COMMUNITY HEALTH NURSING / or vulnerabilities and hence,

requires special care or attention

DEMOGRAPHY  May be geographically bounded
 Study of the population as to size,
characteristics, health, illness DEMOGRAPHY
 Study of the population as to:
Important Concept! o Size
 Three percent (3%) of the  How many are they
population is immunizable (3-11 now
month olds)  How many are they
X years ago / later
MAWRA (projection)
 Married Women in Reproductive o Distribution
Age  Where is the
population located?
PRIMARY HEALTH CARE Urban? Rural?
 Mnemonics is ELEMENTS DAM Crowding Index?
o Composition
E is for:  What are the
 EDUCATION characteristics of
the population?
L is for:  Age?
 LOCAL AND ENDEMIC DISEASES  Patterns of
Morbidity?
E is for:  Mortality?
 EXPANDED PROGRAM ON Important Concept!
IMMUNIZATION  Philippines
o The population can be
M is for: reflected by a pyramid
 MATERNAL AND CHILD HEALTH o This shows that the age of
the population is very young
E is for:  Japan
 ESSENTIAL DRUGS o The population can be
reflected by a reversed bell
N is for
configuration
 NUTRITION
o This shows that most of the
population is in the middle
T is for
age group
 TREATMENT AND CONTROL OF
DISEASES
HEALTH
 As a continuum; health is a social
S is for:
phenomenon
 SANITATION
Health Death
▲ ▲
D is for:
 As a right
 DENTAL HEALTH
o A Winslow definition
A is for:  As a tool to development or as a
 ACCESSIBLE HEALTH CARE result of development
 As a result of genetics / heredity
M is for:  As a global objective
 MENTAL HEALTH  As a physical, emotional, mental,
social well-being and not merely the
COMMUNITY absence of disease or infirmity
 Group of people with similar o A WORLD HEALTH
characteristics, needs, interests and ORGANIZATION definition

1
  As a social phenomenon EPIDEMIOLOGICAL TRIAD
o Affected by socio-political, Composed of:
economic situation of the  Agent
population  Host
 Environment
OPTIMUM LEVEL OF FUNCTIONING AGENT
(OLOF)
 A person is considered healthy if
OLOF is obtained
 Even if he is blind

PUBLIC HEALTH (Winslow)

 Science and art of preventing ENVIRONMENT HOST
disease, prolonging life, promoting
health and efficiency through Interjected Concept!
organized community efforts for  Anopheles mosquito
sanitation, disease control, o Malaria vector
education, organization of health o Thrives in slow-flowing
services for early diagnosis and water
treatment of diseases, development o Night-biters
of social machinery, to ensure a  Aedes mosquito
standard of living adequate for the o Dengue vector
maintenance of health to realize the o Thrives in clear, stagnant
birthright of health and longevity water
o Day-biters
Important Concept!
 Keyword in Winslow’s definition of NURSING
Public Health is BIRTHRIGHT  Assisting individuals to become
 Emphasis is on: healthy and healthy individuals to
o Environmental Sanitation attain optimum level of wellness
o Communicable Diseases
COMMUNITY HEALTH NURSING
COMMUNITY HEALTH (Maglaya)
 Medical intervention approach which  The utilization of the nursing
is concerned with the health of the process in different levels of
WHOLE POPULATION clientele – individuals, families,
population groups, and communities
Aims of Community Health concerned with the promotion of
 Health Promotion health and prevention of diseases
 Disease Prevention and disability, including rehabilitation
 Management of Factors Affecting
Health GOAL OF COMMUNITY HEALTH
o Modifiable NURSING
o Non-modifiable  To raise the level of citizenry by
helping communities and families to
Important Concepts! cope with the discontinuities in and
 Primary threats to health in such a way as to
o Promotion and Prevention maximize their potential for high-
level wellness
 Secondary
o Early Treatment PRINCIPLES OF COMMUNITY HEALTH
o Prompt Treatment NURSING
 Tertiary
o Rehabilitation and Therapy

2
  The community is the patient, the
family is the unit of care and there
are four (4) levels of clientele:
o Individual
o Family
o Population Group
o Community
 The clientele is an active partner
and not a passive recipient of care
 In particular, Community Health
Nursing practice is affected by the
changes in technology. In general,
it is affected by changes in society
 Community Health Nursing goals
are achieved through multi-sectoral
efforts
 Performance of
internal examination and the
delivery of babies
 Suturing lacerations
in the absence of a physician
 Provision of First
Aid measures and emergency care
 Recommending herbal and
symptomatic care, etc. (ANSAP to
administer)
RESPONSIBILITIES OF THE COMMUNITY
HEALTH NURSE IN THE CARE OF
FAMILIES
 Provision of health care services

 Community Health Nursing is part of  Development and utilization of

the health system and the larger
human service system
ROLES OF THE PUBLIC HEALTH NURSE
 Mnemonic is CHEFS
family nursing care plan
RESPONSIBILITIES OF THE COMMUNITY
HEALTH NURSE IN THE CARE OF
COMMUNITIES

C is for:  Community organizing and

 CLINICIAN mobilization; Community
development and people
H is for: empowerment
 HEALTH
 Case-finding and epidemiological
E is for: investigation (i.e. meningococcemia)
 EDUCATOR
 Program planning, implementation
F is for: and evaluation (i.e. EPI)
 FACILITATOR
o Organizes other sectors of  Influencing executive and legislation
the society to educate in matters concerning health and
constituents development (advocacy)

S is for: RESPONSIBILITIES OF A COMMUNITY

 SUPERVISOR HEALTH NURSE
o Over Barangay Health
 Participate in the development of an
Workers (BHWs)
overall plan, its implementation, and
evaluation
RESPONSIBILITIES OF THE COMMUNITY
HEALTH NURSE (as per Republic Act
 Provide quality nursing service
7164: Philippine Nursing Act of 1991)
 Maintain networking / links with
other health team members and
 Supervision and
agencies in the provision of health
care of women during pregnancy,
care services
labor and puerperium

3
  Conduct researches related to
Community Health Nursing (most Preventive Potential
neglected)  High
 Medium
 Provide opportunities for  Low
professional growth and continuing
education Modifiability
 Easily modifiable
In the care of families,  Partially modifiable
 Beginning families  Non-modifiable
 Early child-bearing families
Salience
FIRST LEVEL ASSESSMENT
UNDESIRABLE GROUPS
Health Threats  Infants / young children
 Conditions that are conducive to  School Age
disease, accidents, or failure to  Adolescents
realize one’s own health potential  Mothers
 Males
Health Deficits  Disabled
 Instances of failure in health  Occupation-related
maintenance (disease, disability,
developmental lag, etc.) e.g. SPECIALIZATIONS IN PUBLIC HEALTH
malnutrition  Occupational Health
 School Health
Stress Point / Foreseeable Crisis  Environmental Health
 Anticipated periods of unusual  Others:
demand on the family in terms of o Epidemiology
adjustment or to family resources o Women’s Health
 Unemployment  Research
 Death of a family member
 Unexpected pregnancy COMMUNITY DIAGNOSIS
 Process by which data about the
Important Concepts! community is collected in order to
 Health for All in 2000 identify factors which may influence
 Primary Health Care the health and illness of a
 Alma Ata Convention population, to formulate a
 Russia 1978 community health nursing diagnosis
SECOND LEVEL ASSESMENT and develop and implement
 Recognition of the problem community health interventions and
 Decision on appropriate health strategies
action
 Care of affected family heath TYPES OF COMMUNITY DIAGNOSIS
members  Comprehensive
 Provision of healthy home  Problem-Oriented
environment
 Utilization of community resources DEMOGRAPHY
for health care (consistent with  Sources: Population Census
Primary Health Care; APROTECH  Survey
utilizes what is in the community)  Sampling only
 Census
PROBLEM PRIORITIZATION  Total enumeration; everyone is
 Nature of the Problem included
 Health Deficit
 Health Threat De Jure
 Foreseeable Crisis

4
  People assigned to where they o Includes population
usually live regardless of where they increase per fraction of a
are at the time of the census second

De Facto  Total population

 People assigned to the place where o 60 million x (2.71) 5.17
x
they are physically present at the 0.0233
time of the census, regardless of
their usual place of residence VITAL STATISTICS
 Application of statistical measures to
vital events that is used to gauge
the levels of health, illness and
COMPONENTS OF DEMOGRAPHY health services of a community
 Size
 Composition CRUDE BIRTH RATE
o Age distribution  Measures the natural growth or
o Sex ratio increase in the population
o Population Pyramid
o Median Age Total live births x 1000
o Dependency Ratio Midyear Population
 Number, which
needs to be supported by CRUDE DEATH RATE
every 100 economically  Measures the natural decrease in
productive ages the population
 0 – 14 > 64
 15 – 65 x 100 Number of deaths x 1000
Midyear Population
Others:
 Occupational Groups INFANT MORTALITY RATE
 Economic Groups  Measures the risk of dying before
 Ethnic Groups age of one (1)

Population Distribution Total deaths of infants before age 1 x1000

 Urban or rural Total live births
 Crowding Index
Total number of persons  This is the most sensitive index
Total rooms  It reflects the status or condition of
 Population Density the health care delivery system
o Number of people per area
MATERNAL MORTALITY RATE
POPULATION SIZE  Measures the risk of dying from
 Rate of Natural Increase maternal causes
Number of Maternally-related deaths x1000
Three (3) Methods Total live births

 Arithmetic Method (worst method)  This is the second most sensitive

o Poriginal or index + bt index
o Where b is the rate of
NEONATAL DEATH RATE
increase
 Rate of death among children
o Where t is the time
before reaching the age of one (1)
month
 Geometric Method (good method)
Total deaths of infants < 28 days old x1000
 Exponential Method (best method)
Total live births

5
PRIMARY HEALTH CARE E is for:
 Strategy aimed at providing  EDUCATION, INFORMATION,
essential care that is community ADVOCACY
based, accessible, integral to the
total socio-economic development L is for:
effort of the nation, acceptable and  LOCAL / ENDEMIC DISEASES
sustainable at an affordable cost
E is for:
Characteristics of Primary Health Care  EXPANDED PROGRAM ON
 Mnemonic is ACASIA IMMUNIZATION

A is for: M is for:
 ACCESSIBLE  MATERNAL AND CHILD HEALTH

C is for: E is for:
 COMMUNITY BASED  ESSENTIAL DRUGS

A is for: N is for:
 AFFORDABLE  NUTRITION

S is for: T is for:
 SUSTAINABLE  TREATMENT AND CONTROL OF
DISEASES
I is for:
 INTEGRAL S is for:
 SANITATION AND ENVIRONMENT
A is for:
 ACCEPTABLE D is for:
 DENTAL HEALTH

CONVENTION OF ALMA ATA A is for:

 1978  ACCESSIBLE HEALTH CARE /
 Alma Ata, Russia ACCESS TO APPROPRIATE
 Health for All by the Year 2000 HEALTH FACILITIES
 Philippines : A signatory
 Wealth of experience in CBHPs M is for:
 MENTAL HEALTH
PILLARS OF PRIMARY HEALTH CARE
 Mnemonic is SCAN BRIGHT CHILD PROGRAM
 Rationale:
S is for: o Challenges of Young
 SUPPORT MECHANISMS IN Children
PLACE  Heath and Nutrition
 High incidence of
C is for: malnutrition
 COMMUNITY PARTICIPATION  Psychological
Situation
A is for:  Only 33% of 3 – 5
 APPROPRIATE TECHNOLOGY year olds avail of
day care and pre-
N is for: school
 NETWORKING AND LINKAGES  Early Education
 Heavy
PRIMARY HEALTH CARE drop-out
 Mnemonic is ELEMENTS DAM rates in

6
 grades 1,2 o Proper nutrition and
and 3 exercise
 Need: o Supplemental feeding in
o Integrated delivery of Grade 1
services for children with an  Food Security (Department of
emphasis on convergence Agriculture)
of services at homes, at the
center, and in school 4. Support to Service Delivery
 Coordination and Monitoring
RATIONALE OF BRIGHT CHILD
PROGRAM: ONE SCRIPT / ONE BRAND HERBAL MEDICINES
 In pursuing an integrated delivery of  Mnemonic is LOBBY SANTA
food and nutrition, health,
psychosocial development and early L is for:
childhood education to the young  LAGUNDI
children
O is for:
OBJECTIES OF THE BRIGHT CHILD  OLASIMANG BATO / PANCIT-
PROGRAM PANCITAN
 Promote
o Implementation of programs B is for:
and services for the Bright  BAWANG
Child
 Mobilize B is for:
o Support for program  BAYABAS
services with the Bright Y is for:
Child Brand  YERBA BUENA
 Achieve
o 80% awareness / recall of S is for:
the Bright Child nationwide  SAMBONG

COMPONENTS OF BRIGHT CHILD A is for:

PROGRAM  AMPALAYA

1. Advocacy and Social Marketing N is for:

 NIYOG-NIYUGAN
2. Service Delivery
 Health and Nutrition (DOH / NNC or T is for:
National Nutrition Council)  TSAANG GUBAT
o Immunization
o Maternal Health Care A is for:
o Proper Nutrition (Nutrition  AKAPULKO
and healthy standards)
Planting
3. Psychosocial Care and Development  Organic Gardening
 (DSWD and DepEd) o Use only natural fertilizers
 Home based and center based child  Avoid pesticides
minding and day care services  Keep garden premises clean
 Supplemental Finding
o Effective parenting and Harvesting
nutrition education  Collect only healthy parts of the
 Early Education (DepEd) plants, also from healthy plants
o 8 week curriculum  Harvest when flowering
 Drying
o Grade 1 curriculum
o “Patuyuin sa hangin at
malilim na lugar”

7
  Avoid sun drying o Drink every four (4) hours
OLASIMANG BATO
Storage  Olasimang Bato is indicated for:
 Plastic o Gout
 Use colored (opaque) containers o Arthritis
 Charcoal at the bottom of the o Decreases uric acid
container  Salad
 Close tightly o One-half (1/2) cup; three
times a day
BASIC PRINCIPLES IN HERBAL  Decoction
MEDICINE o Same as Lagundi
 Correct dose
 Use one and one-half cup of plant
 Use only one (1) kind of herb for
each disease (pito-pito is not
BAWANG
endorsed)
 Bawang is indicated for:
 Stop use of herbal medicine at the
o Regulation of blood
first sign of untoward reaction (i.e.
pressure
allergy)
o Decreasing cholesterol
 Consult health worker if symptom
persists after two (2) to three (3) levels
days after use of herbal medicine  Use two (2) cloves; three times a
day after meals
LAGUNDI  Preparation
 Lagundi is indicated for CAF o Inihaw
o Ginisa (no or minimal oil)
C is for: o Binabad sa tubig
 COUGH  (at least thirty (30)
minutes)
A is for:  Blanched
 ASTHMA
BAYABAS
F is for:  Bayabas is indicated for:
 FEVER o Antiseptic Cleaner
o Mouth infections
AGE LEAVES NEEDED o Gingivitis
Fresh Dried o Tooth decay
Adult 6 tbsp 4 tbsp  Decoction
7 – 12 y/o 3 tbsp 2 tbsp o Use to clean wound at least
2 – 6 y/o 1.5 tbsp 1 tbsp two (2) times a day
 Gargle
Properties of Lagundi o Cool Decoction
 Wash leaves
 Rinse YERBA BUENA
 Boil in two (2) cups of water  Yerba Buena is indicated for:
 Simmer in slow fire for fifteen (15) o General Body Pains
minutes  Decoction
 Do not cover the pot o Boiling or Tapal
o Use clay pot o Same as Lagundi
 Allow to cool  Poultice
 For asthma and cough o Apply to affected area
o Drink in three (3) parts
 Morning SAMBONG
 Noon  Sambong is indicated for:
 Evening o Diuretic effect
 For Fever

8
 o Anti-urolithiasis (pantunaw o One (1) part herb to two (2)
ng bato) parts water
 Not for kidney or for Urinary Tract  Use decoction to cleanse affected
Infection area
 Decoction
Same as Lagundi BRAIN ATTACK / STROKE
 Proclamation No. 92 by President
AMPALAYA Gloria Macapagal-Arroyo
 Ampalaya is indicated for:  Stroke Society of the Philippines
o Non-Insulin Dependent (1995)
Diabetes Mellitus (NIDDM) o Assists the DOH in
 Decoction promoting public awareness
o One (1) part leaves to two  Battlecry:
(2) parts water o Stroke is Brain Attack
o One-third cup; three times a o Stroke is Emergency
day before meals o Stroke is Treatable
 Buds o Stroke is Preventable
o Steamed and eaten  It happens when brain cells die
o One-half (1/2) cup; two because of inadequate blood flow
times a day  Permanent
o Dead brain cells cannot be
NIYOG-NIYOGAN replaced
 Niyog-niyogan is indicated for:  Statistics
o Ascariasis o 500 or 100K per year
 Eat seeds two (2) hours before o Among leading causes of
going to bed death and illness
 Repeat after, same dose if no effect  Risk Factors
o Non-modifiable
AGE NUMBER OF SEEDS  Age
Adults 8 – 10 seeds  Sex
9 – 12 y/o 6 – 7 seeds  Family History
6 – 8 y/o 5 – 6 seeds o Modifiable
4 – 5 y/o 4 – 5 seeds  DM
TSAANG GUBAT  HPN
 Tsaang Gubat is indicated for: CAD
o Abdominal Pains  Smoking
 Decoction  Obesity
o Boil leaves in two (2) cups  High cholesterol
of water levels
o Divide in two parts  Increased alcohol
 Drink every four (4) consumption
hours  Use of oral
 Gargle contraceptives
o Promotes dental health  Lifestyle

AKAPULKO Interjected Concept!

 Akapulko is indicated for:  Couples for Christ
o Skin infections o DOH’s partner in Natural
o Scabies Family Planning
 Poultice / Extract
o Apply at affected area at GMA 50
least two (2) times a day  G is for GAMOT na
 Decoction  M is for MABISA at
 A is for ABOT-KAYA

9
 o Fifty percent (50%) off on  OPPRESSED
selected drugs:
 Antibiotics P is for:
 Paracetamol  POOR
 PTB drugs
E is for:
GOAL OF GMA 50 PROGRAM  EXPLOITED
 To ensure that affordable, high-
quality, safe and effective drugs and A is for:
medicines are always available,  AWAKENED
especially to the poor.
STRATEGIES OF THE GMA 50 PROGRAM S is for:
 Short Term 2000 – 2002  STRUGGLING
 Importation of high-quality, safe and
effective, affordable drugs and FIVE MAJOR FUNCTIONS OF THE
medicines DEPARTMENT OF HEALTH
 Expand as appropriate, the list of
drugs and medicines for importation  Ensure equal access to basic health
 Increase the number of outlets services (Sentrong Sigla)
 Medium and Long Term
 Promote use of generic drugs and  Ensure formulation of health policies
medicines for proper division of labor and
 Ensures continuous supply proper coordination of operations
 Develop reimbursement scheme for among agencies (Bright Child)
medicines with PHILHEALTH
 Reduce significantly the prices of  Ensure maximum level of
drugs and medicines implementation nationwide of
 Wage war versus substandard services regarded as public health
drugs (BFAD) goods

DEPARTMENT OF HEALTH (DOH)  Plan and establish arrangements for

public health systems to achieve
VISION economics of scale
 Health for all Filipinos
 Health in the Hands of the People  Maintain a medium of regulation and
by 2020 standards to protect consumers and
 Empowerment to influence own guide providers
health
Important Concept!
MISSION  No giving of services due to
 In partnership with the Filipino devolution – done by local
people, provide equity, quality, and governments
access to health care, especially the
marginalized CENTERS FOR HEALTH DEVELOPMENT
 Regional Offices of the DOH
Interjected Concept! o CHDs
 In the community setting, the o Office of the Regional
marginalized refers to: Director
 Mnemonic is DOPE AS o Office of the Assistant
Regional Director
o Health Operations Division
(programs are here)
D is for: o Local Health Assistance
 DEPRESSED Division (DOREPS)
O is for:

10
 o Licensing and Registration the beginning toward the DOH
Division Vision
o Management Support
Division HEALTH FOR MORE IN 1994
 Activities of DOH in 1994 focused
Under the Health Operations Division: on cancer prevention, reproductive
 FHS health, mental health and
 Infectious Disease Cluster maintenance of a safe environment
 Health Promotion Cluster
 Regional Epidemiology and
Surveillance Units
 Environmental and Operational HEALTH FOCUS IN 1995
Health Center  “THINK HEALTH, HEALTH LINK”
 National Health Strategy
REPUBLIC ACT 7160  Multi-sectoral
LOCAL GOVERNMENT CODE  Building supportive environments
 Devolution of responsibilities to local through advocacy, community
governments action, networking
 Aimed at empowerment of local
government units through Five Thrusts
decentralization  Multi-sectoral Action and
Consciousness building
Devolution  Linkages and Networking
 Transfer of resources, functions,  Community Organizing
authority from the center to the  Risk Assessment and Management
periphery  Capacity Building
DOH
Policies DOH FOCUS
Guidelines  Infectious Diseases
Implementation (now by the Local  Child Health
Government Units)  Women’s Health
 Healthy Lifestyle
Devolved Services and Functions  GMA 50
 Primary Health Care  National Health Insurance
 Maternal and Child Health Care (indigency program)
 Mental Health o Paid by the LGUs
 Family Planning
 Nutrition Infectious Diseases
 Control of Communicable Diseases  Improvement of Tuberculosis case
 Purchase of Medicines detection and cure rates
 Medical Supplies and Equipment  Control of rabies through advocacy
 Access to Primary, Secondary, and for dog control
Tertiary Health Services  Important Concepts!
 Maintenance of Barangay Health  Active Case Finding
Workers, Regional Health Units,  Health workers search for TB
City, Municipal, District and patients in their homes
Provincial Hospitals  Passive Case Finding
 TB patients will go to health centers
REPUBLIC ACT 7164
 Philippine Nursing Act of 1991 Child Health
 Immunization Focus
23 in 1993  Nationwide measles campaign to
 Refers to twenty-three (23) bring measles coverage to 95%
programs, projects, activities of the moving towards measles elimination
DOH for the year 1993, which mark  Advocacy for enforcement of Food
Fortification (Asin and Vitamin A)

11
  Gamot na Mabisa at Abot-kaya  VALUE-BASED MARITAL
BONDING
Women’s Health
 Emphasizes strengthening of family E is for:
planning as a health intervention  ECONOMICAL
 Safe motherhood
 Mainstreaming of National Family S is for:
Planning  SCIENTIFIC
 Advocacy for voluntary surgical
sterilization HEALTHY LIFESTYLES
 Making the whole spectrum of  Emphasis on smoking cessation
Family Planning services available  Nationwide advocacy of healthy diet
(Couples’ Choice) and physical activities under the
banner of “Healthy People for a
Natural Family Planning Stronger Republic”
Three (3) Methods  Responsible parenthood
 Cervical Mucus / BILLINGS
 Basal Body Temperature NATIONAL HEALTH INSURANCE
 Symptothermal PROGRAM
o Combination of both  Focuses on broadening the reach,
methods above in terms of product recognition,
ensuring re-enrolments, enhancing
Lactational Amenorrhea Method (LAM) benefits and improving Phil-Health -
 Done for six (6) months DOH - LGU coordination
 Phil-Health and LGU shall provide
Three Criteria for LAM their respective counterpart
 Child less than six (6) months contribution for the premium subsidy
 Menses are still absent to SPONSORED SECTOR
 Pure Breast-feeding (indigency program)
o No pacifier, water,  DOH to provide advocacy, capacity
supplementary food building, and technical assistance
related to promoting NHIP
The following methods are not part of
NATURAL FAMILY PLANNING because HEALTHY PEOPLE FOR A STRONG
they are considered ‘not scientific’: REPUBLIC
 Withdrawal  In the long haul, we wish to achieve
 Rhythm method the development of a constituency
 Calendar method that is:
o Healthy
Standard Days Method (SDM) o Empowered
 Makes use of Rosary Beads o Well-educated
o Productive
Important Concepts!!! o In control of their lives
 Family Planning started in the 1960s
 There is 48% contraceptive OTHER RELEVANT LAWS:
prevalence rate
REPUBLIC ACT 1082
Natural Family Planning SAVES  Employment of more physicians,
dentists, nurses, midwives, sanitary
S is for: inspectors particularly in rural areas
 SAFE
REPUBLIC ACT 3573 (1992)
A is for:  Reportable diseases to nearest
 ACCEPTABLE Regional Health Unit (RHU) and that
any person may be inoculated,
V is for:

12
 administered or injected
prophylactic preparations
MINISTRY CIRCULAR NO. 2 OF 1986
 Acquired Immune Deficiency
Syndrome / HIV as a NOTIFIABLE
or REPORTABLE DISEASES
REPUBLIC ACT 6425
 Dangerous Drugs Act
o Sale, administration,
delivery and distribution of
prohibited drugs
PRESIDENTIAL DECREE 651
 Registration of all births within thirty
(30) days
PRESIDENTIAL DECREE 996
 Mandatory immunization of all
children below eight (8) years old
against the six (6) immunizable
diseases
PRESIDENTIAL DECREE 825
 Environmental Sanitation
o Penalty for improper garbage
disposal
REPUBLIC ACT 8749 of 2001
 Clean Air Act
PRESIDENTIAL DECREE 965
 Applicants for marriage license to
receive family planning training
REPUBLIC ACT 6713
 Code of Conduct and Ethical
Standards for Public Officials and
Employees
o Public Trust
o Public Official Accountability
 Service with Accountability
REPUBLIC ACT 7305
 Magna Carta for Public Health
Workers
o Promotes and protects the
economic well-being of
public health nurses, their
working conditions and
terms of employment; the
development of skills and
capabilities and to
encourage hose with proper
qualifications and excellent
with abilities to join and remain
in government service
ENVIRONMENTAL SANITATION
 Study of all factors in man’s physical
environment which potentially
affects health, well-being and
survival
 Factors:
o Water Sanitation
o Food Sanitation
o Refuse and Garbage
Disposal
o Excreta
o Vector and Rodent Control
o Housing
o Pollution
o Noise
o Radiological Protection
o Institutional Sanitation
WHO IN DOH IS RESPONSIBLE?
 Environmental Health Service (EHS)
central office
CHDs
 Environmental and Occupational
Health Cluster of the Health
Operations Department
HOW?
 Water quality surveillance
 Evaluation of food establishments
 Waste management
 Sanitation of public places
 Sanitation management of disaster
areas
 Impact assessment of
environmentally critical projects
 Enforcement of sanitation laws
PRESIDENTIAL DECREE 856
 Sanitation Code of the Philippines in
1978
WATER SUPPLY SANITATION PROGRAM
 Approved water facilities
 Unapproved water facilities:
o Open dug wells
o Unapproved springs
 Access to safe and potable water
 Water quality and monitoring
surveillance
 Request of quality health standards
13
  Certification of Potability  Flush Toilets
o Permit given by the
SECRETARY OF HEALTH
or his LOCAL
REPRESENTATIVE (LGU) Level 3
 Disinfection of water services in:  Connected to the treatment plants
o New water supplies
o Improved / impaired water FOOD SANITATION PROGRAM
supply  Food establishments are appraised
o Previously infected based on:
 Water container disinfection o Inspection / approval of all
food sources, containers,
APPROVED TYPES OF WATER transport vehicles
FACILITIES o Sanitary Permit
 For RESTAURANTS
Level 1 – POINT SOURCE o Health Certificates
 Protected Well  For FOODHANDLERS
 No distribution system o Destruction and banning of
 Generally rural foods unfit for consumption
 Serves 15 – 25 households
 Outreach of not more than 250 POLICIES
meters  Food establishments are appraised
 Spring based on:
 Sinasalok o Training of food handlers
and operators in food
Level 2 – COMMUNAL FAUCET SYSTEM sanitation
OR STAND POST o Classification of
 Source reservoir establishments
 Not more than 25 meters away from  Class A
the farthest house  Excellent
 Delivers to about 100 houses  Class B
 For clustered houses  Very Satisfactory
 Does not enter the individual houses  Class C
 Satisfactory
Level 3 – WATERWORKS OR INDIVIDUAL o Health certificates are given
HOUSE CONNECTIONS to all food vendors
 For densely populated communities o Information, Education, and
 Cities
Counseling (IEC) given to
 Urban Areas
households
 Requires minimum levels of
treatment and disinfection
HOSPITAL WASTE MANAGEMENT
PROGRAM
EXCRETA
 Combining hospital wastes with
PROPER EXCRETA AND SEWAGE
domestic, commercial wastes poses
DISPOSAL SYSTEM
hazards to people
Level 1
POLICIES
 No water necessary to wash waste
 All hospitals to prepare hospital
 Pit latrines
waste management as a
 Pit Privy
requirement for registration / license
 Ash is poured here after defecation
 Use of appropriate technology and
indigenous materials
Level 2
 Training of all hospital personnel in
 Requires small amounts of water to
waste management as an essential
wash waste into the receiving space
part of the hospital training program
 Pour Toilets

14
  Poliomyelitis
NURSING ROLES IN ENVIRONMENTAL  Diphtheria
HEALTH  Pertussis
 Health Education  Tetanus
 Training  Hepatitis
 De-worming o Even if Hepatitis is not
 Coordination of Programs received by the child, he is
 Advocate considered as a FULLY
 Sanitation Campaign IMMUNIZED CHILD upon
 Role Model receiving the six others
 Researcher before one (1) year of age
o (most neglected function of
the nurse) LOGISTICS OF EPI
 Disaster management  Vaccines
 Mixing system
EXPANDED PROGRAM ON  AD syringe
IMMUNIZATION o Autodisposable
 Basic element of Primary Health  Mixing Syringe
Care  Safety Deposit Boxes
 Based on epidemiological situation
 Communities to be protected rather Important Concepts!
than just individuals  3% of the population are
 Immunization as a basic health immunizable children
service and hence a primary  3.5% of the population ore women
approach  For tetanus toxoid
 HERD Community – a primary o Immunizable pregnants
approach
SCHEDULE OF IMMUNIZATION
 At Birth
ELEMENTS OF EXPANDED PROGRAM o Bacillus Calmette Guerin
ON IMMUNIZATION (BCG)
 Target-setting (AFP surveillance)  At Six (6) weeks of age
Cold chain and logistics o DPT 1, Polio 1, Hepatitis B
management 1
 IEC (give side effects of vaccine)  At Ten (10) weeks of age
 Assessment and Evaluation o DPT 2, Polio 2, Hepatitis B
 Surveillance and Research 2
 At Fourteen (14) weeks of age
GOAL OF EPI o DPT 3, Polio 3, Hepatitis B
 Reduction of morbidity and mortality
3
of children 0 – 11 months old
 For Tetanus Toxoid
against the seven (7) immunizable
o Tetanus Toxoid 1
diseases
 First Pregnancy
 5 to 6 months
SPECIFIC GOALS OF EPI
pregnant
 Attain 95% fully immunized children
o After four (4) weeks
 Preserve polio-free status
 Eliminate measles  Tetanus Toxoid 2
 Eliminate neonatal tetanus  Three years of
 Decrease morbidity and mortality immunity achieved
related to diphtheria and pertussis after TT2)
 Eliminate extra-tuberculosis cases o Second Pregnancy
 5 to 6 months
SEVEN (7) IMMUNIZABLE DISEASES pregnant
 Tuberculosis  Tetanus Toxoid 3
 Measles (First Booster Dose)

15
  Five (5) years of o What if the child failed to
immunity achieved return after the first dose?
after TT3)  Answer:
o Third Pregnancy o Still give succeeding dose
 5 to 6 months to complete doses; no need
pregnant to start from the first dose
 Tetanus Toxoid 4
(Second Booster  Question:
Dose) o Is it necessary to repeat the
 Ten (10) years of first dose?
immunity achieved  Answer:
after TT4 o No, just give the remaining
o Fourth Pregnancy doses
 5 to 6 months
pregnant REMEMBER!!!
 Tetanus Toxoid 5  Even if the interval exceeded that of
(Third Booster the intended interval, proceed with
Dose) the vaccine dose
 Lifetime immunity
achieved after TT5  Question:
o What is the eligible age or
ADMINISTRATION OF IMMUNIZATIONS to what age can the EPI be
IMMUNIZATION DOSAGE ROUTE given?
BCG 0.05 ml I.D.  Answer:
DPT 0.5 ml I.M. o Before six (6) years old
OPV 2 drops P.O.  Question:
Hepatitis B 0.5 ml I.M. o In case of measles
Measles 0.5 ml S.Q. epidemic, is it alright to give
measles vaccine at an early
SIDE EFFECTS (NORMAL EFFECTS) OF age?
IMMUNIZATIONS  Answer:
 BCG o In the presence of an
o Inflammation epidemic, measles can be
o Provide warm compress given as early as six (6)
 DPT months of age
o Inflammation
o Fever  Question:
o Abscess o Contraindication for DPT,
OPV, Hepatitis B?
 Answer:
 Measles o None, except for
o Fever 3 – 5 days after convulsions due to DPT 1,
administration which is NOTIFIABLE
o Mild rashes
Important Concepts!
Other effects different from normal  Fever, Diarrhea
effects o These are not specific
 Pneumonic is AEFI contraindications to
 Adverse Effects Following immunization
Immunization  Malnutrition
o Not a contraindication
FREQUENTLY ASKED QUESTIONS o Rather an indication of
ABOUT IMMUNIZATIONS immunization
 No contraindication UNLESS LIFE
 Question: AND DEATH SITUATION

16
 COLD CHAIN
NOTE: Heat Vaccine Storage
 If a child is not fully immunized Sensitivity
before one year of age, a second or Most OPV -15°C to 25°C
a third dose of polio or DPT may be Sensitive Measles
given after a year interval, However, Least DPT 2°C to 8°C
the child will be in danger of getting Sensitive BCG
the disease during the interval, TT
earlier doses need not be repeated
FULLY IMMUNIZED CHILD (FIC)
 DPT should not be given to children  Has received the following
above age six (6) immunizations:
o 1 BCG
 Pertussis is not as serious in older o 3 OPV
children o 3 DPT
o 1 AMV (measles vaccine)
 Majority of children already have
 Before his first birth day
immunity at age six (6)
 Note that Hepatitis B is not included
yet
 If second dose of Tetanus Toxoid is
not given before second pregnancy,
RURAL HEALTH PHYSICIAN / MHO
then the dose may be given after
 Plans, implements and evaluates
delivery to protect the mother and
programs
succeeding pregnancies
 Coordinates immunization activities
 Arranges outreach immunization
COLD CHAIN
tem for hard to reach areas
 How long can the vaccine be
 Provides feedback
stored?
 Six (6) months at a region
Important Concept!
 Three (3) months at a district /
 Nurse does the abovementioned
province
responsibilities of the Rural Health
 One (1) month at the Health Center
Physician if there is no such person
 Not more than five (5) days using
in the community
transport boxes
 Maintain ice in the box
PHN or MAIN CENTER MIDWIFE
 First in, First out
 Takes over the roles and
responsibilities of the RHP in his
STORAGE
absence
 All vaccines are destroyed by HEAT
 Assists in the management of the
program
BCG
 Acts as cold chain manager
 Destroyed by heat
 Prepares vaccine requirements and
 Destroyed by sunlight
oversees allocation
 Not destroyed by freezing
 Supervises midwives
 Analyzes, consolidates and submits
OPV
reports related to EPI
 Destroyed by heat
 Develops appropriate IEC materials
 Not destroyed by freezing
and assists in development and
dissemination of appropriate
DPT
messages
 Destroyed by heat
 Destroyed by freezing
HEALTH EDUCATION
 Process whereby knowledge,
Hepatitis B and Tetanus Toxoid
attitude and practice are changed to
 Destroyed by freezing

17
 improve individual, family and
community health METHODS AND STRATEGIES IN HEALTH
 Health education is a basic health EDUCATION
service  Interviewing
 Every member  Counseling
 Lecture – Discussions
ELEMENTS AND SEQUENCE OF HEALTH  Open Forum
EDUCATION  Workshops
 Information  Group Work
o Provision of knowledge  Team Teaching
o Lowest level  IEC Materials
o No interaction between you  Publications
and the client  Freebies
 Posters, leaflets  Multi-media

Communication QUALITIES OF A GOOD HEALTH

 Exchange of information EDUCATOR
 Mastery and knowledge
Education  Credibility
 Change in knowledge, skills and  Listening Capabilities
attitude  Teaching Skills
 Flexibility
PRINCIPLE OF HEALTH EDUCATION  Patience
 Consideration of health status of the  Creativity and imagination
people  Motivational Skills
 Health Education is learning  Participative
 Health Education involves  Humor
motivation, experience, and change  Recapping and Summary
in conduct and thinking
 Health Education as a basic function MAG HL (HEALTHY LIVING) TAYO
of all health workers AIMS
 Health Education takes place where
the clients are (tri-media)  To raise the awareness of the
 Heath Education as a cooperative Filipinos on the need to practice a
effort healthier lifestyle
 Health Education meets the
interests, needs and problems of the  Raise the consciousness of policy
people affected makers on the need to provide the
 Health Education is achieved by Filipinos with an environment
doing supportive of healthy lifestyle
 Health Education is a slow and
continuing process KEY MESSAGES OF MAG HL TAYO
 Health Education makes use of  Do not smoke
supplementary aids and devices  Regular exercise
 Health Education utilizes community  Eat a healthy diet everyday
resources  Watch your weight / weight control
 Health Education is a creative  Manage Stress
process  Regular health check-up
 Health Education helps people
attain health through their own PRIMARY AUDIENCE OF MAG HL TAYO
efforts  All family members belonging to the
 Health Education makes careful C – E economic classes in urban
evaluation of the planning, areas
organization and implementation of  Each of the five (5) healthy
all health education programs and messages will specifically prioritize
activities the following target audiences:

18
  Adults to elderly for exercise  Standard Preparation
 School children for healthy diet o One (1) liter of WATER
 Mothers and daughters for watch o Eight (8) teaspoons of
your weight SUGAR
 Teen-agers for do not smoke o One (1) teaspoon SALT
 Working adults for manage stress  Alternative Formula
o One (1) glass of WATER
SECONDARY AUDIENCE OF MAG HL o Two (2) teaspoons of
TAYO SUGAR
 Executives and employees of Local o One (1) pinch of SALT
Government Units
 Legislators and politicians
Remember!
 Media
 Infant must be given ¼ to ½ cup per
episode of diarrhea
COMMUNICATION BATTLECRY
 Child must be given ½ to 1 cup per
 “Mag HL tayo!!!”
episode of diarrhea
 Adult must be given 1 cup per
COMMUNICATION STRATEGIES
episode of diarrhea
 Develop, produce monthly
messages:
BREASTFEEDING
o January
 Continue even with diarrhea
 Regular health
check-up B is for:
o February  BIRTH SPACING
 Exercise regularly
o May / June R is for:
 Do not smoke  REDUCED ALLERGIC REACTION
o July
 Eat a healthy diet E is for:
o October  ECONOMICAL
 Manage Stress
o December A is for:
 Watch your weight /  AVAILABLE ALWAYS
Weight control
S is for:
DIARRHEA  SAFE, SOFT STOOL
 Diarrheal Management
 Three (3) Fs T is for:
o Fluids  TEMPERATURE RIGHT
o Frequent Feeding
o Fast Referral F is for:
 FRESH
 If the child does not get better in
three (3) days or if danger signs E is for:
develop:  EMOTIONAL BONDING
o Fever
o Fontanelles and eyeballs E is for:
o Frequent watery stool  EASILY ESTABLISHED
o Repeated vomiting
D is for:
o Blood in the stool
 DIGESTIBLE
o Poor meal intake
o Weakness I is for:
 Consult a physician  IMMUNITY

Oresol

19
N is for: o Cooking Oil with Vitamin A
 NUTRITIOUS
IMPLEMENTATION
G is for:  Department of Health
 GIT DISORDERS ARE o The lead agency
DECREASED  National Nutrition Council (NNC)
o Determination of RDA
Measures of Prevention of Diarrhea o Determination of mandatory
 Breastfeeding food
 Supplemental feeding if necessary  Department of Finance
 Hand washing o Tax exemption as incentive
 Clean and potable water (PHC support mechanisms)
 Sanitation  Department of Science and
FORTIFICATION Technology
 Addition of additional nutrients to o Assists small manufacturers
processed foods at levels above the
in acquisition and design of
natural state
fortification machine
 Strategic addition of micronutrients
 Department of Trade and Industry
usually deficient in the diet to a
o Upgrades technologies and
widely consumed food
soft loans for acquisition of
 Legal Basis
technology
o Republic Act 8976
 Land Bank
o Philippine Food Fortification
o Provision of loans
Act
 Sugar Regulatory Administration,
 Philippine Constitution
National Food Authority, Bureau of
o The state shall protect and
Customs
promote the right of the o Monitored by the BFAD
people and instill health
consciousness among them
NATIONAL SALT IODIZATION PROGRAM
 Asin Law
SANGKAP PINOY PROGRAM
o DOH, BFAD, DepEd,
STRATEGY
UNICEF, ECD
 To encourage manufacturers to
fortify food, processed foods, or
IODINE
food products with essential
 Element required by tissues for
nutrients at levels approved by the
synthesis of thyroid hormones
DOH
(necessary for mental and physical
 Authorizes manufacturers to use the
development)
DOH seal of acceptance
IODINE DEFICIENCY
 Causes mental retardation, goiter
TYPES OF FOOD FORTIFICATION
and other growth and development
abnormalities
Voluntary Food Fortification
 Food manufacturers may apply for
EFFECTS OF IODINE DEFICIENCY
DOH seal of acceptance should
 Prenatal Development
they choose to fortify
 Mental retardation
 Physical retardation
Mandatory Food Fortification
 Deafness
 Obligatory fortification for staple
foods:
Newborn / Infants
o Rice with iron
 Increased infant mortality
o Wheat Flour with Vitamin A
 Abnormal brain development
and iron  Impaired mental ability
o Refined sugar with Vitamin
A Children / Adolescents

20
  Goiter o Implement Patak sa Asin in
 Lower I.Q. (loss of 10 – 15 pts.) Markets
 Learning disabilities  Request assistance
from Center for
Adults Health
 Goiter Development
 Slower response times (CHD)
 Impaired mental function  Convene Sanitary
Inspectors and
Pregnancy and Lactation market
 Increased incidence of: administrators
o Miscarriage  Launch information
o Stillbirths campaign on
o Birth defects traders and retailers
 Require retailers to
Other Effects of Iodine Deficiency: place signages of
 Loss of 13 I.Q. Points ‘Iodized Salt’
 This translates to lower educability o Support capacity salt
 Net effect is lower economic iodization capacity building
productivity (selected areas only)
 Put up plants in the
OBJECTIVES OF NATIONAL SALT following areas for
IODIZATION PROGRAM Iodization:
 Virtual Elimination of Iodine  Pangasinan
Disorders through Universal Salt (workplan in
Iodization place)
 80% iodized salt utilization of  Bulacan
households by year 2003  Mindoro
 90% iodized salt utilization of o Support implementation of
households by 2004 DOH monitoring system
 Institutionalization by 2005 o Launch information
campaign
What can be done to catch up? o Lapis TV ad
 Enact local ordinance support of: o Hatol TV ad
o ASIN LAW o Stickers
 Signed December
1995 NATURAL FAMILY PLANNING
 Requires all salt for
human and animal  Philippine Constitution
consumption to be o The right of spouses to
iodized
found a family in
o Based on the Asin Law
accordance with their
Revised IRR religious conviction and the
 LGUs shall enact demands of responsible
local ordinances parenthood
 Monitor market,
food outlets, and EXECUTIVE ORDER 307
other  Directed local Chief Executives to
establishments ensure that information on and
within their sources for all methods, including
jurisdiction NFP endorsed by the program are
 Support advocacy available at appropriate levels of
and consumer service outlets, adhering to the
communication standards of quality care
activities

21
 promulgated by the national
government  To train at least 75% of frontline
health providers on Natural Family
ADMINISTRATIVE ORDER 125 SERIES Planning methods
2002
 NATIONAL NATURAL FAMILY  To raise the use of 20% among
PLANNING STRATEGIC PLAN current married women / couples
YEAR 2002 – 2006 who are not yet using any method of
contraception
Objective:
 Mainstreaming of Natural Family How??
Planning to Family Planning  Through Implementing Strategies...
 Only up to 2006
 By 2006, if NFP is know, it will revert IMPLEMENTING STRATEGIES
back to FP  Policy and organization
strengthening
ADMINISTRATIVE ORDER 132 SERIES  Advocacy and orientation
2004  Training and certification
 Created the DOH NFP Program and  Networking and development of
its program management support groups
 A separate program from Family  Monitoring and evaluation
Planning EPIDEMIOLOGY
 The study of the distribution and
FOUR (4) PILLARS OF FAMILY determinants of health related
PLANNING states, events in specified
 Birth Spacing populations and the application of
o Effective in postponing and this study to the control of health
achieving pregnancy problems
 Responsible Parenthood
 Informed Choices Uses of Epidemiology
o Couple chooses via the  Causation
CAFETERIA method  Natural History
 Respect for Life  Description of health status of
population
NATURAL FAMILY PLANNING  Evaluation of intervention.
 Goals and Objectives
o The overall goal is to reduce 1. Causation Determined By
health risks to females and Epidemiology
children due to short birth
intervals and for frequent Genetic Environmental
pregnancies and childbirth Factors Factors
▼▼▼ (including lifestyle)
High-risk Pregnancies ▼▼▼ ▼▼▼
 Too early ▼▼▼ ▼▼▼
 Too late ▼▼▼ ▼▼▼
 Too frequent Good Health
 Too many ▼▼▼
Ill Health
Specific Objectives by 2006
2. Natural History
 To raise fertility consciousness of at
least 75% of young women Good Health
immediately before or soon after ▼▼▼
menarche and of 75% of young Subclinical Changes
females at puberty in preparation for ▼▼▼
responsible sexuality and family life Clinical Disease

22
 ▼▼▼ ▼▼▼  Refers to the geographic area in
Death Recovery which contact between susceptible
host and etiologic agent occurred
3. Description of health status of people  Where does the problem occur, in
 Proportion of Ill health, change over relation to place of residence,
time geographical distribution and place
of exposure
 Where is the rate of disease highest
or lowest

4. Evaluation of Intervention PERSON

 Organizing epidemiologic data
Treatment according to the characteristics of
Medical Care the people involved, provides that
▼▼▼ subjects can be clearly placed in
Good Health Ill Health one category or another
 Who is getting the disease
 Who is affected with reference to
DESCRIPTIVE EPIDEMIOLOGY age, sex, social class, ethnic group,
 As to time occupation, etc.
 Function of RESU
 When does the disease occur RATIOS AND PROPORTIONS
commonly or rarely (in terms of
hour, days, months, seasons, years) Variables and Constants
 Is the frequency of disease at  Variables
present different from frequency in o Differing
the past?  Constants
o Does not change regardless
Patterns of Disease Occurrence of time, place, etc.

ENDEMIC VARIABLES
 A persistent level of occurrence with  Types of Variables
low to moderate disease level o Quantitative
 Points along a
HYPERENDEMIC LEVEL numerical scale and
 Persistently increased level of values are rendered
occurrence in a graded order
 Measures of control
SPORADIC location and
 An irregular pattern of occurrence, dispersion
with occasional cases occurring at o Qualitative of Nominal Scale
irregular intervals  Measurable and not
necessarily
EPIDEMIC
 When the occurrence of disease is NOMINAL DATA
in excess of the expected level  Quality and not quantity
 May be classified but not based on
PANDEMIC what is better or worse or less
 When an epidemic spreads over acceptable
several countries or continents  Value
 Example: AIDS, SARS
EPIDEMIC PATTERNS BASIC MEASURES
POINT SOURCE COUNT
 Number of cases of a disease
PLACE

23
RATIO  Proportion of persons in a
 Expresses the relationship of counts population who have a particular
among two (2) groups disease or attribute at a specified
point in time or over a period of time
PROPORTION  Refers to NEW CASES PLUS OLD
 A ratio in which the numerator is CASES
part of the denominator

RATES
 Refers to the occurrence of events
over a given interval of time
 Mode may be simpler or multi
WHAT DO WE COUNT
PEOPLE
 To estimate proportion of the
population sick with a chronic
disease (prevalence)
Formula:
All new and pre-existing case
during a given time period x10n
Population during the same
time period
ATTACK RATE
 A variant of an incidence rate,
applied to a narrowly defined
population observed for a limited
time, such as during an epidemic

Formula:

EPISODES Number of new cases

among the population
WHY USE RATIOS during the same period x 100
 To make comparisons between two Population at risk at the
different populations that may have beginning of the period
different numbers of people at risk
 To calculate the number of expected or
cases
(ILL / ILL + NOT ILL) x 100
RATE: Points to Consider
 The persons in the denominator  Note that the denominator is the
most reflect the population from population at risk
which the cases in the numerator
arises CASE FATALITY RATE
 The counts in the numerator and  Killing index or killing power of a
denominator should cover the same disease
time period  Proportion of persons with a
 In theory, the persons in the particular condition who died from
denominator the condition

INCIDENCE RATE Formula:

 Expresses the probability of illness
in a population over a period of time Number of cause
 Concerns NEW CASES ONLY specific deaths among
the incident cases x 100%
Formula: Number of incident
Cases
New cases occurring
during a given time period x 10n
Population at risk during
the same time period SARS
Timeline
PREVALENCE RATE

24
November 16, 2002
 Initial case appears in Guandong,
South China
February 26, 2003
 Outbreak as a severe form of
pneumonia was reported in Hong
Kong and Vietnam
 March 10, 2003
 Severe form of pneumonia named
SARS
March 15, 2003
 Philippines had its first suspected
case
March 17, 2003
 SARS research started – DOH
response
April 11, 2003
 First Philippine probable
reported
April 16, 2003
 WHO announced that SARS is
cause by Corona Virus
Fourteen (14) probable cases in the
Philippines
 Seven (7) reported
 Two (2) died
 Five (5) recovered
SARS affects all age groups
 Infectious agent
 A new member of the Corona virus
family
 Able to survive in inanimate objects
for up to four (4) hours
 Can be killed by exposure to
ultraviolet light
 Mutates easily and each mutation
triggers off an epidemic of
respiratory diseases
 The name: Corona Virus
INFECTIVITY / VIRULENCE
 Low Infectivity
 Infectivity is the ability of the virus to
jump from one person to another
Highly Virulent
 Virulence is the property of the virus
to cause damage in the patient’s
organs
 Transmitted through droplet spread
and spreads as far as one (1) meter
or roughly three (3) feet away
CASE DEFINITIONS
SUSPECT CASE
 A person presenting after November
1, 2002 with a history of:
o High fever > 38°C
o Cough or breathing difficulty
o One or more of the following
exposures during the ten
(10) days prior to the onset
of symptoms:
o Close contact, with a person
who is suspected or
probable case of SARS
case
SUSPECT CASE
 A person with unexplained acute
respiratory illness resulting into
death after November 1, 2002 but
on whom no autopsy has been
performed
AND
 One or more of the following
exposures during the ten (10) days
prior to the onset of the symptom
PROBABLE CASE
 A suspect case with radiographic
evidence of infiltration consistent
with pneumonia or respiratory
distress syndrome on chest x-ray
 A suspect case of SARS that is
positive for SARS Corona Virus on
one (1) or more assays
 A suspect case with autopsy
findings consistent with the
pathology of SARS without
identifiable cause
CLINICAL PICTURE
 Exposure to SARS
 Incubation Period
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 o Two (2) to ten (10) days; up o Rules
to thirteen (13) days o Implementing guidelines
reported  Engineering
 Early Symptoms o Exhaust pipes design
o Fever o Ventilation
o Myalgia  Personal Protective Equipment
o Dry cough o Last method
o Headache
 Prodromal TYPES OF MASK
o One (1) to two (2) days
o Non-productive cough Tissue or Paper Mask
o Shortness of Breath  Forms a barrier of sorts but offers
o Lower Respiratory Phase no real protection against droplets.
 From day four (4) onwards The paper moistens within one hour,
o Infectivity becoming ineffective
o Very high
Gauze Mask
Lower Respiratory Phase
 Next to useless – particles can still
▼▼▼ ▼▼▼
make their way through. Still better
Recovery Acute Respiratory
than wearing no mask
(approx. 90%) Distress
Syndrome
Important Concepts!
(approx. 10%)
 The N stands for respiratory filters
that can be used when no oil is
TREATMENT OF SARS
present in the contaminants
 Early detection and treatment
 The 95 means that the product has
improves chance of recovery
been treated and certified to have a
 No specific treatment has been
filter efficiency of 95% or greater
developed yet
against particulate aerosols
o No vaccines available
 The N-95 respirator has the ability to
 Steroids and anti-virals are being
filter particles one (1) micrometer
used at present
with a filter efficiency of greater than
 Anti-bacterials are given to cover
95%
secondary bacterial infections
WHO SHOULD WEAR A MASK?
PERSONAL PROTECTIVE EQUIPMENT
 People with symptoms of respiratory
(PPE)
illness
 Cap
 Caregivers of patients with
 Gown
respiratory illness
 Gloves
 Health care workers
 N-95 Mask
 Household contacts of confirmed
o Mask of choice
respiratory cases
o Six (6) hours maximum use
 Goggles PREVENTION
 Shoe Covers  Maintain good personal hygiene
 Ensure good ventilation
HIERARCHY OF HAZARD CONTROL AND  Adapt a healthy lifestyle
MANAGEMENT
 Elimination MALARIA
o Remove the hazard  Anopheles mosquito thrives in slow
 Substitution flowing river or water that is not
o Substitute for chemical stagnant
causing hazard
 Administration Agent
o Policies

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Plasmodium falsiparum
 Most common in the Philippines,
accounts for around 70% of cases
 Causes severe / complicated
malaria and death if not treated
promptly / appropriately
 Resistance to anti-malaria drugs is
widespread but low grade
Plasmodium vivax
 Accounts for 30% of cases
 Rarely causes severe disease
 Sensitive to anti-malarial drugs
 Resistance suspected in some
countries
 Relapse is common if not treated
adequately with anti-relapse drugs
Plasmodium malariae
 Very rare, less than 1% of cases in
the Philippines
 Infection is usually not severe but
may last up to fifty (50) years if not
treated
 Drug resistance has not yet been
documented
 Non-immune travelers to endemic
areas
MALARIA CONTROL PROGRAM
VISION
 Malaria Free Philippines by 2020
MISSION
 To empower the health workers, the
population at risk, and all others
concerned to eliminate malaria in
the Philippines
STRATEGIES TO ACHIEVE GOALS
 Early diagnosis and effective
treatment
 Utilization of insecticide treated
mosquito nets
 Immediate and effective responses
to malaria epidemic
 Selective vector control in areas
where it can be afforded and
sustained

Plasmodium ovale VECTOR CONTROL

 Not found in the Philippines, found  Main – not FOGGING (only during
only in Africa epidemics)
 Relapse may occur if not treated  But – INSECTICIDE TREATED
adequately with anti-relapse drugs MOSQUITO NETS
 Drug resistance has not yet been  Target: One (1) treated mosquito net
documented per household

Anopheles VECTOR CONTROL OPTIONS

 Night Biter
 46% in Luzon 1.INSECTICIDE TREATED NETS
 1 % in Visayas  Reduce man-mosquito contact
 53% in Mindanao  Initial treatment carried out by MCP
 Top Ten (10) Provinces personnel, six months after, the
o Palawan people were able to do it
o Tawi-Tawi
o Agusan del Sur SINGLE TREATMENT METHOD
o Sulu  Place mosquito net inside plastic
o Davao del Sur bag
o Isabela o Immerse the mosquito net
o Davao del Norte in an insecticide
o “Ikusot sa loob ng plastic
o Compostela valley
bag”
 Apayao Cagayan
 Air dry the mosquito net
o Avoid sun exposure
AT HIGH RISK
 Pregnant Women  Three (3) drippings
 Children o Use only when thoroughly
 Indigenous Cultural Communities dried

27
2. INDOOR RESIDUAL SPRAYING  Number of parasites per milliliter of
 Kills adult mosquitoes on walls; not blood
the “kiti-kiti”
 Method of choice during outbreaks New Approach
or epidemics  RAPID DIAGNOSTIC TEST (RDT)
 Lasts for six months if not wiped  Seven (7) to Fifteen (15) minute test
away  Sensitivity and specificity > 90%
 Uses immunochromatographic
3. LARVICIDING and BIOLOGICAL methods to detect Plasmodium
CONTROL specific antigen
 Flight range of malaria mosquito is  Detects circulating antigen and
three-hundred meters (300 m) sequestered Plasmodium falsiparum
o Therefore, cleaning is a  Diadvantage
community effort o Parasite density not seen /
 Chemical Agents known
o Paris Green o Will only know he has P.
o Temephor falsiparum
 Biological Agents
o Lavivorous fishes CHEMOTHERAPY GUIDELINES
o Gabusia affinis
 Paecilia reticulata CHLOROQUINE + SULFADOXINE /
PYRIMETHAMINE (CQ + SP)
ENVIRONMENTAL MANAGEMENT  First line drug in the treatment of
 Cleaning of Streams probable malaria and confirmed P.
o Environmental not biological falsiparum provided disease is not
o Covering openings in severe
unfinished houses ARTHEMETHER-LUMEFANTRIN (co-
Artem)
PERSONAL PROTECTIVE EQUIPMENT  Second line drug
 Chemoprophylaxis  Given only to microscopically
o Use of mosquito repellants confirmed P. falsiparum which did
not respond to adequate CQ + SP
 Burning of coconut husks
treatment
 Wear long sleeves
 Not recommended for:
 Animal bait tied
o Pregnant women
MALARIA DIAGNOSIS o Children < eight (8) years
 Gold Standard old
o Definitive diagnosis of
infection is based on blood QUININE + TETRACYCLINE /
smear DOXYCYCLINE
 Third line drug
 Given to those who did not respond
Conventional Approach to Co-Artem or if CQ + SP is not
 Light Microscopy available
o Gold Sandard  Drug of Choice in the treatment of
SEVERE MALARIA
o Can detect very low
 Tetracycline and Doxycycline are
parasitemia
contraindicated for:
 5 – 10 parasites per
o Pregnant women
ml
o Children < eight (8) years
 Specie identification is possible
 Quantitative parasite old
 Count can be done  Quinine and Clindamycin are given
instead
Reporting of Light Microscopy
 Parasite Density

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PRIMAQUINE
 Given single dose to confirmed P.
falsiparum cases to prevent
transmission
 Given for fourteen (14) days to
confirmed P. vivax to prevent
relapse
MEDICAL MANAGEMENT OF LEPROSY
CHLOROQUINE  Multidrug therapy (MDT) is the
 Used in the treatment of confirmed accepted standard for leprosy
P. vivax  MDT must be started as soon as
diagnosis is made

TREATMENT COMPLETION
 A patient on PB regimen should take
six (6) blister packs within nine (9)
LEPROSY months
 A patient on MB regimen should
DIAGNOSIS OF LEPROSY take twelve (12) blister packs within
 Based on the clinical signs and eighteen (18) months
symptoms  At the end of the duration, patient is
considered as treatment completed
o Madarosis (T.O.)
 Falling of the  Patient may have lesion after being
eyebrows T.O. but this lesion would also
disappear
o Anhydrosis  Standard regimen is safe during
 No sweat pregnancy
 For TB patients
o Leonine Face  Remove rifampicin in MB blister
 Like a lion’s face pack so that they would not double
up on their dose
Diagnosis – History
TUBERCULOSIS
 Nature of 1st lesion or symptom and
its progression  80 million people in 2003

 Treatment received in the past Department of Health (DOH)

 Sets policies and guidelines
 General history about any significant
past / present illness Local Government Units (LGUs)
 Health program implementation
 History of contact with leprosy case through the Rural Health Units
if out of family (RHUs) and Barangay Health
Stations (BHS)
Classification
Single Pauci- Multi-
Lesion bacillary bacillary
Philippines
Pauci- (PB) (MB)
 One of twenty high-burdened
bacillary
countries
(SLPB)
Number One Two to Greater
Mission and Tasks
of (1) Five than
 Case TB patient for Detect / Find TB
Lesions (2 – 5) Seven
patient through active / passive case
(> 7)
finding

29
MAIN STRATEGY TYPES OF TUBERCULOSIS CASES
 DIRECT OBSERVED TREATMENT  New
SHORTCOURSE o No treatment or less than
o Political commitment one (1) month treatment
needed  Relapse
o Quality microscopy service o Cured and Smear Positive
o Regular availability of drugs again
o Standard records and  Transfer In
reports o Changed treatment facility
o Supervised treatment  Return after Default
o Interrupted treatment
PROGRAM COMPONENTS o Smear Positive
CASEFINDING
 Objectives  Treatment Failure
o To identify TB symptomatics o Still positive on the fifth (5 th)
 Cough for two (2) month
weeks  Others
o To identify three diagnosis o Became positive on the
TB case early through: second (2nd) month
 Passive o Interrupted treatment /
Casefinding Smear negative
 TB symptomatic
present CATEGORIES
themselves at the
health facility  CATEGORY 1
 Active Casefinding o Virgin cases
 Personal  CATEGORY 2
effort to find TB o Failure cases
cases among the o Relapse
symptomatics o RAD cases (Return after
who do not seek Default)
help  CATEGORY 3
o Extrapulmonary TB
MAJOR POLICIES IN CASEFINDING o Not serious
 Direct sputum smear microscopy
shall be the primary National MEDICATION REGIMEN
Tuberculosis Program (NTP)
diagnostic tool Important Concepts!
 All TB symptomatics must undergo  Mnemonic is HRZES
sputum examination, with or without
x-ray results. THE ONLY H is for:
CONTRAINDICATION IS MASSIVE  ISONIAZID
HEMOPTYSIS
 Three sputum specimen must be R is for:
submitted:  RIFAMPICIN
o First Spot – NOW – upon
seeing patient Z is for:
o Early Morning – patient  PYRAZINAMIDE
does this
o Second Spot – The early E is for:
morning spot is brought by  ETHAMBUTOL
the patient to the RHU
o Therefore, 1st Spot, Early S is for:
Morning, 2nd Spot  STREPTOMYCIN

30
 Four (4) serotypes:
 Dengue 1
 Dengue 2
 Dengue 3
 Dengue 4
CATEGORY 1
 Two (2) months Important Concepts!
o HRZE
 Four (4) months  Common during the rainy season
o HR
 Aedes mosquito thrives at
CATEGORY 2 STAGNANT WATER
 Two (2) months
o HRZES  Dengue is the MOST IMPORTANT
 One (1) month MOSQUITO-BORNE VIRAL
o HRZE DISEASE IN THE WORLD
 Five (5) months
o HRE Who are affected?
 Re-treatment regimen  Anyone
 Infants / school children (0 – 9 years
CATEGORY 3 old) are MOST AFFECTED
 Two (2) months
o HRZE Signs and Symptoms of Dengue
 High continuous fever lasting two (2)
 Four (4) months
to seven (7) days
o HR
 Bleeding tendencies
 Presence of small reddish spots or
SCHEDULE OF SPUTUM FOLLOW-UP
skin flushing
EXAMINATIONS
What to do?
 CATEGORY 1
 Bring all suspects to hospital
o
2nd/ 3rd , 4th, 6th
 Do not medicate
 CATEGORY 2  Give paracetamol
o
3rd, 4th, 5th, 8th  Never aspirin
 CATEGORY 3
o
2nd Tranmission
 Stop if patient is OK, if NOT,  Aedes albopictus
CONTINUE  Aedes aegypti
 Mosquito which bites a person with
Important Concepts dengue hemorrhagic fever (DHF)
 FDC will be infected eight (8) to ten (10)
o All in one days after biting DHF infected
o A form of MDT person
o Not a single drug  Small black and white mosquito with
o Familary stripes
o Day biters
R – DO – R o Can fly 30 – 300 meters
 Selective drug taking develops o Prefers dark color for
resistance apposition
 Aedes aegypti
o Commonly found in:
 Closet
DENGUE  Drawers
 Dark, cool places
Aedes mosquito  Aedes albopictus

31
 o Commonly found:
 Outdoors
 Shrubs
 Trees
PREVENTION OF DENGUE
 Eliminate breeding sites
o Flower vases
 Prevent mosquito bites
MENINGOCOCCEMIA
 Acute Bacterial infection
 Mostly affected are:
o Children
o Young adults
o More Females
 Crowded situations
o Barracks / institutions
 Five to ten percent (5% - 10%) of
problem in endemic countries are
asymptomatic
 Neisseria meningitides
o Normally present in the
throat
 A small majority of those who
acquired infection will predispose to
intervene disease bacterimic sepsis
meningitis or pneumonia
 Patients with sepsis develop
petechial rash with that environment
CASE
 Definition
o Sudden onset of fever and
any one of the following:
 Neck stiffness
 Altered
consciousness
other meningeal
signs
 Petechial rashes /
purpural
 Gram negative
cocci or gram stain
of CSF / skin
scrapings
 Without apparent
cause
Clinical features:
 Sudden onset of fever, intense
headache, nausea and often,
vomiting
 Stiff neck, petechial rash with pink
macules to very rarely vesicles
Causative Agent
 Neisseria meningitidis
 Gram negative diplococci
 Colonize the oropharynx or
nasopharynx of asymptomatic
carriers
 Don’t survive well outside human
environment
 Reservoir is HUMANS ONLY
Three (3) Types
 Suspect
 Probable
o When Gram negative
diplococcus is positive after
cerebrospinal fluid (CSF)
examination
 Confirmed
o If Gram negative
diplococcus is confirmed as
Neisseria meningitidis
o Therefore, CONFIRMED!!!
Mode of Transmission
 Direct contact with contaminated
respiratory secretion or airborne
droplets
Incubation Period
 Two (2) to ten (10) days
 Commonly three (3) to four (4) days
Period of Communicability
Important Concept!
/  Twenty-four hours after antibiotic
therapy, PATIENT IS NO LONGER
INFECTIOUS
PREVENTION OF MENINGOCOCCEMIA
 Education to prevent exposure
 Reduce overcrowding
 Investigation of contacts and
sources of infection
CONTROL OF MENINGOCOCCEMIA
 Report cases to local health
authorities
 Do respiratory isolation for twenty-
four (24) hours after start of
chemotherapy
 Disinfect discharges from nose /
throat / soiled articles
32
  Protect contacts with effective o Self Quarantine
chemotherapy  Admission at hospital
o Rifampicin 600 mg BID for o Do not self medicate
adults
VACCINATION
Specific  85% to 95% protective
 Penicillin – Drug of Choice o No ZERO CONVERSION
(parenteral) vaccination
 Ampicillin and chloramphenicol are  Starts to be protective after five (5)
also effective days from injection
 Cephalosporin  Protection
 Start treatment immediately when o Lasts for two and a half to
presumptive diagnosis is made three years (2.5 – 3 yrs)
before identification of organism is o Not protective to children
made below two years old
o Nor recommended public
EPIDEMIC MEASURES health measure; taken as a
 Careful surveillance personal protective
o Early diagnosis measure
o Immediate treatment
 Separate individuals FACTORS INCREASING SUSCEPTIBILITY
TO MENINGOCOCCEMIA
 Smoking
SIGNS AND SYMPTOMS  Overcrowding
 Fever chills / day  Presence of other infections
 Headache Underlying immune deficiency
 Neck stiffness HOST FACTORS
 Neck / back pain down to lower  Lack of bactericidal antibody
extremities  Age < 1 year or 15 to 24 years old
 Nausea and vomiting  Cigarette smoke; active or passive
 Rash (small red purple spots)  Respiratory infections
 Seizures o Viral infections
o Cough and cold
Important Concept!
 Diplococcus is kidney bean shaped CONTROL OF MENINGOCOCCEMIA
 For adults:
TRANSMISSION  Rifampicin 600 mg BID
 Close personal contact  For children > one (1) month old
 Lip kissing  Rifampicin 10 g / kg body weight
 Sharing utensils  For children < one (1) month old
 Secretion from  Rifampicin 5 g / kg body weight
o Nose
o Mouth Suspect
o Throat  Diagnosed chemically based on
o Sneezing signs and symptoms
 Sharing of microphones

PREVENTION
 Consult doctor
o With one (1) day low fever
 Avoid crowded places for two hours
 Strengthen immune system
 Good hygiene
 Take prophylactic / preventive
antibiotics

33
34