitary toilet
poor waste disposal
forms of malnutrition

FORMS OF MALNUTRITION
Protein-Energy Malnutrition (PEM) is a nutritional problem
resulting from a prolonged inadequate intake of bodybuilding
and/or energy-giving food in the diet.

Kinds:
MARASMUS
KWASHIORKOR
FORMS OF MALNUTRTION
MARASMUS
This child does not get the right amount and kind of energy food.
She/He:
< is always hungry
< has the face of an old man
< is very thin < easily gets sick
< looks weak
THIS CHILD IS JUST SKIN AND BONES

KWASHIORKOR
This child does not get enough body-building food,
although she/he may be getting enough energy.
She/He:
< has swollen face, hands, and feet
< easily gets sick
< has dry, thin, pale hair
< has sores on the skin
< has thin upper arms < looks sad
< has dry skin
< is underweight

THIS CHILD IS SKIN, BONES, AND WATER!

VITAMIN A DEFICIENCY (VAD)

a condition in which the level of Vitamin A in the body is low.
Causes:
not eating enough foods rich in vitamin A e.g. yellow vegetables and
lack of fat or oil in the diet which help the body absorb Vitamin A.
poor absorption or rapid utilization of Vitamin A during yellow fruits

Eye Signs
night blindness (early stage); total blindness (later stage)
bitots spot (foamy soapsuds-like spots on white part of the eye)
dry, hazy and rough appearing cornea
crater-like defect on cornea
softened cornea; sometimes bulging
Other Manifestations

increased cases of childhood sickness,

and death and decreased resistance to infection
susceptibility to childhood malnutrition and infection
(measles, diarrhea and pneumonia)

Prevention
eating foods rich in Vitamin A, such as liver, eggs,
milk, crab meat, cheese, dilis, malunggay, gabi
leaves, kamote tops, kangkong, alugbati, saluyot,
carrots, squash, ripe mango, including fats and oils
breastfeeding the child
immunizing the child
taking correct dose of Vitamin A capsules as
prescribed
VAD is most common in children suffering from
PEM and other infectious diseases. Bottle fed
infants are also at risk of VAD especially if the milk
formula used is not fortified with Vitamin A.
Common among preschoolers and infants ( FNRI)

SCHEDULE FOR TREATMENT OF

VITAMIN A DEFICIENCY
Schedule

Give 1 Dose

Infants 6-11mos

Preschoolers
(12-83) mos

Postpartum mothers

100,000 IU

200,000 IU

200,000 IU
Within
1month

Give after 6 100,000 IU

months High
risk
Condition
present

200,000 IU

After delivery
of each child
only

SCHEDULE FOR RECEIVING VITAMIN A

SUPPLEMENT TO INFANTS
PRESCHOOLERS AND MOTHERS

Schedule

Infants 6-11mos

preschoolers

Give today

100,000 IU

200,000 IU

Give
tomorrow

100,000 IU

200,000 IU

100,000 IU

200,000 IU

Give after 2
weeks

3. ANEMIA - a condition characterized by the

lack of iron in the body resulting in
paleness. S/S: paleness of the eyelids,
inner cheeks, palms and nailbeds; frequent
dizziness and easy fatigability.
Common cause:
inadequate intake of food rich in iron ; can also
be
caused by blood loss during menstruation,
pregnancy
and parasitic infections.
Prevention:
Eating iron-rich food such as liver and other
internal
organs; green leafy vegetables; and foods rich in
Vitamin C

Recommended Iron
Requirements

Dosage

Infants ( 6-12
months)

0.7 mg. Daily

Children ( 12-59
months)

1 mg daily

Children 0-59
month

3-6 mg./kg. Body

wt./day

4.GOITER
- Enlargement of thyroid gland due to lack of iodine
in the body.
-common in areas where the iodine content in the
soil, water and food are deficient.
- Effect of Iodine deficiency to fetus:
may be born mentally and physically retarded.
- Goiter can be prevented by:
< daily intake of food rich in iodine
< use of iodized salt
Iodine Supplementation
Dosage Children
0-59 months ( in endemic areas) =Iodine capsules
(200mg) potassium iodate in oil orally once a year.

CDD (CONTROL OF DIARRHEAL DISEASES

HEALTH AND SANITATION

Environmental Sanitation is still a health problem in the country. Diarrheal

diseases ranked second in the leading causes of morbidity among the general
population. Other sanitation related diseases : tuberculosis, intestinal parasitism,
schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic
fever

DOH thru Environmental Health Services (EHS) unit is authorized to act on all
issues and concerns in environment and health including the very comprehensive
Sanitation Code of the Philippines (PD 856, 1978).

EHS sets policies on:

Approved types of water facilities
Unapproved type of water facility
Access to safe and potable drinking water
Water quality and monitoring surveillance
Waterworks/Water system and well construction

WATER SUPPLY SANITATION PROGRAM

Approved type of water facilities
Level 1 (Point Source)a protected well or a developed spring with an outlet but without a distribution
system
indicated for rural areas
serves 15-25 households; its outreach is not more than 250 m from the farthest user
yields 40-140 L/ min

Level II ( Communal Faucet or Stand Posts)

With a source, reservoir, piped distribution network and communal faucets
Located at not more than 25 m from the farthest house
Delivers 40-80 L of water per capital per day to an average of 100 households
Fit for rural areas where houses are densely clustered

Level III ( Individual House Connections or Waterworks System)

With a source, reservoir, piped distributor network and household taps
Fit for densely populated urban communities
Requires minimum treatment or disinfection in mans physical environment, which
may exercise a deleterious effect on his health, well-being and survival.

PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM

EHS sets policies on: Approved types of toilet facilities :

LEVEL I
Non-water carriage toilet facility
no water necessary to wash the waste into receiving space
e.g.pit latrines, reed odorless earth closet.
- Toilet facilities requiring small amount of water to wash the
waste into the receiving space e.g. pour flush toilet & aqua
privies

LEVEL II on site toilet facilities of the water carriage type with

watersealed and flush type with septic vault/tank disposal.

LEVEL III water carriage types of toilet facilities connected to

septic tanks and/or to sewerage system to treatment plant.

NURSING RESPONSIBILITIES AND ACTIVITIES

Health Nurse and other Nursing staff shall impart the need for an effective and
efficient environmental sanitation in their places of work and in school.

Actively participate in the training component of the service like in Food

Assist in the deworming activities for the school children and targeted
groups.
Effectively and efficiently coordinate programs/projects/activities with
other
government and non-government agencies.
Act as an advocate or facilitator to families in the community in matters
of Handlers
Class, and attend training/workshops related to environmental health.
program/projects/activities on environmental health in coordination with
other members of Rural Health Unit (RHU) especially the Rural Sanitary
Inspectors.
Actively participate in environmental sanitation campaigns and projects
in the community. Ex. Sanitary toilet campaign drive for proper garbage
disposal, beautification of home garden, parks drainage and other
projects. Be a role model for others in the community to emulate terms
of cleanliness in the home and surrounding.

CDD (CONTROL OF DIARRHEAL DISEASES)

MANAGEMENT OF THE PATIENT WITH DIARRHEA

A. NO DEHYDRATION
Condition well, alert
Mouth and Tongue moist
Eyes normal
Thirst drinks normally, not thirsty
Tears present Skin pinch goes
back quickly
TREATMENT PLAN A- HOME TTT.

THREE RULES FOR HOME TREATMENT

1.Give the child more fluids than usual
use home fluid such as cereal gruel
give ORESOL, plain water

2. Give the child plenty of food to prevent undernutrition

continue to breastfeed frequently

if child is not breastfeed, give usual milk
if child is less than 6 months and not yet taking solid food, dilute milk for 2 days
if child is 6 months or older and already taking solid food, give cereal or other
starchy food mixed with vegetables, meat or fish; give fresh fruit juice or mashed
banana to provide potassium; feed child at least 6 times a day. After diarrhea stops,
give an extra meal each day for two weeks.

3. Take the child to the health worker if the child does not get better
in 3 days or
develops any of the following:

many watery stools

repeated vomiting
marked thirst
eating or drinking poorly
fever
blood in the stool

ORESOL TREATMENT
Amount of ORS to give
after each loose stool

Amount of
ORS to
provide
for use at
home

< 24
months

50-100 ml.

500 ml./day

2 10
years

100-200 ml.

1000 ml./day

10 years As much as
up
wanted

2000 ml./day

age

B. SOME DEHYDRATION
Condition restless, irritable
Mouth and Tongue dry
Eyes sunken
Thirst thirsty, drinks eagerly
Tears absent
Skin pinch goes back slowly
WEIGH PT, PLAN B

APPROX. AMT. OF ORS- TO GIVE IN 1ST 4 HRS

AGE

WEIGHT
KG

ORS
ML

4MOS

200-400

4-11MOS

5-7.9

400-600

12-23MOS

8-10.9

600-800

2-4YRS

11-15.9

800-1200

5-14YRS

16-29.9

1200-2200

15 YRS UP

30 UP

2200-4000

more
2. Continue breastfeeding
3. For infants below 6 mos. who are not
breastfeed, give 100-200 ml clean water during the
period
4. For a child less than 2 years give a teaspoonful
every 1-2 min.
5. If the child vomits, wait for 10 min, then continue
giving ORS, 1 tbsp/2-3 min
6. If the childs eyelids become puffy, stop ORS ,
give plain water or breast milk, Resume ORS when
puffiness is gone
7. If ( -) signs of DHN- shift to Plan A

Note: Use of Drugs during Diarrhea Antibiotics

should
only be used for dysentery and suspected cholera
Antiparasitic drugs should only be used for

C. SEVERE DEHYDRATION
Condition lethargic or unconscious; floppy
Eyes very sunken and dry
Tears absent
Mouth and tongue very dry
Thirst- drinks poorly or not able to drink
Skin pinch goes back very slowly

PLAN C- treat the child quickly

1.Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal
Saline
3.Re-assess pt. Every 1-2 hrs 4. Give ORS as
soon as the pt. can drink

ROLE OF BREASTFEEDING IN THE CONTROL OF

DIARRHEAL DISEASES PROGRAM

1. Two problems in CDD

High child mortality due to diarrhea
High diarrhea incidence among under fives
*Highest incidence in age 6 23 months
3. Highest mortality in the first 2years of life
4. Main causes of death in diarrhea :
DEHYDRATION
MALNUTRITION
5. To prevent dehydration, give home fluids am as soon
as
diarrhea starts and if dehydration is present, rehydrate
early, correctly and effectively by giving ORS
6. For undernutrition, continue feeding during diarrhea
especially breastfeeding.

7. Interventions to prevent diarrhea

> breastfeeding
> improved weaning practices
> use of plenty of clean water
> hand washing
> use of latrines
> proper disposal of stools of small children
> measles immunization
8. Risk of severe diarrhea 10-30x higher in bottle fed infants
than in breastfed
infants.
9. Advantages of breastfeeding in relation to CDD
> Breast milk is sterile
> Presence of antibodies protection against diarrhea
> Intestinal Flora in BF infants prevents growth of diarrhea
causing
bacteria.
10. Breastfeeding decreases incidence rate by 8-20% and
mortality by
24-27% in infants under 6 months of age.
11. When to wean? 4-6 months soft mashed foods 2x a day
6 months
variety of foods 4x a day

> Improved Nutrition -exclusive

breastfeeding for the
first 46 months of life and partially for at
least one
year.
> Improved weaning practices
> Use of safe water -collecting plenty of
water from the
cleanest source
> protecting water from contamination at
the source
and in the home
> Good personal and domestic hygiene
-handwashing
> Use of latrines

NON-COMMUNICABLE DISEASES AND REHABILITATION

Prevention and Control of Cardiovascular Diseases

> heart 1st leading cause of death ;
> blood vessels- 2nd leading cause of death

*Congenital Heart Disease (CHD):

Result of the abnormal development of the heart that exhibits
septal defect, patent ductus arteriosus, aortic and pulmonary
stenosis, and cyanosis; most prevalent in children
Causes:
envtl factors, maternal diseases or genetic aberrations
*Rheumatic Fever or Rheumatic Heart Disease:
Systematic inflammatory disease that may develop as a
delayed reaction to repeated and an inadequately treated
infection of the upper respiratory tract by group A
betahemolytic streptococci.

*Hypertension:
Persistent elevation of the arterial blood pressure.
> Primary or essential;frequent among females
but severe.
Malignant form is more among males.

*Schemic Heart Disease/ Atherosclerosis:

> Condition usually caused by the occlusion of the
coronary arteries by thrombus or clot formation.
> Higher among males than females for the latter
are
protected by estrogen before menopause
> Precipitating Factor: HPN, DM, Smoking
Minor precipitating facto: stress, strong family
history, obesity

Primary Prevention thru health education is

the main focus of the program:
1.
2.
3.
4.
5.

Maintenance of ideal body wt.

diet low fat
alcohol/smoking avoidance
exercise
regular BP check up

Cancer Prevention and Early Detection

Any malignant tumor arising from the abnormal and

uncontrolled division of cells causing the destruction in the
surrounding tissues.
Common Cancer: Lung cancer, cervical cancer, colon cancer,
cancer of the mouth, breast cancer, skin cancer, prostate
cancer
3rd leading cause of illness and death ( Phil.)
Incidence can only be reduced thru prevention and early
detection

NINE WARNING SIGNS OF CANCER:

C - Change in blood bowel or bladder habits
A - A sore that does not heal
U -Unusual bleeding or discharge
T - Thickening or lump in breast or elsewhere
I - Indigestion or difficulty in swallowing
O - Obvious change in wart or mole
N - Nagging cough or hoarseness
U - Unexplained anemia
S - Sudden unexplained weight loss

PRINCIPLES OF TREATMENT OF
MALIGNANT DISEASES

One third of all cancers are curable if

detected early and treated properly.
Three major forms of treatment of cancer:
Surgery
Radiation Therapy
Chemotherapy

Natl Diabetes Prevention and

Control Program
Aim: Controlling and assimilating
healthy lifestyle in the Filipino culture
( 2005-2010) thru IEC

Main Concern:
modifiable risk factors:
diet, body wt.,smoking, alcohol,
stress,
sedentary living, birth wt. ,migration

Prevention and Control of Kidney Disease

*Acute or Rapidly Progressive Renal Failure :

A sudden decline in renal function resulting from the
failure
of the renal circulation or by glomerular or tubular
damage
causing the accumulation of substances that is normally
eliminated in the urine in the body fluids leading to
disruption in homeostatic, endocrine, and metabolic
functions.
Acute Nephritis: A severe inflammation of the kidney
caused by infection, degenerative disease, or disease of
the blood vessels.
Chronic Renal Failure: A progressive deterioration of
renal function that
Neprolithiasis: A disorder characterized by the presence
of calculi in the kidney.

Nephrotic Syndrome:
A clinical disorder of excessive leakage of plasma
proteins into the urine because of increased
permeability of the glomerular capillary membrane
Urinary Tract Infection:
A disease caused by the presence of pathogenic
microorganisms in the urinary tract with or without
signs and symptoms.
Renal Tubular Defects: An abnormal condition in
the
reabsorption of selected materials back into the
blood and
secretion, collection, and conduction of urine

Urinary Tract Obstruction: A condition wherein the

urine flow is blocked or clogged.

Community-Based Rehabilitation Program

A creative application of the primary health

care approach in rehabilitation services, which
involves measures taken at the community
level to use and build on the resources of the
community with the community people,
including impaired, disabled and handicapped
persons as well.
Goal: To improve the quality of life and
increase productivity of disabled, handicapped
persons.
Aim: To reduce the prevalence of disability
through prevention, early detection and

NATIONAL TUBERCULOSIS PROGRAM

Introduction

Tuberculosis considered as the worlds deadliest

disease
and is a major health problem in the Philippines .

In 1993, Tb was declared a global emergency by the

WHO due to resurgence in many parts of the world.
In the Philippines, TB was ranked 6th leading cause of
morbidity and mortality in 2002. estimated incidence
rate is 243/100,00 population/year (WHO Report 2006)
Philippines ranks 9th among the 22 high burdened
countries under the WHO watch list.

Description:

TB is a highly infectious chronic disease caused by the tubercle bacilli.

primarily a respiratory disease but can also affect other organs of the
body
common among malnourished individuals living in crowded areas
common among children of underdeveloped and developing countries
in the form of Primary Complex after a bout of a debilitating disease
such as measles

Signs and Symptoms:

> Cough of 2 weeks or more
> Fever
> Chest or Back pains not referred to any musculo-skeletal disorders
> Hemoptysis or recurrent blood-streaked sputum
> Significant weight loss
>Other signs and symptoms such as sweating, fatigue, body malaise
and
shortness of breath

Infectious Agents:

> from Humans, Mycobacterium tuberculosis and mycobacterium

africanum
> from Cattle, Mycobacterium bovis
*At present (year 2000), there are 23 new strains of the TB bacilli
found in the US.

Mode of Transmission:

> Airborne droplet through coughing, singing, or sneezing.

> Direct invasion through mucus membranes or breaks in the skin
may
occur but is extremely rare.
> Bovine TB results from ingestion of unpasteurized milk or dairy
milk
or dairy products.
> Extra pulmonary TB other than laryngeal is generally not
communicable even if there is a draining sinus.

Period of Communicability:

> as long as viable tubercle bacilli are being discharged in

the
sputum.
> Degree of communicability depends on the number of
the
bacilli discharged, virulence of the bacilli, adequacy of
ventilation, exposure of the bacilli to the sun or UV light
and
the opportunities for their aerosolization by coughing,
talking
or sneezing
> Children with Primary Complex is usually not infectious
> Effective antimicrobial chemotherapy usually reduces
communicability to insignificant levels within days to a
few
weeks.

Susceptibility and Resistance

> most hazardous period for development of clinical

disease is
the first 6-12 months after infection
> Risk for developing disease is highest in children
under 3 years
of age, lower in later childhood and high again among
adolescents, young adults and the very old.
> For those infected, susceptibility to disease is
markedly
increased in those with HIV infection, other forms of
Immunosuppression, underweight and undernourished
persons with scoliosis, diabetes or gastrectomies and
among
substance abusers

Methods of Control
Preventive Measures

> Prompt diagnosis and treatment of infectious cases

> BCG vaccination of newborns, infants and grade I/school
entrants
> Educate the public in mode of spread and methods of
control
and the importance of early diagnosis
> Improve social conditions, which increase the risk of
becoming infected, such as overcrowding
> Make available medical, laboratory and x-ray facilities for
examination of patients at high risk of infection and beds for
those needing hospitalization
> Provide PHN and outreach services for home supervision of
patients to supervise therapy directly and to arrange
examination and preventive treatment of contacts

NATIONAL TUBERCULOSIS PROGRAM

Vision:
A country where TB is no longer a public health problem.
Mission:
Ensure that TB DOTS services are available, accessible, and
affordable to the communities in collaboration with the
LGUs and other partners.
Goal: To reduce prevalence and mortality from TB by half by
the year 2015 (Millennium Development Goal)
Targets:
> Cure at least 85% of the sputum smear-positive TB patient
discovered
> Detect at least 70% of the estimated new sputum smearpositive TB cases

NTP Objectives and Strategies

Objective A:
> Improve access to and quality services provided to TB
patients,
TB symptomatics and the communities by health care
institutions and providers.
Strategies:
1. Enhance quality of TB diagnosis

> Adopt quality assurance system for direct sputum

smear
examination, including external quality assurance.
> Establish more TB diagnostic Committees and expand
their functions to include TB in children.
> Strengthen the network of quality laboratory services
accordance with National TB Reference Laboratory
roles/functions.

Ensure TB patients treatment compliance

> implement an efficient drug supply management system

adopt directly observed treatment (DOT) through treatment
partners.
> Ensure public and private healthcare providers adherence to
the implementation of national standards of care for TB
patients.
> Establish and sustain public-private mix DOTS, including the
public-public mix DOTS
> Expand hospital-based DOTS
> Advocate for the widespread adoption of a comprehensive
and unified policy on TB
> Improve access to services through innovative service
mechanisms for patients living in challenging areas
(geographically isolated communities, with peace and order
problem, culturally-different, and those in institutions like
prisons)

Objective B:

Enhance the health- seeking behavior on

TB by communities, especially the TB
symptomatics

Strategies:
> Develop effective, appropriate, and
culturally-responsive
IEC/communication
materials.

> Organize barangay advocacy groups.

Objective C:
Increase and sustain support and financing
for
control activities.
Strategies:
> Facilitate implementation of TB-DOTS
Center
certification and accreditation.
> Build TB coalitions among different
sectors.
> Advocate for counterpart input from local
government units.
> Mobilize/ extend other resources to
address
program limitations.

Objective D:
> Strengthen management (technical and operational)
of TB
control services at all levels.
Strategies:
> Enhance managerial capability of all NTP program
managers at all levels.
> Establish an efficient data system for both public and
private sectors.
> Implement a standardized recording and reporting
system.
> Conduct regular monitoring and evaluation at all
levels.
> Advocate for political support through effective local
governance.