Dipasupil Strawberry Mae

BSN 2-2 (Group 2 RLE)

DOH PROGRAMS
What is DOH Programs?
- The Department of Health (DOH) is the principal health agency in the Philippines. It is
responsible for ensuring access to basic public health services to all Filipinos through
the provision of quality health care and regulation of providers of health goods and
services. Its mandate is to develop national plans, technical standards, and guidelines
on health. Aside from being the regulator of all health services and products, the DOH is
the provider of special tertiary health care services and technical assistance to health
providers and stakeholders.

DENGUE PREVENTION AND CONTROL PROGRAM

BACKGROUND
Dengue is the fastest spreading vector-borne disease in the world endemic in 100
countries·
 Dengue virus has four serotypes (DENV1, DENV2, DENV3 and DENV4)
 First infection with one of the four serotypes usually is non-severe or
asymptomatic, while second infection with one of other serotypes may cause
severe dengue.
 Dengue has no treatment but the disease can be early managed.
 The five-year average cases of dengue are 185,008; five-year average deaths
are 732; and five-year average Case Fatality Rate is 0.39 (2012-2016 data).
TRANSMISSION
Dengue virus is transmitted by day biting Aedes aegypti and Aedes albopictus
mosquitoes.
DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY
 Dengue illness is categorized according to level of severity as dengue without
warning signs, dengue with warning signs and severe dengue.
 Dengue without warning warnings can be further classified according to signs
and symptoms and laboratory tests as suspect dengue, probable dengue and
confirmed dengue.
a. dengue without warning signs
a.1 suspect dengue
- a previously well individual with acute febrile illness of 1-7 days duration plus two of
the following: headache, body malaise, retro-orbital pain, myalgia, arthralgia, anorexia,
nausea, vomiting, diarrhea, flushed skin, rash (petechial, Hermann’s sign)
 a.2 probable dengue
- a suspect dengue case plus laboratory test: Dengue NS1 antigen test and at least
CBC (leukopenia with or without thrombocytopenia) or dengue IgM antibody test
(optional)
a.3 confirmed dengue
- a suspect or probable dengue case with positive result of viral culture and/or
Polymerase Chain Reaction (PCR) and/or Nucleic Acid Amplification Test- Loop
Mediated Amplification Assay (NAAT-LAMP) and/ or Plaque Reduction Neutralization
Test (PRNT)
b. dengue with warning signs
• a previously well person with acute febrile illness of 1-7 days plus any of the following:
abdominial pain or tenderness, persistent vomiting, clinical signs of fluid accumulation
(ascites), mucosal bleeding, lethargy or restlessness, liver enlargement, increase in
haematocrit and/or decreasing platelet count
c. severe dengue
severe plasma leakage leading to
 shock (DSS)
 fluid accumulation with respiratory distress
severe bleeding
 as evaluated by clinician
severe organ impairment
 Liver: AST or ALT ≥ 1000
 CNS: e.g., seizures, impaired consciousness
 Heart: and other organs (i.e., myocarditis, renal failure)
PHASES OF DENGUE INFECTION
b. Febrile Phase
 Usually, last 2-7 days
 Mild hemorrhagic manifestations like petechiae and mucosal membrane bleeding
(e.g., nose and gums) may be seen.
 Monitoring of warning signs is crucial to recognize its progression to critical
phase.
c. Critical Phase
 Phase when patient can either improve or deteriorate.
 Defervescence occurs between 3 to 7 days of illness. Defervescence is known
as the period in which the body temperature (fever) drops to almost normal
(between 37.5 to 38°C).
  Those who will improve after defervescence will be categorized as Dengue
without Warning Signs, while those who will deteriorate will manifest warning
signs and will be categorized as Dengue with Warning Signs or some may
progress to Severe Dengue.
 When warning signs occurs, severe dengue may follow near the time of
defervescence which usually happens between 24 to 48 hours.
d. Recovery Phase
 Happens in the next 48 to 72 hours in which the body fluids go back to normal.
 Patients’ general well-being improves.
 Some patients may have classical rash of “isles of white in the sea of red”.
 The White Blood Cell (WBC) usually starts to rise soon after defervescence but
the normalization of platelet counts typically happens later than that of WBC.
MANAGEMENT (based on patient type)
1. Group A- patients who may be sent home
These are patients who are able to:
 Tolerate adequate volumes of oral fluids
 Pass urine every 6 hours
 Do not have any of the warning signs particularly when the fever subsides
 Have stable hematocrit
2. Group B- patient who should be referred for in-hospital management
Patients shall be referred immediately to in-hospital management if they have the
following conditions:
 Warning signs\
 Without warning signs but with co-existing conditions that may make dengue or
its management more complicated (such as pregnancy, infancy, old age, obesity,
diabetes mellitus, hypertension, heart failure, renal failure, chronic hemolytic
diseases such as sickle- cell disease and autoimmune diseases, etc.)
 Social circumstances such as living alone or living far from health facility or
without a reliable means of transportation.
 The referring facility has no capability to manage dengue with warning signs
and/or severe dengue.
3. Group C- patient with severe dengue. Requiring emergency treatment and urgent
referral
These are patients with severe dengue who require emergency treatment and urgent
referral because they are in the critical phase of the disease and have the following:
 Severe plasma leakage leading to dengue shock and/or fluid accumulation with
respiratory distress;
 Severe hemorrhages;
  Severe organ impairment (hepatic damage, renal impairment, cardiomyopathy,
encephalopathy or encephalitis)
Patients in Group C shall be immediately referred and admitted in the hospital within 24
hours.
LABORATORY TESTS
Test Description
 Requested between 1-5 days of illness
 Use to detect dengue virus antigen during early phase of acute
1. Dengue NS1 RDT dengue infection
 Test is for free in all health centers and selected public hospitals
nationwide
 Requested beyond five days of illness
 Use to detect dengue antibodies during acute late stage of dengue
infection (IgM) and to determine previous infection (IgG)
 May give false positive result due to antibodies induced by dengue
2. Dengue IgM/IgG vaccine
 May cross react with other arboviral diseases such as Chikungunya
and Zika
 DOH augmentation is limited to selected government hospitals
only
 One of the gold standard laboratory tests to confirm dengue virus.
 Molecular based test confirmatory test
3. Polymerase Chain Reaction (PCR)
 Available only in dengue sub-national and national reference
laboratories
 A novel molecular-based confirmatory test used to detect dengue
4. Nucleic Acid Amplification Test- Loop virus.
Mediated Isothermal Amplification Assay  Work just like PCR but cheaper and simpler in nature.
(NAAT-LAMP)  In the pipeline to be introduced under the National Dengue
Prevention and Control Program in district and provincial hospitals
 Gold standard to characterize and quantify circulating level of anti-
5. Plaque Reduction Neutralization Test
DENV neutralizing antibody (NAb)
(PRNT)
 Available only at the dengue national reference laboratory

6. Other tests:
 Routinely used in hospitals as standard dengue diagnostic tests
-Total While Blood Cell (WBC) count
 Look for trend of decreasing WBC, decreasing platelet and
-Platelet
increasing hematocrit
-Hematocrit

CHRONIC-KIDNEY DISEASE PREVENTION AND CONTROL PROGRAM

BACKGROUND
Majority of the increases in total morbidity and mortality in the Philippines have actually
come from Non-Communicable Diseases (NCDs), specifically chronic kidney disease
(CKD). If left untreated, CKD can progress to more severe complications such as End-
Stage Kidney Disease (ESKD) that now requires more immediate and regular
interventions. These interventions include renal replacement therapies ranging from
hemodialysis to renal transplant. The increasing numbers of CKDs have become an
urgent national concern due to the burden of the disease and high costs of care. Hence,
this program aims to reinforce strategies for the prevention and control of CKDs such as
lifestyle-related disease prevention, facilitation of early detection and evaluation, and
proper disease management for people with CKDs.
Symptoms of CKD
There are usually no symptoms of kidney disease in the early stages. It may only be
diagnosed if you have a blood or urine test for another reason and the results show a
possible problem with your kidneys.
At a more advanced stage, symptoms can include:
 tiredness
 swollen ankles, feet or hands
 shortness of breath
 feeling sick
 blood in your pee (urine)
See a GP if you have persistent or worrying symptoms that you think could be caused
by kidney disease.
Find out more about the symptoms of CKD.
Causes of CKD
Chronic kidney disease is usually caused by other conditions that put a strain on the
kidneys. Often it's the result of a combination of different problems.
CKD can be caused by:
 high blood pressure – over time, this can put strain on the small blood vessels in
the kidneys and stop the kidneys working properly
 diabetes – too much glucose in your blood can damage the tiny filters in the
kidneys
 high cholesterol – this can cause a build-up of fatty deposits in the blood vessels
supplying your kidneys, which can make it harder for them to work properly
 kidney infections
 glomerulonephritis – kidney inflammation
 polycystic kidney disease – an inherited condition where growths called cysts
develop in the kidneys
 blockages in the flow of urine – for example, from kidney stones that keep
coming back, or an enlarged prostate
 long-term, regular use of certain medicines – such as lithium and non-steroidal
anti-inflammatory drugs (NSAIDs)
You can help prevent CKD by making healthy lifestyle changes and ensuring any
underlying conditions you have are well controlled.
Tests for CKD
CKD can be diagnosed using blood and urine tests. These tests look for high levels of
certain substances in your blood and urine that are signs your kidneys aren't working
properly.
If you're at a high risk of developing kidney disease (for example, you have a known risk
factor such as high blood pressure or diabetes), you may be advised to have regular
tests to check for CKD so it's found at an early stage.
The results of your blood and urine tests can be used to tell the stage of your kidney
disease. This is a number that reflects how severe the damage to your kidneys is, with a
higher number indicating more serious CKD.
Find out more about how CKD is diagnosed.
Treatments for CKD
There's no cure for CKD, but treatment can help relieve the symptoms and stop it
getting worse.
Your treatment will depend on how severe your condition is.
The main treatments are:
 lifestyle changes to help you remain as healthy as possible
 medicine to control associated problems such as high blood pressure and high
cholesterol
 dialysis – treatment to replicate some of the kidney's functions; this may be
necessary in advanced CKD
 kidney transplant – this may also be necessary in advanced CKD
You'll also be advised to have regular check-ups to monitor your condition.
Find out more about how CKD is treated and living with CKD.
Outlook for CKD
CKD can range from a mild condition with no or few symptoms, to a very serious
condition where the kidneys stop working, sometimes called kidney failure.
Most people with CKD will be able to control their condition with medicine and regular
check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the
condition.
If you have CKD, even if it's mild, you're at an increased risk of developing other serious
problems, such as cardiovascular disease. This is a group of conditions affecting the
heart and blood vessels, which includes heart attack and stroke.
Cardiovascular disease is one of the main causes of death in people with kidney
disease, although healthy lifestyle changes and medicine can help reduce your risk of
developing it.