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EPI PidsPhil 10lec Protecting The Filipino Children - Expanded Programe of Immunization and Beyond
EPI PidsPhil 10lec Protecting The Filipino Children - Expanded Programe of Immunization and Beyond
Newborn Tetanus
Pertussis Hepatitis B
Global Polio Eradication
Initiative
14,000 80
70
12,000
60
10,000
50
8,000
40
6,000
30
4,000
20
2,000 10
0 0
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Office of the WHO Representative in the
Philippines
Mortality Estimates based on Stein, et al. JID 2003:187
Unprecedented decline of measles cases in
sentinel sites, 2003-2007
2000
351 deaths 4 deaths
One
1750 Ligtas
Not one confirmed
1500 Tigdas confirmed case in 2006
>100 confirmed
measles case
No. cases
N
J
J
M
M
M
S
S
2003 2003 2004 2005
2004 2006 2005 2007
NEC, 2007
In the past 15 years, more children are protected
against tetanus, and cases have declined
600 80
NT cases
495 CPAB 70
500
60
400 372 366
336 330 339 50
313
No. of cases
299 291
300 40
243
225
212
195 187 186
30
200 161
20
95
100
10
0 0
19921993199419951996 1997 1998 1999 2000 2001 200220032004200520062007 2008
Source: VPD Surveillance, NEC; FPS and
* As of September 2008
Year MCH Surveys 1997-2008
However, babies born in 9 provinces/cities remain
at high risk of dying from newborn tetanus
0
10
20
30
40
50
60
70
80
90
100
N i ad 2
A z ge r 0 0
e r ia 4
b 2
A r a i j an 0 0 3
me 2
E t n ia 0 0 6
hi o 2
p i a 0 05
C o N i ge 2 00
ng r 2 5
o
M o D R 0 06
ld 2
G u ova 0 07
in 2
L i b e a 2 00 5
er 00
ia 5
H a 20
Bu it i 0 7
r k i I nd i 20 0
na a 6
F a 20 0
Bo s 6
P a e n i2n0 0
C a k is t 2 03
m e a n 06
r o 20
on 07
M 20
B o a l i 20 4
liv 0
Co K e ia 2 0 6
ng
o n y a 00 3
Z im(B ra 20 0
M a b a zz) 3
D o d a g bw e 2 00
m as 20 6
R e ca 0 6
C op u b r 20 0
lo l ic 4
I nd m b 2 0
o n ia 2 07
S e 0
Philippines
M o e n s ia 2 0 5
z a eg a 0 0
mb l 2 7
i 0
Mqaue 0 5
2
V law 0 0
C a iet na i 2 030
mb m 4
2
N a t ho 0 7
mi 20
G bi 0
P h ha a 2 0 4
i li p n a 0 7
T a pin e 20 0 3
n s
H o z a n 2 00
nd i a 2 3
R u r a 00
P h w an s 2 0 4
il ip d a 0 5
p i n 20
PHL
es 0 5
S w E g y 20
B a a z i p t 20 8
2003 2008
n g l a n 0 05
la d d 2
e 0
N seh 2 0 7
FIC Demographic and Health Survey Coverage by
0
J o pa l 207
r
M o d an 0 0 6
ro 2 0
c c 07
o2
00
4
Vaccines have saved tens of
thousands of lives every year in the
Philippines
How Safe Are Vaccines?
Vaccines used in the Public Sector:
• Are bought through UNICEF procurement system from
pre-qualified manufacturers
– Good Manufacturing Practices, Clinical data, Consistency of Final
Product, relies on functional National Regulatory Authority
– Meets all critical indicators required for pre-qualification
purposes following a WHO independent assessment /
reassessment
• National
• 17 Regions
• 82 Provinces
At RITM and Regions…
Walk-in Freezer
Iced-line Freezers
Walk-in Cooler
At the Province and City Health Vaccine Room
Transport Boxes
At a later time, inner square still lighter than the outer circle
If the expiry date has not been passed
USE the vaccine
Discard point:
AEFI Surveillance
WHAT IS AN ADVERSE EVENT FOLLOWING
IMMUNIZATION (AEFI)?
Prefilled Syringes
Inappropriate cooling
pack
Inappropriate
disposal
• Clarified the
Midwifery Law
– Midwives should
provide all
immunizations
Office of the WHO Representative in the
Philippines
This issuance made the Philippines
the 13th country and the 1st
developing country with a policy on
the legal assistance for health
workers and medical support for
those who had adverse event
following immunization (AEFI)
9.89M 10.73M
Vaccines save lives!
BEYOND EPI……….
2015
NDS NDHS NDHS NDHS
Indicators (target
1993 1998 2003 2008
)
Under-Five
Mortality 54 48 40 34 18
(5-year average)
(percent reduction
from 1993 ref. 11% 26% 37% 67%
period)
Trends in under-five mortality rates, 1993-2008
NDHS
(1993-1997()1998-2002)(2003-2007)
Direct Causes of Underfive and Neonatal
Deaths
Under
Nutrition
53%
• inequity
20.0 1.8
18.0 1.6
16.0
1.4
14.0
1.2
12.0
10.0
1
8.0 0.8
6.0 0.6
4.0 0.4
2.0 0.2
0.0 0
45
40
35
30
no education
25
42 >college
20
33 32
15
10
5 9 7
3
0
Neonatal Mortality Postneonatal Mortality Child Mortality
Childhood Deaths
By Wealth Index, 2003 NDHS
30
25
20
poorest
15
25 richest
10 21 21
13
5
6 1
0
Neonatal Postneonatal Child
Mortality Mortality Mortality
Among live births in the five years preceding the survey,
the percentage delivered in a health facility, and the
percentage delivered at home, according to birth order
and residence, Philippines 2008
Characterist Percentage delivered in Percentage
ics a health facility delivered at home
Birth
order
1 59.8 40.0
2-3 46.7 52.9
4-5 30.7 69.0
6+ 19.8 79.8
Residence
Urban 59.2 40.3
Rural 29.8 70.0
Children under age 5 with symptoms of acute
respiratory infection (ARI) in the two weeks
preceding the survey, Philippines 2008
Breastfeeding status of children below 6 months old,
Philippines 2003 and 2008
Breastfeeding and Appropriate Infant
Feeding prevents
• 16,000 under five deaths
• 1.2million episodes of illness
• 10 million days of illness
• 450,000 health facility
consultations
• 36,000 hospital admissions
Diarrhea Treatment
continued feeding
81.8
Zinc supplements
1.5
antimotility
8.3
antibiotics
17.2
increased fluids
35.9
ORS/RHF
58.6
care-seeking
34.2
0 20 40 60 80 100
Magnitude of STH
In the Philippines:
Prevalence Rate (PR) among children 6–14 y/o
ranged from 6% - 97% (CDCS 1998-2002)
PR among children 1–5 y/o is 66% (UNICEF, 2004)
Associated factors:
Poverty
Poor nutrition
Inadequate sanitation
Lack of clean drinking water
Age/Sex/Physiologic
State
Philippines
6 mos - < 1 yr
1-5y
6 - 12 y, M
F
13 - 19 y, M
F
20 -39 y, M
F
40 - 59 y, M
F
≥ 60 y, M
F
Pregnant
Lactating
PEM, 2007
Heath-related costs from poor sanitation
(US$ 1 billion/ year)
91% is due to pre-mature death
Premature
death, 91%
38%
of population with PhilHealth coverage
compared to 30% in the 2003 NDHS
National
average:
4%
3%
2%
1%
0%
Lowest Second Middle Fourth Highest
Public Private
• 3.9% and 3.3% visited or sought advice/treatment from public and
private health care providers in past 30 days
• Use of private health care increases with economic status while the
use of publicly provided health care moves in the opposite direction
(Table 14.3)
• Average cost of confinement is Php16,800
–Less than 1% reported obtaining in-patient care
for free
–Average cost of confinement in public facilities is
Php9,800
–Average cost of confinement in private facilities
is Php24,300
6%
5%
4%
3%
2%
1%
0%
Lowest Second Middle Fourth Highest
Public Private
• 3.9% and 3.3% visited or sought advice/treatment from public and private
health care providers in past 30 days
• Use of private health care increases with economic status while the use of
publicly provided health care moves in the opposite direction (Table 14.3)
• Among those who used health care services:
• Use of regional hospital services highest in NCR and lowest
in Bicol
• Use of provincial and district hospital services highest in CAR
and lowest in NCR
• Use of RHU services highest in SOCCSKARGEN and lowest in
CAR
• Use of private hospital services highest in CALABARZON and
lowest in Bicol
• Use of alternative and non-professional health care services
highest in Bicol
Predisposing Factors
• maternal and child malnutrition
• high fertility and short birth intervals
• poor maternal care
• insufficient newborn care
• inappropriate infant and child feeding practices
• poor access to safe water and sanitation facilities
• poor access to basic health services
Essential Health Interventions/
Child Survival Package