DEPARTMENT OF HEALTH

PROGRAMS
Department of Health
The Department of Health is the executive department
of the government of the Philippines responsible for
ensuring access to basic public health services by all
Filipinos through the provision of quality health care,
the regulation of all health services and products
Vision Health for all Filipinos

Mission Ensure accessibility & quality of health care to

improve the quality of life of all Filipinos, especially the poor.
National Objectives

1. Improve the general health status of the population

(reduce infant mortality rate, reduce child morality
rate, reduce maternal mortality rate, reduce total
fertility rate, increase life expectancy & the quality of
life years).
National Objectives

2. Reduce morbidity, mortality, disability &

complications from Diarrheas, Pneumonias,
Tuberculosis, Dengue, Intestinal Parasitism,
Sexually Transmitted Diseases, Hepatitis B, Accident
& Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma &
Chronic Obstructive Pulmonary Diseases, Nephritis
& Chronic Kidney Diseases, Mental Disorders,
Protein Energy Malnutrition, and Iron Deficiency
Anemia & Obesity.
National Objectives

3. Eliminate the ff. diseases as public health

problems:

Schistosomiasis, Malaria, Filariasis, Leprosy Rabies, Measles

Tetanus, Diphtheria & Pertussis, Vitamin A Deficiency & Iodine

Deficiency Disorders
National Objectives

4. Eradicate Poliomyelitis

5. Promote healthy lifestyle through healthy diet & nutrition,

physical activity & fitness, personal hygiene, mental health &
less stressful life & prevent violent & risk-taking behaviors.
National Objectives

6. Promote the health & nutrition of families &

special populations through child, adolescent &
youth, adult health, women’s health, health of older
persons, health of indigenous people, health of
migrant workers and health of different disabled
persons and of the rural & urban poor.
National Objectives

7. Promote environmental health and sustainable

development through the promotion and
maintenance of healthy homes, schools, workplaces,
establishments and communities’ towns and cities.
What is Republic Act
9288?
Newborn
Screening Act of 2004.
• An Act Promulgating a
Comprehensive Policy and a
National System for
Ensuring Newborn
Screening
EXPANDED NEWBORN
SCREENING
• This law states that prior to delivery, any health
practitioner who delivers or assist in the delivery
of a newborn in the Philippines has the obligation
to inform the parent or legal guardian of the
newborn of the availability, nature and benefits of
ENBS.
• The goal of this program
according to the DOH is to
reduce preventable deaths
of all Filipino newborns due
to more common and rare
congenital disorders
through timely screening
and proper management
•One of its program
objectives is that by
the year 2030 all
Filipino newborns
are screened.
• The Newborn
Screening Center-
National Institutes of
Health being the first
DOH accredited
newborn screening in
the country to test for
ENBS.
 
• What is Newborn
Screening?
-Newborn Screening
(NBS) is a simple
procedure to find out if
your baby has a congenital
disorder that may lead to
mental retardation or even
death if left untreated. 
Why is Newborn Screening important?
• Most babies with metabolic
disorders look “normal” at birth.
By doing ENBS, metabolic
disorders may be detected even
before clinical signs and
symptoms are present. As a
result of this, treatment can be
given early to prevent
consequences of untreated
conditions.
HELP US
SAVE
BABIES
AFFECTED
BY ANY OF
THESE
DISORDERS.
 Endocrine Disorders
• Congenital Hypothyroidism

-a condition in which the baby is

born with the inability to
produce enough thyroid
hormone
• A puffy-looking face.
• Large, thick tongue.
• Large soft spots of the skull.
• Hoarse cry.
• Distended stomach with outpouching of
the belly button (umbilical hernia)
• Feeding problems, including needing to be
awakened for feedings and difficulty
swallowing.
• Constipation.
Congenital Adrenal Hyperplasia

-a group of inherited disorders

characterized by the inability
of the adrenal gland to secrete
cortisol or aldosterone or both
 WHY SCREEN YOUR BABIES?
Effect if SCREENED and
Effect if NOT SCREENED
TREATED early*

• Severe Mental • Normal

Retardation
• Alive
• Death
 Amino Acid Disorders
• Maple Syrup Urine Disease

- a genetic defect in which a

person is unable to break down the
amino acids leucine, isoleucine and
valine; urine of affected persons
smells like maple syrup
• lethargy.
• poor appetite.
• weight loss.
• weak sucking ability.
• irritability.
• a distinctive maple sugar odor in earwax, sweat, and urine.
• irregular sleep patterns.
• alternating episodes of hypertonia (muscle rigidity) and hypotonia
(muscle limpness)
Phenylketonuria
-an inherited condition in
which a baby is born without
the ability to properly
break down the amino
acids called phenylalanine
 WHY SCREEN YOUR BABIES?
Effect if SCREENED and TREATED
Effect if NOT SCREENED early*

• Mental retardation • Alive

• Coma and death • Normal growth
from metabolic crisis • Normal intelligence
for some, learning
problems to others
• Galactosemia
-an inherited disorder in which
the body is unable to
metabolize galactose and the
person is unable to tolerate
any form of milk-human or animal

Death or cataracts
• Convulsions.
• Irritability.
• Lethargy.
• Poor feeding -- baby refuses to eat formula
containing milk.
• Poor weight gain.
• Yellow skin and whites of the eyes (jaundice)
• Vomiting.
Glucose-6-Phosphate Dehydrogenase
Deficiency
-a hereditary condition in which red
blood cells break down when the
body is exposed to certain drugs ,
foods, severe stress or severe
infection
*Severe Anemia; Kernicterus
• paleness (in darker-skinned kids, paleness is
sometimes best seen in the mouth, especially on the
lips or tongue)
• extreme tiredness or dizziness.
• fast heartbeat.
• fast breathing or shortness of breath.
• jaundice (the skin and eyes look yellow)
• an enlarged spleen.
REMINDERS TO
PARENTS
• G6PD deficiency is the 
most common 
condition among the 
ENBS Panel of 
Disorders. Napthalene 
or moth ball, and some 
drugs including herbal 
medicine should be 
avoided by people with 
G6PD deficiency
• While waiting for the ENBS 
result, parents are advised 
not to expose their baby to 
moth ball. More so, all 
medications that will be given 
to the baby must be 
prescribed by a doctor. If the 
ENBS result is G6PD 
deficient, consult the baby’s 
doctor and proceed with the 
confirmatory test. Refer the 
result to your p hysician.
NATIONAL
IMMUNIZATION
PROGRAM
Let us define terms……
• VACCINE
-a substance used to stimulate the
production of antibodies and provide
immunity against one or several diseases,
prepared from the causative agent of a
disease, its products, or a synthetic
substitute, treated to act as an antigen
without inducing the disease.
• VACCINE

-A vaccine is a substance that helps protect

against certain diseases. Vaccines contain a dead
or weakened version of a microbe. It helps your
immune system recognize and destroy the living
microbe during a future infection.
-safe, immunogenic and stable
 Safety

• Must produce protective immunity

• Must have only minimal side effects

• More discomfort in side effects can be acceptable,

however, depending upon the severity of the
disease the vaccine is designed to prevent

NATIONAL EPIDEMIOLOGY CENTER

Immunogenicity

• Must
cause a strong and measurable
immune response

• Must induce the right type of immunity

NATIONAL EPIDEMIOLOGY CENTER

Stable

• Must be stable during its shelf life

NATIONAL EPIDEMIOLOGY CENTER

• ANTIBODY
-a blood protein produced in
response to and counteracting a
specific antigen. Antibodies combine
chemically with substances which the
body recognizes as alien, such as
bacteria, viruses, and foreign
substances in the blood.
-an antibody is a protein produced
by the body's immune system when it
detects harmful substances, called
antigens
IMMUNITY
-the ability of an organism to
resist a particular infection or
toxin by the action of specific
antibodies or sensitized white
blood cells
• ANTIGEN
-a toxin or other foreign substance
which induces an immune response
in the body, especially the production
of antibodies.
-any substance that causes your
immune system to
produce antibodies against it.
• LIVE ATTENUATED VACCINE

-a vaccine created by reducing the

virulence of a pathogen, but still
keeping it viable (or "live"). 
-
• The Expanded Program on
Immunization (EPI) was established
in the year 1976.

• Its objective is to ensure that infants,

children and mothers have access to
the vaccines.
• The six vaccine preventable
diseases (VPDs) which are
included are tuberculosis,
poliomyelitis, diphtheria,
pertussis, measles and tetanus
What was then the EPI is now the National
Immunization Program (NIP). Now, we have
almost doubled the number of vaccines in
routine childhood immunization. We have
expanded vaccination to the adolescent and
adult age groups. More vaccines are also set
to be offered.
• In the year 2017, EPI was
changed to National
Immunization Program
(NIP), in which to date there
are 14 VPDs with a wider
coverage including the
school children, adolescents,
and senior citizens
• The vaccines included are the
following:
• BCG, Hepa B, OPV, IPV, Penta,
PCV, Rotavirus Vaccine, MMR,
MR, Td, JE, HPV, Influenza
Vaccine and PPV.
• Reconstituted and
multi doses vaccines?
• Reconstituted Vaccines
- those vaccines in a vial must
be mixed with a diluent provided
by the manufacturer which needs
to be used at once and
discarded after six (6) hours.
- BCG, Measles (AMV),
Measles-Rubella (MR) and
MMR
• Multi-dose vaccines
- a vial can be used by more
than one (1) individual
• - can be kept and used up
to 28 days provided that
the expiry date has not and
was able to maintain its
recommended temperature
considering the Vaccine
Vial Monitor (VVM).
• Open Vial Policy
• VVM
- a label placed in each
vaccine in which it is an
indicative of how the vaccine are
properly stored thus
maintaining its potency.
VVM LOCATIONS
BCG Vaccine

• At birth
• 0.05 ml
• Intradermal
• Upper right arm
 Hepa B Vaccine

• At birth
• 0.5 ml
• Intramuscular
• Outer mid-thigh
Pentavalent Vaccine (DPT-Hep B-
Hib)
•6 weeks, 10 weeks, 14
weeks
• 0.5 ml
• Intramuscular
• Outer right upper thigh
 Oral Polio Vaccine (OPV)

• 6 weeks, 10 weeks, 14
weeks
• 2 drops
• Oral
• mouth
• Rotavirus Vaccine
-6weeks, 10 weeks
-oral
-mouth
 Inactivated Polio Vaccine (IPV)

• 14 weeks
• 0.5 ml
• Intramuscular
• Outer left upper thigh
Pneumococcal Conjugate Vaccine (PCV)

• 6 weeks, 10 weeks, 14 weeks

• 0.5 ml
• Intramuscular
• Outer left upper thigh
 MMR
•9 m0nths and 12 months
• 0.5 ml
• Subcutaneous
• Upper right arm
• Japanese Encephalitis
-9 months
-subcutaneous
-Upper arm
- MR
- Grade 1 and 7
- Subcutaneous
- Upper right arm
• HPV
-Female 9-13 years old (Grade 4 student)
-Intramuscular
-Outer upper arm
• Influenza Vaccine
-60 years old and above, annually
-Intramuscular
-Outer upper arm
• PPV
• Pneumococcal polysaccharide vaccine —known as Pneumovax 23 

-Adults 60 and 65 years old

-Intramuscular
-Upper right arm
• Td
-Intramuscular
-Outer left upper arm
-Grade 1 and 7 for children
-for child-bearing woman:
*Td 1: as early as possible in pregnancy
*Td 2: 4 weeks after Td 1
*Td3: 6 months after Td2
*Td4: 1 year after Td 3
*Td5: 1 year after Td4
Tetanus vaccine, also known as tetanus
toxoid, is a toxoid vaccine used to prevent
tetanus. During childhood, five doses are
recommended, with a sixth given during
adolescence. After three doses, almost
everyone is initially immune, but additional
doses every ten years are recommended to
maintain immunity.
What is Td vaccine for pregnant?
Pregnant women have been
getting both tetanus and
diphtheria toxoids (Td) and
tetanus toxoid (TT) vaccines
worldwide since the 1960s to
prevent neonatal tetanus
Disposing of Used Needles and Syringes
❖All used injection equipment except
reusable syringes and needles
should be placed in a safety box.
❖ Safety boxes are:
❑ water-proof
❑ tamper-proof
❑ puncture-resistant
Disposing of Used Needles and Syringes
❖All used injection equipment except
reusable syringes and needles
should be placed in a safety box.
❖ Safety boxes are:
❑ water-proof
❑ tamper-proof
❑ puncture-resistant
UNSAFE IMMUNIZATION PRACTICE
Do Not Leave the Needle Inside the Vial
UNSAFE IMMUNIZATION PRACTICE
Do Not Recap Needle
UNSAFE IMMUNIZATION PRACTICE
Do Not Touch the Needle
UNSAFE IMMUNIZATION PRACTICE
Do Not Overfill Safety Box
 UNSAFE IMMUNIZATION PRACTICE
Do Not Dispose Used Needles in Open
Boxes
NEWBORN HEARING TEST
 The Newborn Hearing Test
• is done on or after 24 hours after
birth before the infant is
discharged if hospital born.
• If the infant is out -of- hospital
born, then he or she should be
screened not more than three (3)
months of age.
• Who can 
perform the 
Hearing Test?
• audiometrists, 
audiologists, licensed 
health professionals 
such as medical 
technologists, 
physicians, nurses, 
midwives and trained 
health workers like 
nursing attendants 
and barangay health 
workers.
• Currently 
acceptable 
universal 
screening 
methods are 
otoacoustic
emissions (OAE)
and automated
auditory
brainstem
response (AABR)
Otoacoustic Emissions (OAE)
• A miniature earphone and microphone are placed in the ear. 
Sounds are played and a response is measured. If the ear 
reacts, a response can be measured in the ear canal by the 
microphone. 
• The two types of OAE screenings are: a. Transient Evoked 
Otoacoustic Emissions (TEOAE)  Sounds emitted in response to 
an acoustic stimulus of very short duration; usually clicks but can 
be tone-bursts. b. Distortion Product Otoacoustic Emissions 
(DPOAE)  Sounds emitted in response to two simultaneous 
tones of different frequencies.
Automated Auditory Brainstem Response (AABR)

• Sounds are played to the baby's ears after 
electrodes are placed on the baby's head to 
detect responses. This screening measures how 
the hearing nerve responds to sounds and can 
identify babies who have a hearing loss
VACCINES
1. BCG vaccine
BCG vaccine protects against tuberculosis in
infants.

The letters, B, C and G stand for Bacillus of

Calmette and Guérin.

“Bacillus” describes the shape of a bacterium;

Calmette and Guérin are the names of the
people who developed the vaccine.
Why is BCG given at birth?
In most tuberculosis (TB) endemic countries,
bacillus Calmette Guérin (BCG) is usually
given around birth to prevent severe TB in
infants.
The neonatal immune system is immature.
➔ BCG vaccine comes in powder form and
before use must be reconstituted with
the accompanying diluent.

➔ The reconstituted vaccine is even more

sensitive to heat than the powder and
must therefore be used within six hours
or disposed of
❖ BCG vaccine and diluent should be stored
at a temperature between 0 C and +8° C.

❖ BCG vaccine is not damaged by freezing.

Store BCG vaccine and its diluent
side-by-side in a refrigerator or vaccine
carrier
❏ One dose of 0.05 ml.

❏ If there is no scar at the injection site

six weeks after a BCG immunization, the
injection must be repeated.

❏ If there is still no scar six weeks after

the second injection the child should be
referred to a physician.
❖ BCG vaccine is usually injected in the top
layer of the skin of the upper left arm.

❖ Health workers use the same place on

every child for BCG injections so that
everyone knows where to look for the
scar.
Needle position for injection of BCG vaccine
(intradermal)
Normal reaction

When BCG vaccine is injected a small raised

lump appears at the injection site.

This usually disappears within 30 minutes.

Normal reaction

When BCG vaccine is injected a small raised

lump appears at the injection site.

This usually disappears within 30 minutes.

After approximately two weeks a red sore
develops which is 10 mm in diameter (the
size of the end of an unsharpened pencil).

The sore remains for another two weeks and

then heals. A small scar, about 5 mm
across, remains. This is a sign that the child
has been effectively immunized.
 BCG: Administration guidelines

RECOMMENDATION REMARKS

AGE At birth If not given at birth,

any time thereafter
DOSE Usually 0.05 ml If child is over 1
year old, give 0.1 ml.
NUMBER OF One
DOSES
INJECTION SITE Upper left arm in top
layer of skin.
 Oral polio vaccine

Oral polio vaccine (OPV) gives protection

against the three types of virus that cause
polio.
It is a liquid that comes in two types of
containers: small plastic bottles that work like
droppers, and glass vials with droppers in a
separate plastic bag
Oral polio vaccine
OPV should be stored at a temperature between
0° C and +8° C. It is easily damaged by heat but
is not harmed by freezing.
Recommends that children get four doses of polio
vaccine.

At birth
6 weeks of age
10 weeks of age
14 weeks of age.
Four doses are given, each of two drops.
If a child has diarrhoea, give OPV as usual but
administer an extra dose, i.e., a fifth dose, at
least four weeks after he or she has received
the last dose in the schedule.
★ OPV is dropped in the mouth with the dropper
that comes with the vaccine.

★ OPV has no side-effects.

 Oral polio vaccine: Administration guidelines
RECOMMENDATIONS REMARKS

Age Dose 0 – birth There must be at least

Dose 1 - 6 weeks 4 weeks between
Dose 2 - 10 weeks doses 1 and 2 and
Dose 3 - 14 weeks between doses 2 and
3.

Dose 2 drops

Number of doses 4 doses

Immunization site mouth

Diphtheria-pertussis tetanus
vaccine DPT
Diphtheria-pertussis-tetanus (DPT) vaccine is
made from:

diphtheria toxoid
pertussis vaccine
tetanus toxoid
If DPT vaccine stands for a long time it
separates from the liquid and looks like fine
sand at the bottom of the vial. Shaking the vial
mixes the vaccine and liquid again.
● DPT vaccine should be stored at a
temperature between 0° C and +8° C.

● The diphtheria and tetanus toxoid parts of

DPT vaccine are damaged by freezing.

● Pertussis vaccine is damaged by heat.

DPT vaccine should be given at the ages of:

6 weeks
10 weeks
14 weeks

The interval after the first and second doses

must be at least four weeks.
DPT vaccine should NOT be given to children
over 5 years of age or to children who have
suffered a severe reaction to a previous dose
of this vaccine.

Instead, a combination of diphtheria and

tetanus toxoids (DT) should be given.
Three doses are given, each of 0.5 ml.

DPT boosters:
Many countries recommend a booster dose of
DPT vaccine at the age of 12 to 24 months.
ROUTE OF ADMINISTRATION:

DPT is injected into the muscle in the

outer part of the thigh.

Needle position for injection of DPT

vaccine (intramuscular)
Reactions to DPT vaccine are usually mild.

They include:

Fever: A child may have fever the evening

after receiving DPT vaccine.

The fever should disappear within a day.

 DPT: Administration guidelines
RECOMMENDATION
AGE Dose 1 - 6 weeks Dose 2 - 10
week Dose 3 - 14 weeks
DOSE Usually 0.5 ml for each dose
NUMBR OF DOSES 3
IMMUNIZATION SITE Muscle of upper thigh.
REMARKS
If a child is not given DPT
vaccine at 6 weeks, give it
as soon as possible
thereafter. Wait 4 weeks
between doses. Complete
all 3 doses before 6
months of age to avoid
sideeffects, which are
commoner after that age.
Hepatitis B
vaccine
Hepatitis B vaccine is a cloudy liquid
that comes in a vial or a prefilled
syringe.

It does not have to be reconstituted.

It does not have to be reconstituted.

If hepatitis B vaccine stands for a long

time it separates from the liquid and
looks like fine sand at the bottom of the
vial.

It must be mixed by shaking.

the recommended schedule is:

6 weeks, same time as DPT1 and OPV1

10 weeks,same time as DPT2 and OPV2;
14 weeks, same time as DPT3 and OPV3
Three doses are given, each of 0.5 ml.

Hepatitis B vaccine is injected in the

muscle of the upper thigh.
 HEPATITIS B vaccine: Administration guidelines

RECOMMENDATIONS

Age Dose 1 - birth or 6 Wait at least 4

weeks Dose 2 - 6 or 10 weeks between
weeks Dose 3 - 14 each dose.
weeks

Dose Usually 0.5 ml for each

dose

Number of doses 3

Immunization site Muscle of the upper

thigh
MMR vaccine
MMR vaccine to protect against
measles, mumps, and rubella.

MMR vaccine, dose at 9 to 15 months

of age,
MMR vaccine comes in powder form
together with a diluent.

Before it can be used it must be

reconstituted.

Reconstituted measles vaccine must be

used within six hours or disposed of
MMR vaccine and diluent should be
stored at a temperature between 0°C
and +8°C. Dry measles vaccine is not
damaged by freezing.
MMR vaccine is usually given as soon as
possible after 9 months of age.

Maternal antibodies against measles last

longer than other antibodies, so
immunization with measles vaccine is
often not effective before 9 months of
age.
 MEASLES vaccine: Administration guidelines

RECOMMENDATIONS

Age 9 MONTHS If a child is not

immunized at 9
months, immunize as
soon as possible
thereafter. months of
age

Dose Usually 0.5 ml for each

dose

Number of doses 1

Immunization site Subcutaneous injection

in the upper right arm
Tetanus toxoid
 Tetanus toxoid
Tetanus toxoid (TT) is given to
women of childbearing age to
prevent neonatal tetanus.

It is the same tetanus toxoid as

that given to children in DPT
vaccine.
When given to a woman who is or becomes
.

pregnant, the antibodies that form in her

body cross the placenta into the fetus.

These antibodies protect the baby against

tetanus during birth and for a few months
thereafter.

They also protect the woman against tetanus.

When tetanus toxoid stands for a long time
the vaccine separates from the liquid and
looks like fine sand at the bottom of the vial.

Shaking the vial mixes the vaccine and liquid

again
When tetanus toxoid stands for a long time
the vaccine separates from the liquid and
looks like fine sand at the bottom of the vial.

Shaking the vial mixes the vaccine and liquid

again
 Tetanus toxoid: periods of protection

DOSE PERIOD OF PROTECTION

TT1 At first contact with No protection

woman of childbearing
age, or as early as
possible in pregnancy

TT2 At least 4 weeks after 3 YEARS

TT1.

TT3 At least 6 months after 5 YEARS

TT2

TT4 At least 1 year after TT3. 10 years

TT5 At least 1 year after TT4. All childbearing years

 TETANUS TOXOID vaccine: Administration guidelines

RECOMMENDATIONS

Age As soon as possible

after a woman reaches
childbearing age

Dose Usually 0.5 ml for each

dose

Number of doses 5

Immunization site Muscle of upper arm

Haemophilus influenzae type b (Hib)
Hib vaccine is safe and highly
effective.

It prevents meningitis, pneumonia,

epiglottis, and other serious
infections caused by the Hib
bacterium.
The epiglottis is a small, movable "lid" just
above the larynx that prevents food and
drink from entering your windpipe.

But if the epiglottis becomes swollen —

either from infection or from injury — the
airway narrows and may become completely
blocked.
Available in two formulations (liquid
or freeze-dried), each of which is
available as monovalent or
combination preparations.
Hib vaccines should be stored
between 2°C and 8°C. If liquid
vaccine is frozen, discard it.
Hib vaccine is given by
intramuscular injection in the
anterolateral aspect of the thigh
(infants) or deltoid muscle (older
children).
Hib vaccine is given by
intramuscular injection in the
anterolateral aspect of the thigh
(infants) or deltoid muscle (older
children).
 HIb vaccine: Administration guidelines

RECOMMENDATIONS

Age Dose 1 – 6 weeks · Dose

2 – 10 weeks · Dose 3 – 14
weeks

Dose Usually 0.5 ml for each

dose

Number of doses 3

Immunization site Anterolateral aspect of the

thigh (infants), deltoid
muscle (older children)
Hib vaccine is given by
intramuscular injection in the
anterolateral aspect of the thigh
(infants) or deltoid muscle (older
children).
VACCINE KIND OF INJECTION SITE
INJECTION
BCG Intradermal Upper left arm
DPT INTRAMUSCULAR Outer part of thigh
OPV ORAL Mouth
HEPATITIS B INTRAMUSCLAR Outer part of thigh
MEASLES SUBCUTANEOUS Upper left arm
TETANUS TOXOID SUBCURANEOUS Upper arm
Intradermal injection = into the skin.

Intramuscular injection = into a muscle.

Subcutaneous injection = under the skin.

Oral administration of drugs is the most used method of drug

therapy.
PPV (Pneumococcal Polysaccharide Vaccine)

-Adults 60 and 65 years old

-Intramuscular
-Upper right arm
•Influenza Vaccine
-60 years old and above, annually
-Intramuscular
-Outer upper arm