LECTURE\POWERPOINT

[TRANS] LESSON 3: DOH MATERNAL AND CHILD HEALTH PROGRAMS

AO 2018- National Policy on the Prevention of Illegal and
OUTLINE 0003 Unsafe Abortion and Management of Post-
I Current Maternal, Newborn, Infant, and Nutritional Situation Abortion Complications
A Safe Motherhood Program AO 2016- The National Policy on the Provision of Quality
i Related Policies and Laws 0035 Antenatal Care in Birthing Centers and Health
II Reproductive Maternal Newborn Child Adolescent Health and Facilities Providing Maternal Care Services
Nutrition (RMNCAHN) Core Package of Services
RA 10028 Expanded Breastfeeding Promotion Act of 2009
A Reproductive Health
B Four Pillars of Family Planning RA 11166 Philippine HIV and AIDS Policy Act of 2018
III Maternal-Newborn Health
A Prepregnancy Services REPRODUCTIVE MATERNAL NEWBORN CHILD ADOLESCENT
B Antenatal Care Services (First 270 Days)
C Intrapartal Services
HEALTH AND NUTRITION (RMNCAHN) CORE PACKAGE OF
D Postpartal Services SERVICES
E Birth and Newborn Services • To enable all adolescents to make informed choices on
IV National Immunization Program (NIP) reproductive health issues, particularly about pregnancy, by
A Types of Immunity creating awareness and providing access to information,
B Related Policies and Laws education, support, services and necessary treatments in the
i Vaccination Schedules
field of reproductive health.
ii Child Immunization Record

REPRODUCTIVE HEALTH
CURRENT MATERNAL, NEWBORN, INFANT, AND
• State of complete physical, mental and social well-being
NUTRITIONAL SITUATION and not merely the absence of infirmity in all matters relating
• The Department of Health (DOH) issued Administrative Order to reproductive system and to its functions and processes
2008-0029 entitled, “Implementing Health Reforms for the (WHO, 2008).
Rapid Reduction of Maternal and Neonatal Mortality.” • Refers to the constellation of methods, techniques, and
o As a response to the slow decline in the maternal services which contribute to reproductive health and well-
and child mortality in the Philippines being by preventing and solving reproductive health
• Challenges in the delivery of maternal and child health problems (WHO, 2008)
services: • Magna Carta of Women (RA 9710) of 2009
o Low utilization of Family Planning Packages of o The State shall, at all times, provide for a
PhilHealth comprehensive, culture sensitive, and gender
o Decreases in the number of PhilHealth-accredited responsive health services, and programs covering
Maternal and Child Program facilities all stages of a woman’s life cycle and which
o Measles and polio outbreaks and increase in addresses the major causes of woman’s morbidity
measles-related mortalities and mortality
• RA 10354 aka Responsible Parenthood and Reproductive
SAFE MOTHERHOOD PROGRAM Health (RRPH) Law of 2012
• In 2006, the Philippine Department of Health launched the o State recognizes and guarantees the human rights
innovative Women’s Health and Safe Motherhood Project 2 to sustainable human development, health,
(WHSMP2) education and information, and the right to choose
• Maximizing synergies among key services that influence and make decisions and in accordance with one’s
maternal and newborn health and on ensuring a continuum religious convictions, ethics, cultural beliefs, and
of care across levels of the referral system. demands of responsible parenthood
Enacted and enforced by RA. 10354
RELATED POLICIES AND LAWS • Responsible parenthood
Table No.1 Maternal and Child Policies and Laws o The will and ability of a parent to respond to the
POLICIES DESCRIPTION needs and aspirations of the family and children
AND LAWS • Family planning
RA 10354 Responsible Parenthood and Reproductive o Program which enables couples and individuals to
Health Act of 2012 decide freely and responsibly the number and
RA 11148 The “Kalusugan at Nutrisyon ng Mag-Nanay spacing of their children and to have the
Act” information and means to do so, and to have
RA 11210 The “105-Day Expanded Maternity Leave Law” access to full range of safe, affordable, effective,
nonabortifacient modern natural and artificial
AO 2008- Implementing Health Reforms to Rapidly
methods of planning pregnancy
0029 Reduce Maternal and Neonatal Mortality
Department Guidelines Governing the Payment of Training
Order 2009- Fees relative to the Attendance of Health FOURS PILLARS OF FAMILY PLANNING
0084 Workers to Basic Emergency Obstetric and 1. Responsible Parenthood
Newborn Care (BEmONC) Skills Training Course o the couple has the right to determine the number
at Duly Designated Training Centers of children
o The capability of the parents to support the family
AO 2011- Establishment of Basic Emergency Obstetric
0011 and Newborn Care Training Centers in Regional
2. Respect for Life
Hospitals and Medical Centers
o birth interval of 3 to 5 years
AO 2015- Guidelines in the Administration of Life Saving
0020 Drugs During Maternal Care Emergencies by
3. Child Spacing
Nurses and Midwives in Birthing Centers
o abortion is considered illegal based on the
AO 2016- Guidelines on the Provision of Quality Antenatal
Philippine Law and culture
0035 Care in All Birthing Centers and Health Facilities
Providing Maternity Care Services

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 [TRANS] LESSON 3: DOH MATERNAL AND CHILD HEALTH PROGRAMS
4. Informed Choice Table No.3 DOH Recommended Diphtheria Tetanus (DT)
o the couple has the right to determine the kind of Immunization for Women
family planning DOSE SCHEDULE PERCENTAGE DURATION
OF OF
MATERNAL-NEWBORN HEALTH PROTECTION PROTECTION
• This does not just pertain to pregnancy (preparation of a 1 As early as possible < 80% Indefinite
woman during pregnancy is also important to reduce the during first pregnancy
incidence of maternal and neonatal mortality or even in a
nonpregnant
PREPREGNANCY SERVICES childbearing age
1. Micronutrient supplementation woman
o Iron, iodine, calcium, vitamins, and supplements 2 4 weeks after first dose 80% 3 years
within the same
2. Iron and folate: 60 mg elemental iron with 400 microgram pregnancy
folic acid tablet daily for 3-6 months 3 6 months after DT2 95% 5 years
4 1 year after DT3 99% 10 years
3. Iodized oil capsule with 200 mg iodine 1 capsule for 1 year 5 1 year after DT4 99% Lifetime
(women ages 15-45)
o Iodine deficiency can result in hyperthyroidism or 3. Consumption of Iodized Salt
cretinism o Prevents hyperthyroidism, cretinism, and mental
retardation
4. Promotion of the use of iodized salt
4. Micronutrient and Macronutrient Supplementation
5. Nutritional counselling o Iron deficiency anemia
o Vitamin A deficiency
6. Promotion of healthy lifestyle o Iodine deficiency disorder
o Macronutrient Supplementation
7. Advice on family planning and provision of family planning
services Table No.4 Recommended Dose of Iron and Folic Acid
Supplementation
8. Prevention and management of lifestyle-related diseases like TARGET PREPARATION DOSE / DURATION
diabetes and cardiovascular diseases Pregnant 60 mg elemental 1 tab/day x 6 months or
women iron with 400 mcg
9. Counselling, prevention, and management of infection folic acid 2 tabs/day if prenatal
including STIs and HIV/AIDS consultation starts on the
2nd and 3rd trimester of
10. Adolescent health services pregnancy
Lactating 60 mg elemental 1 tab/day x 3 months or 90
11. Deworming women of reproductive age to reduce other women iron with 400 mcg days
causes of iron deficiency anemia folic acid

12. Provision of oral health services Table No.5 Recommended Dose of Vitamin A for Women
TARGET PREPARATION DOSE / DURATION
ANTENATAL CARE SERVICES (FIRST 270 DAYS) Pregnant 10,000 IU 1 cap 2x/wk (4 months
To prevent maternal and perinatal morbidity and mortality women until delivery)
1. Pregnancy Tracking and Enrollment to Antenatal Care (ANC) Postpartum 200,000 IU 1 cap once after delivery
o Tracking of pregnancies in the community by BHW women (may be given within 4
is one of the factors that influence women to seek weeks)
ANC consultation • Vitamin A supplementation should start at the 2nd trimester
o Provide both navigation and basic service delivery • Vitamin A is not given during the 1st trimester since vitamin A
functions, assist pregnant women in developing is a teratogenic
birth plans, and help families facilitate access to
critical health services Table No.6 Recommended Dose of Iodine Supplementation
TARGET PREPARATION DOSE / DURATION
Table No.2 DOH Recommended Prenatal (ANC) Visits in the
Children of 200 mg iodized oil 1 cap per year
Country
school age capsule
PRENATAL VISITS PERIOD OF PREGNANCY
Women 15-25 200 mg iodized oil 1 cap per year
1st visit As early as possible
years old capsule
2nd visit 2nd trimester
Adult males 200 mg iodized oil 1 cap per year
3rd visit 3rd trimester capsule
Every 2 weeks After 8th month until delivery
Table No.6 Recommended Dose of Calcium Supplementation
2. Diphtheria Tetanus Toxoid Immunization TARGET PREPARATION DOSE / DURATION
o Diphtheria Tetanus (DT) toxoid immunization
Pregnant 1.0 - 2.0 g elemental Three divided
involves the IM administration of 0.50 mL DT toxoid
women calcium doses
at the deltoid muscles
o Two doses of the toxoid provide protection to the
5. Early Identification and Management of Nutritionally at Risk
baby against neonatal tetanus through natural
Pregnant Client
passive immunity, while a single dose offers
o Prenatal visit is necessary
protection only to the mother by artificial active
immunity

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 [TRANS] LESSON 3: DOH MATERNAL AND CHILD HEALTH PROGRAMS
6. Counselling on Maternal Nutrition, Breastfeeding and
Rooming-in, Appropriate Infant and Young Child Feeding
Practices
o Prenatal – health education about breastfeeding
and rooming-in
7. Counselling on Maternal Nutrition, Breastfeeding and
Rooming-in, Appropriate Infant and Young Child Feeding
Practices
8. Provision of oral health services including oral health
assessment
9. Counselling on proper handwashing, environmental
sanitation, and personal hygiene
o Personal hygiene is very important particularly
perineal hygiene since they are at risk for infection
(episiotomy and episiorrhaphy)
10. Counselling on nutrition, smoking cessation, and adoption of
healthy lifestyle practices
11. Phil-Health enrollment and linkages to facility
community-based health and nutrition workers
volunteers
o All Filipinos are eligible to have Phil-Health
12. Social welfare support
o Particularly those patient who are underprivileged
or have financial concern
13. Maternity protection during pregnancy
14. Counselling and support to parents and caregivers
15. Provision of counseling and psychosocial support to parents
and caregivers
INTRAPARTAL SERVICES
• During Labor and Delivery
• Essential Intrapartal Newborn Care (EINC)
o Checklist during labor and delivery
o This is not just applicable in the hospital but also in
birthing facilities and health centers
o We should know and observe the protocol of EINC
• Adherence to couple’s birth breastfeeding and rooming-in
plans
• Provision of mother and baby-friendly practices during labor
and delivery
o RA 10028 - Expanded Breastfeeding Promotion of
2009
o EO 51 - Milk Code
• Monitoring of the progress of labor and the well-being of both
the mother and the fetus
• Identification of high-risk newborns that will be delivered
• Coverage and utilization of PhilHealth
• Nutritional counseling
• Provision of lactation management services
o Breastfeeding
• Counselling on proper handwashing, environmental
sanitation and personal hygiene
• Counselling on and utilization of modern methods of family
planning and access to reproductive health care services
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• Maintenance of nonseparation of the mother and her
newborn early breastfeeding initiation
POSTPARTAL SERVICES
• Postpartum visits
o 1st visit - within 24 hours
o 2nd visit - within one week after delivery
• Micronutrient supplementation (continuous)
• Birth registration
• Lactation support and counselling from birth up to 2 years
and beyond
• Nutrition assessment and counselling
• Identification and management of malnutrition
• Organization of community-based mother support groups,
breastfeeding support group
and
and • Lactation breaks, availability of lactation stations
• Provision of oral health services
• Counselling on and utilization of modern methods of family
planning and access to reproductive health services
BIRTH AND NEWBORN SERVICES
• RA 8980 – Early Childhood Care Development
o Refers to the full range of health, nutrition,
education, and social services program for the
needs of the young children from birth to 6 years of
age to promote their optimum growth and
development
• AO 2005-0014
o Early initiation of breastfeeding
o Exclusive breastfeeding for the first 6 months
o Extended breastfeeding for 2 years and beyond
o Appropriate complementary feeding
o Micronutrient supplementation
o Universal salt iodization
o Food fortification
• Expanded newborn screening test
o AO 2018-0025 also known as the “National Policy
and Strategic Framework on Expanded Newborn
Screening for 2017”
o Simple procedure ideally done as early as after 24
hours after initial breastfeeding but not later than 3
days from the time of delivery
o The number of disorders detected by this test
increased from 6 to 28 diseases (congenital
diseases)
• Newborn Hearing Screening Test
o RA 9709 - Universal Newborn Hearing Screening and
Intervention Act of 2009
o Requires that all newborns should be screened
▪ Be screened prior to discharge from hospital or
birthing facility
o Newborn Hearing Screening Test - aims for the early
detection of congenital hearing loss and for referral
of early intervention if there is congenital hearing
loss
NATIONAL IMMUNIZATION PROGRAM (NIP)
• Immunization is an essential public health service and is
commonly defined as the process of conferring artificial
immunity to population groups
3
 [TRANS] LESSON 3: DOH MATERNAL AND CHILD HEALTH PROGRAMS
• Goals:
o To immunize all infants against vaccine preventable
diseases
o To sustain polio-free status of the Philippines
o To eliminate measles infections
o To eliminate maternal and neonatal tetanus
o To control Diphtheria, Pertussis, Hepatitis B infection
and German Measles
o To prevent extrapulmonary tuberculosis among
children
TYPES OF IMMUNITY
• Adaptive Immunity – acquired either natural or artificial and
it is sometimes referred to as immunological memory
• Innate Immunity – inborn protection
Natural
• Passive (maternal) – this occurs when we are protected from
a pathogen by immunity given by someone else
• Active (infection) – this occurs when we are protected from
a pathogen by immunity given by our own system
Artificial
• Passive (antibody transfer) – from someone else
• Active (immunization) – our own immune system will develop
a protection to pathogens
RELATED POLICIES AND LAWS
• Goal: is to reduce morbidity and mortality among infants and
children which are caused by common childhood
immunizable diseases
• Related Policies and Laws
o PD No. 996 of 1976 – providing compulsory basic
immunization for infants and children below 8 years
old
o RA 7846 of 1994 – inclusion of Hepatitis B
immunization for infants and children below 8 years
old
o RA 10152 of 2011 – Mandatory Infants and Children
Health Immunization Act of 2011
o Presidential Proclamation No. 6 of 1996 –
Implementing a United Nations Goal on Universal
Immunity by 1990; and designating Wednesdays as
Immunization Day
▪ Wednesday - immunization day (multiple doses
the vaccine should be consumed immediately

Table No.7 Vaccines of the National Immunization Program of the Philippines

VACCINE DISEASE/S COMPONENTS AGE DOSE ROUTE SITE
Bacillus Calmette Guerin Tuberculosis Live-attenuated bacteria; At birth 0.05 mL ID Right upper arm
(BCG) Freeze-dried with special diluent or deltoid
Hepatitis B Vaccine Hepatitis B Plasma derivative or RNA At birth 0.5 mL IM Vastus Lateralis
(Monovalent) recombinant, Cloudy, liquid
Pentavalent Vaccine (DPT- Diphtheria D - weakened toxins 6, 10, 14 weeks 0.5 mL IM Vastus Lateralis
HepB-Haemophilus Pertussis P - killed bacteria
Influenza) Tetanus T - weakened toxins
Hepatitis B
Pneumonia Liquid, clear
Meningitis
Oral Polio Vaccine (OPV) Poliomyelitis Live-attenuated virus; For GI 6, 10, 14 weeks 0.5 mL PO Mouth
mucosal immunity; clear, pinkish
Inactivated Polio Vaccine Poliomyelitis Liquid, clear; For serum immunity 14 weeks 0.5 mL IM Vastus Lateralis
(IPV) (blood)
Pneumococcal Conjugate Pneumonia Liquid, clear For newborn 6, 0.5 mL IM Vastus Lateralis
Vaccine (PCV) Meningitis 10, 14 weeks
For 2-5 years
give 1 dose
Measles Mumps Rubella Mumps Live-attenuated virus dried freeze 9 months and 0.5 mL SC Outer arm
(MMR) Measles with special diluent 12-15 months
Rubella

VACCINATION SCHEDULES CHILD IMMUNIZATION RECORD

• Absolute contraindication

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 [TRANS] LESSON 3: DOH MATERNAL AND CHILD HEALTH PROGRAMS
o Any serious condition that needs hospitalization counted and
o Immunocompromised condition such as AIDS should be
instructed to
• The following are NOT contraindications return for next
o Fever up to 38.5℃ due dose
o Mild acute respiratory infection IPV Local tenderness Cold compress
o Simple diarrhea Inactivated
o Malnutrition Polio
Vaccine
Table No.8 Common Side Effects of Vaccination and their MMR Local soreness, fever, • Reassure
Management irritability and malaise in parents and
VACCINE SIDE EFFECTS MANAGEMENT some children instruct parents
BCG Wheal for 30 minutes Normal reaction to give
following by ulceration antipyretic to
within 2 weeks then scar the child
formation within 12 weeks • Give 200,000 IU
or 3 months of Vitamin A to
Koch’s phenomenon: an No management promote
acute inflammatory is needed epithelialization
reaction within 2-4 days and increase
after vaccination usually immunity
indicated previous
exposure to tuberculosis
Deep (subcutaneous) Refer to the REFERENCES
abscess at vaccination physician for
site; almost invariably due incision and Notes from the discussion by Prof. Hussein E. Catanyag,, MSN, RN
to subcutaneous or drainage
deeper injection Manila Doctors Colleges of Nursing PowerPoint Presentation
Indolent ulcer: an ulcer Treat with
with persists after 12 weeks Isoniazid (INH)
from vaccination date powder
Glandular enlargement: If suppuration
enlargement of the lymph occurs, treat as
glands draining the deep abscess
injection site
Hepatitis B Local soreness at the No treatment
injection site necessary
May apply cold
compress
Pentavalent Fever usually last for only 1 Advise parent to
day. Fever beyond 24-hour give antipyretic
is not due to the vaccine
but to other causes
Local soreness at the Reassure parents
injection site that soreness will
disappear after 3-
4 days
Abscess after a week or Incisions and
more usually indicates that drainage may be
the injection was not deep necessary
enough or the needle was
not sterile
Convulsions, although very Proper
rare, may occur in children management of
older than 4 months convulsions
caused by pertussis
component
OPV None • Nothing per
orem for 30
minutes to
prevent the
child from
vomiting and
enhance
absorption
• If child vomits,
administer
another dose
• If the child has
simple diarrhea
may give OPV
but dose not

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