Primary Health Care

Philippine Midwifery Licensure Examination

Primary
Health
Care
Philippine Midwifery Licensure Examination
Primary Health Care
Philippine Midwifery Licensure Examination

COMMUNITY HEALTH
COMMUNITY
• From the Latin word “comunicas”, which means
group of people.
• Social group
• Geographical boundaries with common values and
interest.

HEALTH
• Is a state of complete mental and social wellbeing
and not merely the absences of disease & infirmity.

COMMUNITY HEALTH
• It is the paramedical or medical interventions or
approach that is concerned with health of the whole
population.
• It aims to do the following:
o Health promotions
o Disease preventions
o Management of factors affecting the health
• Its primary responsibility is health education.
Primary Health Care
Philippine Midwifery Licensure Examination

PHC ORIGIN o Secondary

• Essential health care made universally accessible to ▪ To raise the level of health; for better quality
individuals and families in the community by means of life
acceptable to them. ▪ Combat disease (e.g., HIV, malaria).
• PHC was declared on 1978 at Alma Ata, USSR.
COMPONENTS OF PHC
o The recent summit was held last Feb. 23-24,
• Expanded Program on Immunization
2006.
• Local Endemic Disease Prevention & Control
• It was adapted by the late Pres. Ferdinand Marcos
• Education on Health
Sr. through LOI 949, which was signed on October
• Maternal & Child Health
19, 1979.
• Essential Drugs
• Themes:
• Nutrition
o First theme:
• Treatment of Communicable Disease
▪ “Health for all by the year 2000”
• Safe Water Sanitation
o Second theme:
• Dental Health
▪ “Health in the hands of people by the year
• Access to Hospitals and Center of Wellness
2020”.
• Mental Health
o Current theme:
▪ Health for all

Five As of PHC Four Cornerstone/Pillars of PHC

Accessibility Active community participation
Acceptable Intra and Intersectoral linkages
Affordable Use of appropriate technology
Support mechanism made
Attainable
available
Available

WHAT IS THE FOCUS OF PRIMARY

HEALTHCARE?
• Health promotions (i.e., lifestyle, wellness).
• Disease prevention (i.e., health protection,
preservation of health through getting rid of the risk
factors).
• PHC is for well people in the community, while
hospital is for the ill.
• Its goals are:
o Primary
▪ To enhance the capability of the people
Primary Health Care
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PUBLIC HEALTH  Financial implications.

• According to the World Health Organization ➢ 2nd Delay: Delay in reaching the
(WHO), public health aims to reduce inequalities in healthcare facilities.
health while ensuring the best health for the greatest  Distance to health centers and
number of people. hospitals.
• According to Dr. Charles Edward Winslow, it  Availability of and cost of transpo.
enables any citizen to realize their birthright and  Poor roads.
longevity in health.  Geography (e.g., mountainous
• Longevity in life may be achieved through terrain, rivers).
organized community effort as follows: ➢ 3rd Delay: Delay in receiving
o Environmental sanitation appropriate care.
o Control of communicable diseases  Poor facilities and lack of medical
o Individual hygiene supplies.
• 3 Ps of Winslow:  Inadequately trained and poorly
o Promotive motivated medical staff.
o Preventive  Inadequate referral system.
o Prolonging life o Hereditary
• Health is the modern concept of Optimum Level of ▪ Genetics
Functioning (OLOF). o Political
• Six factors affecting OLOF: ▪ Safety, proper empowerment, oppressions
o Environment o Socio-economic
▪ Water, food, air ▪ Housing, employment, education
o Health Care Delivery System o Behavioral
▪ Three Delay Model ▪ Habit, cultural, belief
❖ Proved to be useful tool to identify the
points at which delays can occur in the Environment

management of OB complications, and Health Care

Delivery Behavioral
System
to design programs to address these
delays. OLOF

➢ 1st Delay: Delay in deciding when to Hereditary

Socio-
economic
seek care.
 Low status of women. Political

 Poor understanding of
complications and risk factors in
LIFE EXPECTANCY
pregnancy and of when medical
• Females are more likely to live longer (75 y.o.) than
interventions are needed.
men (65 y.o.)
 Previous poor experience of
• SWAROOP’S INDEX
healthcare.
o the number of deaths among 50 y.o. and above
 Acceptance of maternal death.
Primary Health Care
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50 𝑦. 𝑜 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒 PROBLEM IDENTIFICATION AND

𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ PRIORITIZATION
DEMOGRAPHY & CENSUS ASSESSMENT
• Demography • Is a step-by-step process.
o A study of population size, composition, and • You must know how to socialize in the community,
spatial distribution as affected by birth, death, and do what the people are doing, and establish rapport.
migration. • Steps in assessment:
• Census o Collection of data (e.g., survey, questionnaire)
o De Facto o Collation (i.e., putting the data together)
▪ Counts all persons as residents of the place o Presentation of data
they happen to be at the time the census is o Interpretations of data
taken. o Analyzation of data
o De Jure o Utilization of data
▪ People were assigned to the place where
UTILIZATION PROBLEM
regardless of where they are at the time of
• Community diagnosis or situational analysis
census, regardless of their usual place of
residence. A. Typology of the family health problem

LEVEL OF CLIENTELE o Wellness condition

▪ Readiness, potential to do activities, able and
Community
capable.
Population o Health Deficit
▪ Disease or deviation from normal health (e.g.,
Family
disease, disabilities, developmental problems).
o Health Threat
Individual
▪ Existing factors in the present time that will
affect the health of the individual or family (e.g.,
• Individual unhealthy lifestyle, family hx of hereditary
o Unit of entry. disease, poor environmental sanitation).
• Family o Foreseeable Crisis
o Unit of service or focus of care. ▪ Stress point; anticipated problem in the
• Population/Group future (e.g., pregnancy, death, loss of job).
o Aggregate of people in the population with
B. Typology of the community health problem
common characteristics who are vulnerable to
certain health problems. o Health Status
• Community ▪ Disease in the community
o Entire client or overall focus of PHC. o Health Resource
▪ Deficiency in the 4Ms (money, materials,
machineries, manpower)
Primary Health Care
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o Health Related
▪ Existing factors in the present time

C. Family Criteria Prioritization

o Nature of the problem and typology

classification
o Modifiability
▪ Probability of success in giving solution or
intervention.
o Preventive potential
▪ Probability of success in reducing the effect of
the problem.
o Salience
▪ Ability of the family to recognize the problem.

D. Community Criteria Prioritization

o Nature of the problem

o Magnitude of the people affected.
o Modifiability
▪ Probability of success in giving
solutions/interventions.
o Preventive potential
▪ Probability of success in reducing the effects
of the problem.
o Social concern
▪ Ability of the community to recognize the
problem.
Primary Health Care
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VITAL STATISTICS 𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑖𝑛 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟

𝑥 1000
• Study of vital events such as: 𝑀𝑖𝑑 − 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
o Birth
o Marriage • NEONATAL DEATH RATE (NDR)
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑏𝑒𝑙𝑜𝑤 1 𝑦. 𝑜.
o Separation 𝑥 1000
𝑇𝑜𝑡𝑎𝑙 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
o Migration
o Morbidity
• INFANT MORTALITY RATE (IMR)
o Mortality
o Measures the risk of dying during the 1st yr. of life.
• Statistics of disease (morbidity) and death 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑏𝑒𝑙𝑜𝑤 28 𝑑𝑎𝑦𝑠
(mortality) indicate the health of a community and 𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
the success or failure of health work.
• Indices of a health status and illness status of a • FETAL DEATH RATE (FDR)
community. 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑏𝑒𝑙𝑜𝑤 20 𝑤𝑘𝑠. 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
FORMULAS
• LITERACY RATIO • MATERNAL MORTALITY RATE (MMR)
o Illiterate o Measures the risk of dying from pregnancy, child
▪ Can’t read or write birth, and puerperium.
o Literate 𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑎𝑡𝑒𝑟𝑛𝑎𝑙 𝑟𝑒𝑙𝑎𝑡𝑒𝑑 𝑑𝑒𝑎𝑡ℎ𝑠
𝑥 1000
▪ Can read and write 𝑇𝑜𝑡𝑎𝑙 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
o Functional Literate
▪ Can read, write, do functional task, and • PROPORTIONAL MORTALITY RATE (PMR)
complete tasks 𝐶𝑒𝑟𝑡𝑎𝑖𝑛 𝑐𝑎𝑢𝑠𝑒 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ
𝑥 100
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 8 𝑦. 𝑜. 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒 𝑤ℎ𝑜 𝑐𝑎𝑛 𝑟𝑒𝑎𝑑 𝑎𝑛𝑑 𝑤𝑟𝑖𝑡𝑒 𝑇𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
𝑥100
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 8 𝑦. 𝑜
• SEX RATIO • CASE FATALITY RATE (CFR)
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑎𝑙𝑒 𝐶𝑒𝑟𝑡𝑎𝑖𝑛 𝑐𝑎𝑢𝑠𝑒 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ
𝑥 100 𝑥 100
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒 𝐶𝑎𝑠𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒

REGISTRATION OF BIRTHS
• DEPENDENCY RATIO • R.A. 3753 (Civil Registry Law)
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑝𝑒𝑛𝑑𝑒𝑛𝑡 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
𝑥 100 • P.D. 651 (Birth Registration Law)
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑝𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
o Mandates all birth and deaths must be
registered within 30 days.
• CRUDE BIRTH RATE (CBR)
• Forms:
o Measurement in the increase of population.
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑏𝑖𝑟𝑡ℎ𝑠 No. 102 No. 103
𝑥 1000 Certification of birth Certificate of death
𝑀𝑖𝑑 − 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
Signed by the mayor,
• CRUDE DEATH RATE (CDR) Signed by the birth doctor, license
o Measures mortality from all causes. attendant embalmer and
undertaker
Primary Health Care
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Done before 30 days Done before 30 days o Yellow: ++

o Orange: +++
o Red: ++++
BAG TECHNIQUE
• A tool making use of the public health bag (OB bag) THERMOMETER
through which the midwife during the visit can • Always wipe from cleanest to dirtiest.
perform nursing procedures with ease and deftness, o Before use:
saving time and effort at the end in view of rendering ▪ Bulb to stem
effective nursing care. o After use:
o A public health bag or OB bag is an essential ▪ Stem to bulb
and indispensable equipment of the public health o Cotton balls used:
midwife. ▪ 3x soap
▪ 3x water
HEAT AND ACETIC ACID TEST
▪ 1x alcohol
• Used to determine proteinuria in a pregnant
▪ 1x for drying
woman.
▪ Total: 8 cotton balls
• Procedures:
o Obtain a mid-stream catch urine sample before
meal.
▪ This is the most important procedure.
o Fill the test tube with 2/3 urine sample then heat.
o Add 3-5 drops of acetic acid.
o Observe changes in the consistency of the
mixture.
• Interpretation:
o Clear: Negative
o Cloudy: Positive

BENEDICT TEST
• Used to determine glucosuria in pregnant woman.
• Procedures:
o Fill the test tube with 5 mL of benedict’s solution
then heat.
o Add 8-10 drops of mid-stream catch urine
sample obtained before meal.
o Reheat the mixture.
o Observe changes in the color of the mixture.
• Interpretation:
o Blue: Negative
o Bluegreen: Trace
o Green: +
Primary Health Care
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EPIDEMIOLOGY • Two types of natural immunity:

• Study of POD (Prevention, Occurrence, Disease o Active
Prevention). ▪ Long term (e.g., through disease experience)
• Backbone of disease prevention. o Passive
▪ Short term (e.g., colostrum)
LEVELS OF PREVENTION
• Primary o In breastfeeding, 6 mo. is for complimentary

o Health promotion & disease prevention (i.e., feeding and 4 mos. is for supplementary feeding.

lifestyle, diet, exercise, immunization) ARTIFICIAL IMMUNITY

o Pre-pathogenic phase • Introduced to the body.
▪ Before the pathogen/microorganisms enters. • Two types of artificial immunity:
• Secondary o Active
o Early detection and prompt treatment. ▪ Long term (e.g., Tetanus Toxoid Vaccine)
o To determine, to check, assessment, and ❖ TT Vaccine is injected intramuscularly in
identify. the deltoid region.
o You are a carrier. ❖ Dose is 0.5 mL.
• Tertiary ❖ When a mother completes her TT
o Rehabilitation, restoration of OLOF. vaccine, she is considered a fully
o Mental health rehab. immunized mother (FIM).
❖ The first booster dose is TT3.
CHAIN OF INFECTION
➢ There are a total of 3 booster doses.
Causative agent
Reservoir of
infection
Portal of exit
Mode of
transmission
Portal of
entry
Susceptible
host
WHEN PROTECTION DURATION
TT1 ASAP 0 0 years
TT2 After 4 wks. 80% 3 years
CAUSATIVE AGENT TT3 After 6 mos. 95% 5 years
• Microorganisms TT4 After 1 yr. 99% 10 years
o Can be virus, bacteria, or parasite. TT5 After 1 yr. 99% Lifetime
• Vector o Passive
o “Living thing” that carries the agent. ▪ Short term (e.g., Tetanus Anti-toxin Vaccine)
• Vehicle
PATTERNS OF DISEASE DISTRIBUTION
o “Non-living thing” that carries the agent.
SPORADIC
MODE OF TRANSMISSION • Seasonal, on and off, intermittent.
• May be direct, indirect, airborne, or droplet. • Examples are the following:
• Easiest way to break the chain of infection is o Rabies
through the mode of transmission. ▪ CA: Rhabdo Virus or Lyssavirus
▪ MOT: Bite
IMMUNITY
o Dengue Hemorrhagic Fever
NATURAL IMMUNITY
• Within the body ▪ CA: Virus
▪ Vector: Female Aedes aegypti
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o Leptospirosis PANDEMIC
▪ CA: Leptospira • Sudden outbreak globally
• Example is the COVID-19 Pandemic, which was
ENDEMIC
caused by the Novel Coronavirus
• Constant, continuous.
• Examples are the following:
o Malaria
▪ CA: Plasmodium falciparum
▪ Vector: Female Anopheles
▪ Mgt.:
❖ Zooprophylaxis
❖ Stream seeding
❖ Stream clearing
o Schistosomiasis
▪ CA: Schistosoma japonicum
▪ Vector: Oncomelania quadrasi
o Filariasis/Elephantiasis
▪ CA: Wuchereria bancrofti
▪ Vector: Mosquito

EPIDEMIC
• Sudden outbreak within the country.
• Susceptible is greater than the number of hosts.
• Types of epidemics:
o Short Time Fluctuation
▪ Point Source
❖ Transmission of disease from one source
only.
▪ Propagated
❖ Transmission of disease from different
sources (i.e., vector-host, vehicle-host,
host-host).
o Cyclic Variation
▪ On and off, fluctuating (e.g., DHF)
o Secular Variation
▪ Increasing throughout the year (e.g., HIV)
❖ CA: Retrovirus
➢ Screening test for HIV is ELISA, while
confirmatory test is Western Blot.
Primary Health Care
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NATIONAL EPIDEMIC SENTINEL SURVEILLANCE HERBAL MEDICATIONS

SYSTEM (NESSS) • R.A. 8423 – Traditional and Alternative Medicine
• If there is an outbreak of disease, NESSS is then Act (TAMA) of 1997
activated for hospital-based monitoring; hospital is
HERBAL MEDS PURPOSE/APPLICATION
for verification and clarification of disease.
Lagundi AsCoF: Asthma, cough, fever
• R.A. 3573 (Law on Reporting of Communicable
Ulasimang Bato/
Diseases) Uric acid, gout, arthritis
Pansit-pansitan
• R.A. 11332 (Mandatory Reporting of Notifiable
Disinfectant, antiseptic,
Diseases and Health Events of Public Health Bayabas
diarrhea
Concern Act) Bawang Hypertension, toothache
o Repealed R.A. 3573 Yerba Buena Pain/analgesic effect
Lab Diagnosed Diseases Sambong Diuretics, lithiasis
Hepatitis A – fecal-oral route Antifungal, skin disease (e.g.,
Akapulko
Hepatitis B – Sexually Transmitted Infections scabies)
Cholera – CA: Vibrio cholerae; causes massive Niyog-niyogan Antihelmintic, parasitism
diarrhea Tsaang Gubat Diarrhea
Typhoid Fever – CA: Salmonella Typhi Ampalaya Type II Diabetes Mellitus
Malaria Tawa-tawa Platelet
Malunggay Lactation, antioxidants
Banaba Anti-inflammatory

PHILIPPINE INTEGRATED SURVEILLANCE AND

RESPONSE (PIDSAR)

CATEGORY I CATEGORY II
Unknown Known/Common
Weekly reporting every
Contagious
Friday
Investigation needed Uses Case Report Form
Immediate reporting
within 24 hrs.
Uses Case
Investigation Form
(CIF)
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NUTRITION SCHEDULE FOR TX OF VIT. A DEFICIENCY

NUTRIENTS Schedule >6 mos. 6-11 mos. 12-71 mos.
• A chemical substance. Give TODAY 50,000 IU 100,000 IU 200,000 IU
Give
• Gives energy (supplies) 50,000 IU 100,000 IU 200,000 IU
TOMORROW
• Repairs damage tissue Give after 2
50,000 IU 100,000 IU 200,000 IU
• Two types of nutrients: WKS.
Pregnant 10,000 IU 1 cap/tab 2x/wk.
o Macronutrients
▪ Carbohydrates (CHO), fats, and proteins
(CHON). SCHEDULE FOR RECEIVING VIT. A SUPPLEMENT
Infants Preschooler
Malnutrition Schedule PP Mother
(6-11 mos.) (12-83 mos.)
Kwashiorkor Marasmus 200,000
100,000
Total energy Give 1 dose 200,000 IU IU w/in 1
IU
Protein deficiency mo.
malnutrition
After
Moon-shaped face Old man’s face Give after 6 100,000
200,000 IU delivery of
mos. IU
Does not want to eat Always hungry each child
Muscle wasting with Muscle wasting ❖ Iron
fat without fats ➢ Anemia
Edema at the feet and  S/Sx
Prominent ribs
hands  Palmar pallor
o Micronutrients
▪ Vitamins and minerals TARGET OF IRON SUPPLEMENT
Infant (6-11 OD for 90
▪ Common deficiencies are: 1 tsp. of Fe
mos.) days.
❖ Vitamin A
Preschooler OD for 180
➢ Leads to nyctalopia or night blindness. 2 tsp. of Fe
(12-71 mos.) days
 Earliest sign is xeropthalmia or
Adolescent
conjunctival dryness. 60 mg OD
Older person
 Bitot’s Spot is a foamy appearing
OD for 180
lesions that is a specific manifestation Pregnant 60 mg
days
of vit. a deficiency. Lactating 60 mg OD for 90 days
 This is a late sign of VAD. ❖ Iodine
➢ Vit. A supplementation is given as ➢ Mental retardation
early as 6 mos. ➢ Hypothyroidism
 For infant (6-11 mos.): 100,000 IU ➢ Cretinism
(Blue)  Untreated congenital
 For children (12-83 mos.): 200,000 hypothyroidism.
IU (Red) • R.A. 8976 (Philippine Food Fortification Act)
o Uses sangkap pinoy seal.
o Under the law, food must contain the following
micronutrients:
Primary Health Care
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▪ Vit. A (Yellow)
▪ Iron (Green)
▪ Iodine (Red)
• P.D. 491 (Philippine Nutritional Act Law)
• Guidelines of nutrition:
o #1 – Eat variety of foods
o #2 – Pure breastfeeding
▪ R.A. 7600 (Rooming-in and Breastfeeding
Act of 1992)
▪ E.O. 51 – Milk Code
o #4 – Proteins
o #5 – Fruits and vegetables
o #8 – Iodized Salt
o #9 – Eat clean and safe foods
o #10 – Healthy lifestyle
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SANITATION • Level III

ENVIRONMENTAL SANITATION o Water-sealed toilet with septic tank plus
• P.D. 856 (Philippine Sanitation Code) treatment
• R.A. 9003 (Ecological Solid Waste Management
Act of 2000)
o Black – non-biodegradable REFERRAL SYSTEM
o Green – biodegradable
o Yellow – infectious
PRIMARY SECONDARY TERTIARY
o Red – hazardous
Emergency Regional
Health center
WATER SANITATION Hospital Hospital
• Unapproved Type – cannot be used Barangay Provincial National
• Approved Type – can be used Health Station Hospital (DOH)
o Level I (point source) Rural Health District Training
▪ Protected well with outlet but without Unit Hospital Hospital
distribution. Community Medical
City Health
Hospital Center
▪ Serves 10-15 households
Birthing Home
▪ 40-140L/min
Lying-in Clinic
▪ At least 250m from the farthest user
• R.A. 7160 (Local Government Code of 1991)
▪ Mostly found in rural areas
o Also known as devolution law.
o Level II
o Provincial
▪ Communal faucet or standposts
▪ Managed by the governor.
▪ 1 faucet:4-6 households
o Municipal
❖ Average household served is 100
▪ Managed by the mayor.
households.
o Interlocal Health Zone (ILHZ)
▪ 40-80L/capita
▪ Cities and municipalities forming health
o Level III
districts.
▪ Individual waterworks system (e.g.,
▪ One district has a population of 100,000-
NAWASA)
500,000 (found in catchment areas)
EXCRETA DISPOSAL • R.A. 1082 (Rural Health Act)
• Level I ▪ Ratio of HCWs:
o Pit latrines ❖ Midwife:
o Aqua privy ➢ 1:5000
o Non-water flush ❖ Nurse
o Pour flush ➢ 1:20,000
• Level II ❖ Doctor
o Water-sealed toilet with septic tank. ➢ 1:20,000
❖ Dentist
➢ 1:50,000
Primary Health Care
Philippine Midwifery Licensure Examination

FIELD HEALTH SERVICE INFORMATION SYSTEM o Two forms:

(FHSIS) ▪ Program Report (Q1)
Management
▪ Morbidity Report (Q2)
Reporting and
Recording
Documentation Events • Annual Report
Evaluate
o Forms:
▪ A1
FOUR COMPONENTS OF FHSIS ❖ Demography, natality, mortality,
FAMILY TREATMENT RECORD (FTR) or environment.
INDIVIDUAL TREATMENT RECORD (ITR)
st
▪ A2
• 1 building blocks of FHSIS.
❖ All disease or morbidity.
• It is used to gather information during the clinic
▪ A3
visit.
❖ All death or mortality.
• In home visits, Initial Data Base (IDB) is used to
gather information in the house. EVENTS
• E1
TARGET CLIENT LIST
nd
o Notification of death
• 2 building blocks of FHSIS
• E2
• Health programs
o Notification of maternal death
SUMMARY TABLE • E3
• Tally must be done daily. o Notification of perinatal death within 7 days
• Reporting is done at the end of the month.
o 12-month form column.
• This is the summarization of services rendered in
the community (i.e., RHU (Highest), HC, BHS
(Lowest)).

MONTHLY CONSOLIDATION TABLE

• Overall output.
• This report is the endorsed and found at the
Provincial Health Office (PHO).

REPORTING TOOLS
• Monthly Report
o Data obtained from the summary table.
o Two forms:
▪ Program Report (M1)
▪ Morbidity Report (M2)
• Quarter Report
o Data obtained from monthly consolidation.
Primary Health Care
Philippine Midwifery Licensure Examination

CLINIC VISIT • Clinic Evaluation

FOUR PHASES OF CLINIC VISIT • Lab and Other Diagnostic Exam
PRE-CONSULTATION • Referral
• Obtaining V/S, gathering more information • Dispensing of Drugs
• Priority number: first come, first served basis o Cotrimoxazole
except in emergencies. o Amoxicillin
• Get chief complaint of the pt. o Rifampicin
• Assessment o Isoniazid
• Free clinic lectures for awareness. o Pyrazinamide
• Doing selective laboratory tests and diagnostic o Paracetamol
procedures. o ORS
• Recording of assessment findings. o Nifedipine
MEDICAL EXAMINATION • Health Education
• Assist the doctor. HOME-BASED MOTHER’S RECORD
• Provide pt. privacy. • Also known as the “pink card”.
• Confidentiality • Tool used in rendering prenatal care.
NURSING/MIDWIFE INTERVENTION • To determine high risk pregnancy.
• Provide health education. • The equivalent of HBMR under the DOH is the
• Best time to ask other problems regarding health to Mother & Child Record.
other members. • Panels:
o Panel 1
POST-CONSULTATION
▪ Profile
• Summarization of services rendered.
▪ OB hx
• Referral and setting further appointments.
▪ TT vaccine
STANDARD PROCEDURES FOR CLINIC VISIT ▪ Present health problems
• Registration o Panel 2
o Record ITR or FTR from FHSIS ▪ Present pregnancy (i.e., LMP, AOG, EDC)
• Waiting Time ▪ Danger signs
o First come, first serve o Panel 3
o Pre-clinic lecture ▪ Referral
• Triaging o Panel 4
o Program-based care ▪ Post-partum
▪ Manage the case. ▪ Family Planning
o Non-program based care
▪ Refer to the doctor
o Emergency case
▪ Provide first aid tx
Primary Health Care
Philippine Midwifery Licensure Examination

HOME VISITS o Place the bag in the convenient place, flat

• Face-to-face contact with the midwife/nurse in a surface, or table
home. o Proceed to bag technique
• The midwife/nurse must bring the following: o Health education
o OB Bag o Documentary
o Black Umbrella (or the darkest color available) o Set appointment
• Past Visit
PURPOSE OF HOME VISIT
• Assess the health condition of the family.
• Care; Provide care
• Educate; Health teaching
• Establish good relationship
o Socialize

PRINCIPLE OF HOME VISIT

• Priorities should be based on needs of the family.
• It should have purpose or objective.
• It should make use of available information.
• The plan of home visit should be practical and
flexible.
• Activities should involve to family member.
• No definite rules in the frequency of visit.

FACTORS OF HOME VISIT

• Policies of specific services
• Acceptance of the family
• Past services involve
• Ability of the family to recognize the problem/needs
• Needs of the family
• Other services involved

3 PHASES OF HOME VISIT

• Preparatory Phase
o Preparation of materials, formation of plan,
record review
• Actual Home Visit
o Greet the client
o Introduce yourself
o Explain the purpose
o Gather data and observe
o Determine health needs
Primary Health Care
Philippine Midwifery Licensure Examination

INTEGRATED MANAGEMENT OF CHILDHOOD ▪ Tetracycline

ILLNESS (IMCI) o First line abx for dysentery
• Developed because of increased morbidity and ▪ Ciprofloxacin
mortality among infants and children. o Tx for very severe febrile disease w/ malaria risk:
• Two categories: ▪ Artesunate
o Young infant (Newborn - <2 y.o.) ▪ Oral quinine
o Young child (<5 y.o.) o Tx for malaria:

IMCI PROCESS ▪ Oral antimalarial drug

• Assess ❖ Artemether-Lumefantrine
o Assess first for general danger signs. o Abx prophylaxis for HIV exposure:
o Check main symptoms. ▪ Cotrimoxazole
o Check for anemia and malnutrition. o If w/ wheezing:
• Classify ▪ Give salbutamol
• Identify o Fever (38.5°C):
o In assessing, classifying, and identification of the ▪ Paracetamol
illness, there are three categories only: • Council
▪ Pink • Follow-up
❖ Severe classification o Follow-up is in five days except in malaria,
❖ Initial management and urgent referral measles, dysentery, and dengue, where follow-up
needed. is needed after 3 days.
➢ Give initial tx before referral. o If with stiff neck, follow-up in 2 days.
❖ At least one danger sign. • Danger Signs (CUVA):
▪ Yellow o Convulsions
❖ Moderate classification o Unable to drink of bf
❖ Specific treatment. o Vomits everything
▪ Green o Abn. sleepy (lethargic)
❖ Mild classification • Four main sx:
❖ Home management and follow-up. o DOB or cough
• Treat o Diarrhea
o First line abx (general): o Fever
▪ Amoxicillin o Ear Infection
o Second line abx (general): ▪ If no problem is seen in the ears, check for
▪ Cotrimoxazole malnutrition and anemia.
o First line abx for cholera: (Refer to IMCI Chart for proper and full guidelines)
▪ Cotrimoxazole
▪ Erythromycin • Points to remember:

o Second line abx for cholera: o Stridor

▪ Furazolidone ▪ Heard during inhale.

Primary Health Care
Philippine Midwifery Licensure Examination

▪ Stridor in a calm child indicates severe

pneumonia.
o Wheezing
▪ Heard during exhale.
▪ Common in asthma.
o Chest Indrawing
▪ Seen during inhale
• Classification of fast breathing:
o <2 mos. old – 60 cpm or more
o <12 mos. old – 50 cpm or more
o <5 y.o. – 40 cpm or more
Primary Health Care
Philippine Midwifery Licensure Examination

EXPANDED PROGRAM ON IMMUNIZATION o DPT (Diphtheria, Pertussis, Tetanus) Vaccine

• Legal basis: ▪ Content:
o P.D. 996 (Providing for Compulsory Basic ❖ DT
Immunization for Infants and Children Below 8 ➢ Weakened bacteria (weakened toxin)
Years of Age) ❖ P
o R.A. 7846 (An Act Requiring Compulsory ➢ Killed bacteria
Immunization Against Hepatitis-B for Infants ➢ This is what causes fever
and Children Below Eight (8) Years Old) ▪ Form and Desire:
o R.A. 10152 (Mandatory Infants and Children ❖ Liquid
Health Immunization Act of 2011) ❖ 0.5 mL
• Fully Immunized Child (FIC) ▪ Route:
o A child who has received one (1) dose of BCG, ❖ IM
three (3) doses of DPT, three (3) doses of OPV, ▪ Side Effect:
three (3) doses of Hepatitis B, and one (1) dose of ❖ Fever
Measles before the child’s first birthday. ▪ Half-life:
• Vaccines under EPI: ❖ 4 hrs.
o BCG (bacille-Calmette-Guerin) Vaccine ▪ Health Teachings:
▪ Content: ❖ Cold and hot compress
❖ Live attenuated bacteria (weakened ❖ Give paracetamol
bacteria) ❖ In case of convulsions within 3 days, do
▪ Form and Desire: not give succeeding DPT doses.
❖ Freeze dried powdered form. o OPV (Oral Polio Vaccine)
❖ Infant: 0.05 mL ▪ Also known as Sabin
❖ Preschool: 0.1 mL ▪ Content:
➢ Booster dose administered before ❖ Live attenuated virus (weakened virus)
school entrance. ▪ Form and Desire:
 Injected at the left deltoid. ❖ Pink liquid
▪ Route and Site: ❖ 2 drops
❖ ID ▪ Route:
❖ Right Deltoid ❖ PO
▪ Side Effect: ▪ Side Effect:
❖ Koch Phenomenon ❖ None
▪ Half-life: ▪ Half-life:
❖ 6-4 hrs. ❖ 4 hrs.
▪ Health Teachings: ▪ Health Teaching:
❖ Wheal formation ❖ BF after 30 mins.
❖ Scarring after 12 wks. ▪ PP 773
❖ Knock-out Polio Campaign
Primary Health Care
Philippine Midwifery Licensure Examination

o Hepatitis B Vaccine ▪ Side Effect:

▪ Content: ❖ Local soreness
❖ RNA recombinant ▪ Half-life:
▪ Form and Desire: ❖ 8 hrs.
❖ Cloudy liquid ▪ Health Teaching:
❖ 0.5 mL ❖ Cold and hot compress.
▪ Route and Site: ▪ PP 1066
❖ IM ❖ National Neonatal Tetanus Elimination
❖ Right vastus lateralis Campaign
▪ Side Effect: o Pentavalent Vaccine
❖ Local soreness ▪ Also known as the 5-in-1 vaccine.
▪ Half-life: ▪ Protects against diphtheria, pertussis,
❖ 8 hrs. tetanus, Hib, and hepatitis b.
o Measles ▪ Route and Site:
▪ Content: ❖ IM
❖ Live attenuated virus (weakened virus) ❖ Right vastus lateralis
▪ Form and Desire: ▪ Form and Desire:
❖ Freeze dried powder with special ❖ Liquid
diluents. ❖ 0.5 mL
❖ 0.5 mL o IPV (Inactivated Polio Vaccine)
▪ Route and Site: ▪ Content:
❖ SQ ❖ Killed virus
❖ Upper outer arm ▪ Route and Site:
▪ Protection: ❖ IM
st
❖ 1 dose: 85% ❖ Left vastus lateralis
nd
❖ 2 dose: 95% ▪ Form and Desire:
▪ Side Effect: ❖ Liquid
❖ Fever and rashes within 1-3 days which ❖ 0.5 mL
is normal. o PCV (Pneumococcal Conjugate Vaccine)
▪ Half-life: ▪ Content:
❖ 8 hrs. ❖ Live attenuated bacterium
o Tetanus Toxoid Vaccine ▪ Form and Desire:
▪ Content: ❖ Liquid
❖ Weakened toxin ❖ 0.5 mL
▪ Form and Desire: ▪ Route and Site:
❖ Liquid ❖ IM
❖ 0.5 mL ❖ Vastus lateralis
▪ Route
❖ IM
Primary Health Care
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o Rotavirus ➢ Doses:
▪ Content:  BCG: 1 dose
❖ Live attenuated virus  Hep B: 1 dose
▪ Form and Desire  Pentavalent: 3 doses
❖ Liquid  OPV: 3 doses
❖ 1.5 mL  IPV: 1 dose
▪ Route:  PCV: 3 doses
❖ Oral  MMR: 2 doses
• R.A. 10152 Schedule ▪ Annual vaccine dose required (AVR)
❖ TVR x Wastage rate = AVR
➢ Wastage rate (constant):
 DPT, OPV, TT: 1.67
 M: 2
 BCG: 2.5
 Hep B: 1.1
▪ Annual vaccine ampule/vial required (AVA)
❖ AVR/No. of doses per ampule or vial =
AVA
➢ No. of doses per ampule or vial:
 BCG: 20 doses
 DPT: 10 or 20 doses
 Hep B: 1 or 10 doses
 TT: 10 or 20 doses
▪ Monthly vaccine doses required (MVR)
• Elements of EPI ❖ AVR/12 mos. = MVR
o Target Setting ▪ Monthly vaccine ampule/vial required (MVA)
▪ Eligible population (EP) ❖ AVA/12 mos.
❖ Total population x Target population = EP o Cold chain logistic management
➢ Factors: ▪ Cold chain is a system of maintaining the
 Infants: 3% or 0.03 potency of vaccines from that of the
 New: 2.7% (constant for infant manufacturer to that of the target client.
and women) ▪ Cold chain manager is the PHN.
 Pregnant woman: 3.5% or 0.035 ▪ Freezer temp (-15 to -25°C)
 Below 5 y.o.: 11.5% or 0.115 ❖ Most sensitive to heat:
 High risk area: 11.5 % or 0.115 ➢ Measles
 Outreach response immunization: ➢ OPV
14.5% or 0.145 ▪ Body of freezer temp (2 to 8°C)
▪ Total vaccine required (TVR) ❖ Less sensitive to heat:
❖ EP x Doses = TVR ➢ The rest of the vaccines.
Primary Health Care
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❖ Most sensitive to freezing and heat: ➢ Allowable timeframe for vaccine

➢ BCG (most sensitive to sunlight and storage:
fluorescent lights)  6 mos. – Regional lvl.
➢ DPT  3 mos. – Provincial/District lvl.
➢ Hep B  1 mo. – Health Centers w/ ref
➢ TT  Not >5 days – Health Centers using
▪ Vaccine Vial Monitor (VVM) transport boxes.
❖ A thermosensitive label on vial/ampule o Information, education, and communication
which gives usual indication of vaccine o Assessment and evaluation of the program’s
that has been kept at a temp which overall performance
presents its potency. o Surveillance, studies and research, and studies
• Sterilization process
o Time:
▪ 20 mins.
▪ 50 reusable syringes
o Steam
o Temperature:
▪ 121-126°C
• Contraindications:
o Anaphylaxis/hypersensitivity

❖ Proper storage of vaccines: o AIDS

➢ Keep diluents on the lower shelves (do o Severe diarrhea

not freeze). o Fever of 38.5°C

➢ Keep OPV and measles in freezer with o Convulsion

ice packs.
➢ Monitor temperature TWICE.
 First hour and last working hour.
➢ Defrost ref when ice is ¼ in. or 1-2 cm
thick.
➢ Distance of the ref to wall should be 12
in. or 1 ft.
➢ When using transport boxes:
 Place OPV and measles in contact
with ice box.
 Wrap the rest of the vaccines with
paper to prevent contact.
Primary Health Care
Philippine Midwifery Licensure Examination

COMMUNICABLE DISEASES • Host

• Communicable diseases are illness/disease from o Where organisms live and multiply.
the following: o Infection will depend on the host’s immunity or
o Infectious agent or toxic products transmitted. susceptibility.
o Directly/indirectly, or through inanimate • Environment
objects. o The total or sum
o Airborne (suspended in the air for >3 m) and ▪ Physical
droplets (suspended in the air for <3 m) ❖ Environment, weather
• R.A. 11332 (Mandatory Reporting of Notifiable ▪ Biological
Diseases and Health Events of Public Health ▪ Socioeconomic
Concern Act) ❖ Behavior, lifestyle
o This act amended R.A. 3573 • Agent
• The main job/responsibilities of a midwife are the o An organism to cause disease or infection.
following:
WATER BORNE DISEASES
o Report it to the local authorities.
TYPHOID FEVER
o Refer new cases to the nearest healthcare
• CA: Salmonella typhi
facilities.
• MOT: Ingestion of contaminated water and food of
o Initiate health education
infected individuals
o Investigate and/or assist in the epidemiological
• Incubation period: 7-14 days
investigation.
• Pathognomonic sign:
• Antigenecity
o Rose spots
o The ability of the CA to stimulate immune
• S/Sx:
response.
o Prodromal (Early Stage)
• Pathogenicity
▪ Fever
o The ability of the CA to produce disease.
▪ Headache
• Virulence
▪ Anorexia
o Overall ability to cause disease.
▪ Lethargy
o Disease producing power.
▪ Abd. pain
• Toxigenecity
▪ Diarrhea
o The ability of the CA to release or produce
▪ Vomiting
toxins.
o Fastigial
• The goal of communicable disease is the
▪ Ladder-like curve temp.
elimination and eradication of disease.
▪ Rose spots in the trunk
EPIDEMIOLOGICAL TRIANGULAR MODEL ❖ Caused by the ulcerations of the Peyer’s
Agent patch.

Host Environment
Primary Health Care
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▪ Dose/s:
❖ Single dose
▪ Route of administration:
❖ IM
▪ Site of administration:
❖ Vastus lateralis

DYSENTERY
• CA: Shigella dysenteriae
• MOT: Ingestion of contaminated water and food
• Incubation period: 3-4 days
• Pathognomonic sign:
o Bloody stool
• S/Sx:
o High grade fever
o Colicky abd. pain with tenderness (very painful)
o Diarrhea straining with bloody mucoid stool
• Dx:
o Defervescence
o Stool examination
▪ Fever gradually resides.
• Tx:
▪ Onset of complications:
o Cotrimoxazole
❖ Hemorrhage
o Chloramphenicol
❖ Peritonitis
• Prevention & Control:
o Convalescence or recovery
o Proper sanitary disposal
• Dx:
o Proper handwashing
o Typhidot test
o Water safety
• Tx:
o Chloramphenicol CHOLERA
• Prevention & Control: • CA: Vibrio cholerae (eltor)
o Sanitary disposal of feces • MOT: Ingestion of contaminated water and food
o Handwashing and proper hygiene • Incubation period: 1-3 days
o Avoid the 5Fs: • Pathognomonic sign:
▪ Feces (Vehicle) o Rice watery stool
▪ Fluid (Vehicle) • S/Sx:
▪ Food (Vehicle) o Rapid, explosive, rice watery stool
▪ Fomites (Vehicle) ▪ This will lead to severe DHN where if left
▪ Flies (Vector) untreated for 2-3 hrs. may lead to death.
o Vaccination • Dx:
▪ Dosage: o Stool examination
❖ 0.5 mL
Primary Health Care
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• Tx: ❖ Infant/children – 80%

o Tetracycline o Hematocrit or Platelet Determination
• Prevention & Control: ▪ Increased level of hematocrit is a sign of DHN.
o Boiling of water o Dengue NS1
o Proper handwashing and hygiene ▪ This is available at RHUs.
• Prevention & Control:
VECTOR BORNE DISEASES
o Health education
DENGUE HEMORRHAGIC FEVER (DHF)
• CA: Dengue virus o Follow the 5S (DOH)
▪ Search and destroy breeding sites.
• MOT: Mosquito bite
o Vector: Aedes aegypti ▪ Seek early consultation.

• Incubation period: 3-14 days (5-7 days) ▪ Self-protective measures.

▪ Say yes to fogging only during outbreak.
• A.k.a. West Nile Fever, Nyong-Nyong Disease,
Dandy Fever ▪ Sustain hydration.

• Stages: MALARIA
o Febrile Stage (1-4 days) • CA: Plasmodium falciparum
▪ Pt. should increase fluid intake. • MOT: Mosquito bite
o Toxic/Hemorrhagic Stage (4-7 days) o Vector: Anopheles
▪ Critical Phase will take place within 24-48 hrs. • Incubation period: 7 days or longer
▪ Watch out for bleeding (hypo-tachy-tachy) • S/Sx:
o Recovery (7-10 days) o Fever preceded by recurrent chills and profuse
▪ Recovery will start from 48-72 hrs. sweating.
• Dx: o Body malaise
o Tourniquet Test or Rumpel-Leede Test o Anemia
▪ This is the screening test for dengue. • Dx:
▪ This tests capillary fragility. o History of travel to endemic areas (Palawan and
▪ To use, do the following: Mindanao)
❖ Inflate the BP cuff above the brachial o Blood smear
artery/antecubital fossa for five minutes. • Tx:
❖ Put an imaginary 1 in. square and count o Artemether
the number of petechiae within the o Chloroquine
square. • Prevention & Control:
❖ A positive sign is 20 petechiae and o Mosquito Control
more. o Chemical Method
o Capillary Refill Test or Nail Blanch Test o Biological Method (i.e., stream seeding)
▪ This test can help determine if there is a o Zooprophylaxis (i.e., larva eating fish)
circulatory failure, which is caused by DHN. o Environmental Method
❖ Adults – 60% water o Mechanical Method
❖ Older adults – 55% o Health education
Primary Health Care
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FILARIASIS
• CA: Wuchereria bancrofti
• MOT: Mosquito bite
o Vector: Aedes poecilus
• Incubation period: 8-16 mos.
• Pathognomonic sign:
o Elephantiasis
• S/Sx:
o Elephantiasis
o Hydrocele
o Fever
o Lymphedema
o Malaise
• Dx:
o Bronchitis
o Circulating Filarial Antigen (CFA)
o Excessive lacrimation
▪ Sample is taken by finger prick.
o 3 C’s of malaria
o Immunochromatographic Test (ICT)
▪ Coryza
▪ Done during daytime.
▪ Conjunctivitis
o Nocturnal Blood Examination
▪ Cough
▪ Done during nighttime.
o Stomatitis
• Tx:
o Maculopapular rash
o Hetrazan
▪ This starts at the face then spreads as a
• Prevention & Control:
generalized rash (cephalocaudal).
o Eradication of the vector
o Health education
o Environmental sanitation

VIRUS BORNE DISEASES

RUBEOLA OR MEASLES
• CA: Morbillivirus
oA type of virus that belongs to the
Paramyxoviridae family.
• MOT: Airborne • Complications:
• Incubation period: 7-21 days, with the ave. being 14 o Pneumonia
days. o Encephalitis
• Pathognomonic sign: o Death
o Koplik’s spot • Tx:
• S/Sx: o Supportive care
o Koplik’s spot • Prevention & Control:
▪ Clustered white lesion in the buccal mucosa o Vaccination
▪ MV and MMR Vaccine (live attenuated virus)
❖ MMR Vaccine is dried freeze.
Primary Health Care
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▪ Dosage: ❖ During outbreak, the first dose will be

❖ 0.5 mL given at 6 mos.
▪ Dose/s: ▪ Route of administration:
st nd
❖ 2 doses (1 at 9 mos., 2 at 12 mos.) ❖ Subcutaneous
❖ During outbreak, the first dose will be ▪ Site of administration:
given at 6 mos. ❖ Outer part of upper arm
▪ Route of administration: • Mumps can cause permanent hearing impairment.
❖ SQ
RUBELLA OR GERMAN MEASLES
▪ Site of administration:
• CA: Rubella virus (Togaviruses)
❖ Outer part of upper arm
• MOT: Droplet, contact with secretions
MUMPS • Incubation period: 10-21 days
• CA: Mumps virus (Paramyxovirus) • Pathognomonic sign:
o This virus belongs to the Rubelavirus family. o Forchheimer spots
• MOT: Airborne, droplet, contact with salivary • S/Sx:
secretions o Forchheimer spots (red spots)
• Incubation period: 16-18 days, with the ave. being ▪ Found in the soft palate.
14-25 days o Fever
• Pathognomonic sign: o Maculopapular rash
o Swelling of the parotid glands
• S/Sx:
o Painful swelling of the salivary or parotid glands
o Acute onset of fever

o Headache
• Prevention & Control:
o Vaccination
▪ MMR Vaccine (live attenuated virus)
❖ MMR Vaccine is dried freeze • Prevention & Control:
▪ Dosage: o Vaccination
❖ 0.5 mL ▪ MMR Vaccine (live attenuated virus)
▪ Dose/s: ❖ MMR Vaccine is dried freeze
❖ 2 doses (1st at 9 mos., 2nd at 12 mos.) ▪ Dosage:
❖ 0.5 mL
Primary Health Care
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▪ Dose/s: • Prevention & Control

st nd
❖ 2 doses (1 at 9 mos., 2 at 12 mos.) o Vaccination
❖ During outbreak, the first dose will be ▪ Oral Polio Vaccine (OPV) and Inactivated
given at 6 mos. Polio Vaccine (IPV)
▪ Route of administration: ❖ Dosage:
❖ Subcutaneous ➢ OPV – 2 drops
▪ Site of administration: ➢ IPV – 0.5 mL
❖ Outer part of upper arm ❖ Dose/s:
➢ OPV – 3 doses (1st at 6 wks., 2nd at 10
CHICKEN POX
wks., 3rd at 14 wks.)
• CA: Varicella zoster virus
➢ IPV (Single dose at 14 wks.)
• MOT: Direct and indirect contact with discharges
❖ Route of administration:
from respiratory passages or vesicle fluids
➢ OPV – oral
• Incubation period: 14-16 days (2-3 wks.).
➢ IPV – IM
• Pathognomonic sign:
❖ Site of administration
o Maculo-papular-vesicular rash
➢ OPV – mouth
• S/Sx:
➢ IPV – vastus lateralis
o Maculo-papular-vesicular rash
o Proper hygiene and handwashing
▪ Itchy vesicle postular rash that begins in the
o Health education
chest and trunk, then spreading to the
• PP 773
extremities.
o Polio elimination campaign
o Fever
o Body malaise PARASITIC INFECTIONS
• Tx: ASCARIASIS
o Supportive care • CA: Ascaris lubricord (roundworm)
• Prevention & Control: • MOT: Fecal-oral
o Vaccination • Incubation period: 8 wks.
▪ Varivax • S/Sx:
▪ Dose/s: o Abd. pain
st nd
❖ 2 doses (1 at 12 mos, 2 at 18 mos.) o Passage of the worm
• Tx:
POLIOMYELITIS
o Mebendazole
• CA: Poliovirus
o Albendazole
• MOT: Fecal-oral
• Prevention & Control:
• Incubation period: 7-21 days
o Proper hygiene and handwashing
• Pathognomonic sign:
o Hoyne’s sign, poker’s sign ENTEROBIASIS
• S/Sx: • CA: Enterobius vermicularis (human pinworm)
o Paralysis of the lower limbs • MOT: Fecal-oral
• Incubation period: 4-6 hrs.
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• S/Sx: • Tx:
o Perianal itchiness o Praziquantel (Biltricide)
o Disturbed sleep pattern • Prevention & Control:
o Nervousness and irritability o Wear boots in contaminated water
• Dx: o Health education
o Scotch tape swab test o Molluscicide
• Tx: o Proper disposal of feces and urine
o Mebendazole
THREE MOST COMMON PARASITIC INFECTION
o Albendazole
IN THE PHILIPPINES
• Prevention & Control: • Hookworm (Ancylostomiasis)
o Proper hygiene and handwashing
• Ascariasis (Round Worm)
o Regular trimming of nails • Trichuriasis (Whipworm)
ANCYLOSTOSOMIASIS BACTERIAL DISEASES
• CA: Ancylostosoma duodenale TUBERCULOSIS
• MOT: Fecal-oral, ingestion of contaminated food • TB for children is also called as primary complex.
• Incubation period: 4-6 wks. • CA: Mycobacterium tuberculosis
• S/Sx: • MOT: Droplet
o Dermatitis • A.k.a. Koch’s Disease
o Abd. pain • S/Sx:
o Mental and physically underdeveloped o Hemoptysis
• Tx: o Afternoon fever
o Mebendazole o Night sweats
o Albendazole • Dx:
• Prevention & Control: o Screening Test
o Proper hygiene and handwashing ▪ Mantoux Test
o No to barefoot walking ❖ Uses purified protein derivatives (PPD).
SCHISTOSOMIASIS ❖ Check results within 48-72 hrs.
• CA: Schistosoma japonicum (common in the ➢ Positive if:
Philippines)  At least 10 mm
• A.k.a bilhariasis/bilharzia, katayama fever, snail  At least 5 mm for pt. w/ AIDS
fever. o Confirmatory Test
• MOT: Indirect contact with contaminated water ▪ Acid-fast Bacteria (AFB) Test
o Intermediary host: Oncomelania quadrasi ❖ A.k.a. sputum test, direct sputum smear
(snail) microscopy (DSSM).
• Incubation period: 2 mos. • Tx:
• S/Sx: o Directly Observed Treatment, Short-Course
o Abd. enlargement (DOTS)
Primary Health Care
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▪ International program for screening and tx of o Categories of tx:

TB pt. ▪ Category I
▪ DOH recommended treatment according to ❖ New smear + PTB (Sputum Test)
the NTP is short course chemotherapy. ❖ New smear – PTB w/ extensive
▪ Anti-TB Drugs (MDT): parenchymal lesion on CXR.
❖ Rifampacin ❖ Extensive pulmonary TB
➢ Causes red orange discoloration urine. ❖ Tx:
➢ Ideally taken before meals. ➢ Intensive: RIPE
❖ Isoniazid (INH) ➢ Continuous: RI
➢ Causes peripheral neuropathy. ▪ Category II
➢ Vit B6 or Pyridoxine is given. ❖ Tx failure
❖ Pyrazinamide ❖ Relapse
➢ Hepatotoxic, nephrotoxic. ❖ Return after default
➢ May cause hyperuricemia, gouty ❖ Tx:
arthritis-like symptoms. ➢ Intensive: RIPES
❖ Ethambutol ➢ Continuous: RIE
➢ Visual disturbances (optic neuritis) ▪ Category III
➢ Not given to children below 6 y.o. ❖ New smear – PTB w/ minimal
➢ Can also cause loss of green color parenchymal lesion on CXR
recognition in pregnant women. ❖ Minimal
❖ Streptomycin ❖ Tx:
➢ Hepatotoxic ➢ Intensive: RIPE
➢ May cause tinnitus, loss of hearing, ➢ Continuous: RI
th
balance, cranial 8 nerve may be ▪ Category IV
affected. ❖ Chronic
➢ Contraindicated during pregnancy. ❖ Tx:
▪ During intensive phase (2 mos.), H (Isoniazid), ➢ Refer to DOTS facility.
R (Rifampicin), Z (Pyrazinamide), and E • Prevention & Control:
(Ethambutol) are given. o Vaccination
▪ During continuous phase (4 mos.), H ▪ BCG (bacille Calmette-Guerin) Vaccine
(Isoniazid) and R (Rifampicin) is given. • Paragonimiasis
o 2-4 wks. after receiving TB drugs, risk of o CA: Paragonimus westermani
transmission is greatly reduced. o MOT: Ingestion of undercooked or raw crabs,
o High protein diet with liberal amt. of fat is crayfish, or their juices.
encouraged. o A.k.a. lung fluke disease.
o Emphasize importance of compliance to o Parasitic infection that can cause symptoms
chemotherapy regimen. similar to TB.
Primary Health Care
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LEPROSY • Tx:
• CA: Mycobacterium leprae o Multi Drug Therapy (MDT)
• MOT: Prolonged skin-to-skin contact ▪ Paucibacillary form
• A.k.a. Hansen’s Disease, Tiger’s Disease ❖ Dapsone
• Legal basis ➢ Daily
o R.A. 4073 (An Act Further Liberalizing the ➢ Dose:
Treatment of Leprosy by Amending and  Adult:
Repealing Certain Sections of the Revised  100 mg
Administrative Code)  Children (10-14 y.o.)
• S/Sx:  50 mg
o Early ❖ Rifampicin
▪ Change in skin color (R-W) ➢ Once a month
▪ Lesion, loss of sweating ➢ Dose:
❖ Lesions are hypopigmented and hypo  Adult:
aesthetic.  600 mg (2 tab. 300 mg)
▪ Ulcers that do not heal  Children (10-14 y.o.):
▪ Muscle weakness or paralysis  450 mg (1 tab 300 mg + 1 tab 150
▪ Painful or thickened nerves mg)
o Late ▪ Multibacillary
▪ Madarosis ❖ Dapsone
❖ Loss of eyebrows ➢ Daily
▪ Inability to close eyelids ➢ Dose:
❖ Lagopthalmos  Adult:
▪ Sinking of nosebridge  100 mg
▪ Clawing of fingers and toes  Children (10-14 y.o.)
❖ The reason why leprosy is also known as  50 mg
Tiger’s Disease. ❖ Rifampicin
• Dx: ➢ Once a month
o Lepromin skin test ➢ Dose:
▪ Used to determine what type of leprosy a  Adult:
person has.  600 mg (2 tab. 300 mg)
▪ Antigen is injected ID and assessed after 3  Children (10-14 y.o.)
days and 28 days.  450 mg (1 tab 300 mg + 1 tab 150
o Skin slit test (skin smear test) mg)
▪ A sample is collected from a tiny cut in the ❖ Clofazimine
skin and then stained for M. leprae. ➢ Daily
➢ Dose:
 Adult:
 50 mg
Primary Health Care
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 Children (10-14 y.o.) • Dx:

 50 mg (QOD) o PCR test

EMERGING INFECTIONS AVIAN FLU

SEVERE ACUTE RESPIRATORY SYNDROME • CA: A(H5N1) and A(H7N9)
(SARS) • MOT: Direct and indirect contact
• Also referred to as SARS-CoV • Incubation period: 2-5 days
• CA: Human coronavirus • Dx:
• MOT: Airborne and/or droplet o PCR test
• Incubation period: 2-10 days • Tx:
• S/Sx: o Oseltamivir
o Prodromal o Zanamivir
▪ High fever
HAND-FOOT-AND-MOUTH-DISEASE (HFMD)
▪ Chills
• CA: Coxsackievirus/Enterovirus
▪ Malaise
• MOT: Direct, droplet contact with feces of infected
▪ Myalgia
pt.
▪ Headache
• Incubation period: 1-3 days
▪ Diarrhea
• S/Sx:
o Respiratory:
o Common in children under 5:
▪ Dry, non-productive cough
▪ Flu-like manifestation
• Dx:
▪ Fever
o PCR test
▪ Sore throat
• Prevention:
▪ Eruption of mouth sores (red spots and
o 10 days quarantine
blisters)
MIDDLE EAST RESPIRATORY SYNDROME ▪ Skin rash over palms and soles
(MERS)
• Also referred to as MERS-CoV
• CA: Zoonotic virus (MERS-CoV)
• MOT: Direct and indirect contact with camels,
goats, cows.
• Incubation period: 14 days
• S/Sx:
o Fever
o Cough
o SOB
o Pneumonia
o Diarrhea
o Nausea and vomiting
o Kidney failure
Primary Health Care
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COMMUNITY ORGANIZING PARTICIPATORY • Organization Building

ACTION RESEARCH (COPAR)
• The focus will be on the community for self-reliance,
empowerment, and active participation.
• This is to transform the community from apathetic
community to a participative community.
• The community should be the one to identify and
solve the problems, not the RM.
o The RM will only serve as a facilitator/guide of
change or as a mediator.
o Formation of a formal group.
o This is also where the RM will present the results
of the community diagnosis during a community
assembly.
• Sustenance and Strengthening
o Education and training
▪ Leadership training
▪ Livelihood program implementation
• Phase Out

PHASES OF COMMUNITY ORGANIZING o Leave the community.

• Pre-entry
o Site selection
▪ Criteria for site selection:
❖ Depressed
❖ Oppressed
❖ Poor
❖ Exploited
❖ There should also be no problem with
peace and order.
o The RM should visit the mayor for courtesy call
and to help identify appropriate site.
• Entry Phase
o Social preparation phase.
o Where immersion happens.
o This is the time to enter the community.
o This is the most important phase as this is where
you determine if there is resistance within the
community.
▪ During this phase, you need to build rapport
within the community. If there is resistance, do
not continue.
o It is important to inform the community that you
will only be there temporarily so that they will not
fully rely on you.
o This is also the phase of leader spotting.
o Building of community profile.
Primary Health Care
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GENERAL PRINCIPLES OF MNCHN ❖ Parenteral administration of initial dose

• Every pregnancy is wanted, planned, and of antibiotics.
supported. ❖ Assisted delivery during imminent
• Every pregnancy is adequately managed breech presentation.
throughout its course. ❖ Manual removal of placenta.
o According to DOH. there should be 4 prenatal ❖ Removal of retained placental
visits. fragments.
o According to WHO, there should be 8 prenatal ❖ Administration of loading dose of
visits. corticosteroids for threatened pre-
• Every delivery is facility-based and managed by mature delivery.
skilled birth attendants. o CEmONC
o Home deliveries is not allowed. ▪ One CEmONC per 500,000 population.
• Every mother and newborn pair secures proper ▪ Performed in a provincial hospital.
postpartum and postnatal care (mother and child ▪ Requires an operating room.
survival package). ▪ Functions:
❖ All BEmONC fx.
LIFE’S EVENTS
❖ Blood transfusion
• Mother Baby Friendly Hospital Initiative (MBFHI)
o Promotes BF. ❖ CS

o Legal basis of BF:

▪ EO 51
▪ R.A. 7600
▪ R.A. 10028
o There are 10 steps to BF.
▪ 3 E’s
❖ Early
❖ Exclusive
❖ Extended
• EmONC
o BEmONC
▪ For every 125,000 population.
❖ Four BEmONC per 500,000 population
▪ Should be reached within 30 mins.
▪ Functions:
❖ Parenteral administration of oxytocin in
the third stage of labor.
❖ Parenteral administration of loading
dose of anti-convulsant.
Primary Health Care
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DEPARTMENT OF HEALTH (DOH) • Top 10 leading causes of morbidity (2016)

• Leaders in health o Acute respiratory infections
• Enablers and capacity builders o HPN
• Administrative and specific services o Acute lower tract respiratory infections
o R.A. 11223 (Universal Healthcare Act) o UTI
• Vision: Filipinos are among the healthiest people in o Influenza
Southeast Asia by 2022, and Asia by 2040. o Bronchitis
• Mission: To lead the country in the development of o Acute watery diarrhea
a productive, resilient, equitable, and people- o TB
centered health system for Universal Health Care. o Acute bloody diarrhea
• New DOH Secretary: o Dengue fever
o Dr. Teodoro Javier Herbosa, FACS • Top 10 leading causes of mortality (Jan 2022)
o Ischemic heart disease
o CVD
o COVID-19 virus identified
o Malignant neoplasm
o DM
o HPN disease
o Pneumonia
o COVID-19 virus not identified
o Other heart diseases
o Chronic lower respiratory distress
• DOH 2022 Goals:
o Life expectancy is 72 HEALTH DETERMINANTS
• 40% socio-economic factors
o MMR target is 90
• 10% physical environment
o IMR target is 15
• 30% health behaviors
o Slow decline in TB incidence to 427
o Intervention areas:
o Slow decline in stunting to 21.4
▪ Healthy public policies
• Top 10 leading causes of morbidity (May 2022)
▪ Healthy settings
o Acute respiratory infections
❖ School
o HPN
❖ Communities
o Animal bites
❖ Work place
o Acute lower tract respiratory infections
• 20% health services
o UTI
o Intervention areas:
o Skin disease
▪ Health facilities
o Influenza-like illness
▪ Meds and equipments
o TB all forms
▪ HR
o Acute watery diarrhea
▪ Health financing
o Acute febrile illness
Primary Health Care
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HEALTH SECTOR STRATEGY (2023-2028) • Targets of SDG:

• Impact: o F – Financial risk reduction
o Healthier Filipinos. o B – Better Health
• Strategic Thrusts: o R – Responsiveness
o Enable to be healthy • The Next Generation Developmental Goals is
o Protect from health crisis targeted to be achieved by 2045.
o Care from health risks, for health and wellness
MILLENIUM DEVELOPMENTAL GOALS (MDG)
SUSTAINABLE DEVELOPMENTAL GOALS (SDG) • Should have been attained by 2015.
• There are 17 SDGs. • Important MDGs
• Should be attained by 2030 o MDG #4
o Goal is to ensure that all human being can fulfill ▪ Reduce child mortality.
their potential indignity and equality and in health ❖ By 2/3
environment. o MDG #5
• SDGs: ▪ Improve maternal health.
❖ Reduce MMR by 75%
➢ 52/100,000 live births
o MDG #6

FOURMULA ONE PLUS

• FOURmula ONE Plus (F1 +) Pillars:
o Financing
o Service delivery
o Regulation
o Governance
• SDG #1 – No poverty o Performance accountability (+1)
• SDG #2 - Malnutrition
• SDG #3 – Health for all
• SDG #6 – Safe and affordable drinking water
• SDG #8 – Safe and secure working environment
• SDG #11 – Housing as basic services/air quality
waste management.
o R.A. 8749 (Philippine Clean Air Act of 1999)
o R.A. 9275 (Philippine Clean Water Act of
2004)
o R.A. 6969 (Toxic Substances and Hazardous
and Nuclear Wastes Control Act of 1990)
o R.A. 7846 (Mandatory Infant-Health
Immunization Act of 2010)
▪ Hepa B vaccine