One- Day Training Orientation on GP/ STH Control Program

 Rationale
Intestinal helminthiasis remains a global public health problem
being one of the top causes of morbidity worldwide. Intestinal helminth affects
the most vulnerable sector of society – the children aged 1 to 12 years
old. Helminthiasisaffects significantly their health and development causing
decreased physical activity and poor performance in school. The most recent
extensive survey to determine the extent of soil transmitted helminthiasis
(STH) in the country was done in 2004 through the joint effort of the
Department of Health (DOH), University of the Philippines-
College of Public Health (UP-CPH) and United Nations Children
Fund (UNICEF).
Results of the survey among children 12-71 months old (1-5 years old)
showed a cumulative prevalence of 66.6%. The 2004 STH survey also showed
that only less than a third (30%) of households in the study areas have pipe-in
water while the other 69.7% depend on deep wells, open drug wells and
springs, and few on rainwater. The same study also showed that three fourths
(72%) of the households have sanitary toilets and significant percentage
(28%) still use unsanitary toilets.

Department of Health
National Center for Disease Prevention and Control Program
 One- Day Training Orientation on GP/ STH Control Program

 Rationale
Given the high prevalence of STH, the significant proportion of households
without access to sanitary facilities, the existing limited resources of the national
and local governments, the National DOH- National Center for Disease
Prevention and Control (NCDPC) deemed it necessary to integrate its STH
Control Program (STHCP) efforts with its other deworming programs –the
Garantisadong Pambata (GP). The DOH also considered it equally important to
closely link the STHCP initiatives with similar programs undertaken by the other
national agencies, particularly the Department of Education (DepEd) and the
Department o Social Welfare and Development (DSWD).

It is therefore essential to equip the school teachers and local health

personnel on the Integrated Helminth Control Program (IHCP), hence this
training.

Department of Health
National Center for Disease Prevention and Control Program
One- Day Training Orientation on GP/ STH Control Program

Objectives
To upgrade the knowledge, improve skills and
attitudes of the health personnel in the prevention and control of Soil- transmitted Helminthiasis.

Specific Objectives:
1. Discuss the Soil- Transmitted Helminthiasis, its diagnosis and control.
2. Understand and discuss the program thrust and strategies including the mass treatment guide.
3. Formula an action planfor an effective and efficient IHCP implementation.

Training Methodology:
Lecture/ Discussion
Action Planning

Course Content:
Integrated Helminth Control Program
Mass Treatment Guide
Action plan

Department of Health
National Center for Disease Prevention and Control Program
 One- Day Training Orientation on GP/ STH Control Program

 VI. Operating Details:

Orientation Training on the Integrated Helminth Control Program for Teachers and Health Workers.

Participants: Public Health Nurses

School Nurse/ Teachers
DOH Representatives
PHO/ CHO STH Coordinator

Date/Venue: June 18, 2013 - La Union (Max Restaurant)

June 20, 2013 - IlocosNorte (Northview)
June 21, 2013 - Ilocos Sur (Alad Bar)
Aug 7, 2013 - Pangasinan 1- Eastern (Ruperto’s Hotel)
Aug 8, 2013 - Pangasinan 2- Western (Ruperto’s Hotel)

Fund : HRT

Department of Health
National Center for Disease Prevention and Control Program
 One- Day Training Orientation on GP/ STH Control Program
TIME ACTIVITY PERSON RESPONSIBLE

8:00- 8:30 AM Registration PHTO

8:0- 8:45 AM Opening Program PHO

8:45- 9:00 AM Overview of the IHCP Ms.Melita Castillo

9:00- 10:30 AM Integrated Helminth Control program Dr. Amelia Dumaoang

10:30- 10:45 AM AM Break

10:45- 12:00 AM Mass Treatment Guide Ms.Melita Castillo

12:00- 1:00 PM Lunch break

1:00- 2:00 PM Reporting and Recording DepEd Representative

2:00- 3:00 PM Action Planning DOH-DepEd

3:00- 3:15 PM PM break

3:15- 4:30 PM Presentation of Plans Representative Participants

4:30- 5:00 PM Closing Programs

Department of Health
National Center for Disease Prevention and Control Program
 Department of Health
National Center for Disease Prevention and Control Program
INTEGRATED HELMINTH
CONTROL PROGRAM

Dr. Amelia D. Dumaoang, MM-HSM

Head, Infectious Diseases Cluster
 SOIL-TRANSMITTED HELMINTHS
intestinal parasitic worms
which cause soil-transmitted
helminthiasis
develop in the soil
man is the only host
enter the body through the
mouth and soles of the feet
 3 MOST COMMON
HELMINTHS
ASCARIS LUMBRICOIDES

TRICHURIS
TRICHIURA /
ROUND WORM

HOOKWORM
 MAGNITUDE OF STH
 2.7 billion people are affected with intestinal
helminths worldwide the majority in developing
countries (WHO)
In the Philippines:
 PR among children 6–14 y/o is 44.7% (UNICEF/DOH/UP-NIH
2010)
 PR among children 1–5 y/o is 43.7%, (DOH 2010)
Associated factors:
 Poverty
 Poor nutrition
 Inadequate sanitary facilities
 Poor personal and environmental hygiene
EFFECTS OF STH
 SIGNS & SYMPTOMS OF STH
 Abdominal pain and enlargement
 Weight loss
 Anemia
 Malnutrition
 Loss of appetite
LIFE STAGES OF WORMS
Vision

Health and Productive Filipinos in

the 21st Century

Goal

to reduce morbidity and mortality

due to soil-transmitted Helminthiasis
 GENERAL OBJECTIVES

To reduce the prevalence of STH to below

30% among 1-12 years old by 2016 and
lower STH infection among adolescent
females, pregnant women and special
population groups of food
handlers/operators, farmers, soldiers and
indigenous peoples.
 INDICATORS
1. STH prevalence of 1-5 y/o children
reduces to less than 30% from 43.7%
(2010)

2. STH prevalence of 6-12 y/o children

reduced to less than 30% (2010) from
44.7% (2010)

3. Risk to STH infection among special

population groups reduced to less than
10% from 36.9% (2010)
 SPECIFIC OBJECTIVES
1. To increase the coverage of deworming of
target population groups at risk to STH
infection

2. To expand coverage of water, sanitation

and hygiene

3. To increase proportion of households

aware of proper STH prevention and
control
 WHY DEWORM?
SHORT TERM GOAL- treatment is intended
to prevent and control morbidity by:
 Reducing worm burden

LONG TERM GOAL- treatment is to prevent

healthy people from becoming infected by:
 Reducing the source of infection
 TREATMENT GUIDELINES
A. Target Population

 Children 1-5 y/o

 Suffer the greatest morbidity
 Deworming is intended for curative
care

 Children 6-12 y/o

 Harbor the greatest load of infection
 Significant sources of infection
 TREATMENT GUIDELINES
B. Schedule of mass deworming

 Children 1-5 y/o (preschoolers)

 GP – April & October
 RHU, BHS, day care workers

 Children 6-12 y/o (school children)

 July and January
 School nurses and teachers
 TREATMENT GUIDELINES
Filariasis Endemic Areas (2y/o % above)

1st dose will be given on:

1-5 y/o – April by GO
6-12 y/o – July by DepEd

2nd dose will be given in Oct-Nov by FEP

The filariasis team will be in charge of all

activities in their areas including the
recording and reporting of accomplishment
 TREATMENT GUIDELINES
B. Approach to deworming

 Facility - based or fixed post

-deworming children in RHUs, BHS,
day care centers, schools, etc

 Door – to – Door
-deworming children house to house
especially in under-served, remote areas
or poorest segment of the community
 TREATMENT GUIDELINES

DURATION OF DEWORMING

Mass treatment should be done

every 6 months or 2x a year
 Diagrammatic Representation of How
STH Transmission can be Interrupted

Chemotherapy
Health
Education Reduce worm
burden and
decrease
transmission

Health
Education

Sanitation
Health
Education
TREATMENT GUIDELINES
TREATMENT GUIDELINES
 TREATMENT GUIDELINES

Side-effects of anti-helminthic drugs

 Rare and generally a reaction to the

degeneration of worms that have been
killed
 Only S/E that needs intervention is
allergic skin reaction which can be
treated with histamine antagonist
 Mild abdominal pain is most frequently
reported S/E – does not need treatment
 Erratic worm migration
 TREATMENT GUIDELINES

Precautions

• Severe malnutrition
• Diarrhea
• High grade fever
• Abdominal pain
 TREATMENT GUIDELINES

Effects of deworming

• Improved iron stores and

hemoglobin levels
• Improved growth
• Improved food intake
• Improved cognitive performance
• Reduced incidence of clinical
complication
 2013 Update
1.National Prevalence Survey
- All provinces for ages 1-16 y/o (Pre-School –
High School)
2. Sentinel Area Selection to Evaluate
Deworming Program
3. Review/ Revise the Bluebook
4. Collection of All Deworming and
Sanitation Data
5. April-GP Albendazole Requirement
Allocated
6. Sub allotment of Php 450K/region
 AO#2010-0023
Guidelines on
Deworming Drug
Administration and the
Management of
Adverse Events
Following
Deworming(AEFD)
 Definition of Terms
 Adverse Drug Reaction (ADR)- is a
noxious and unintended reaction, which
occurs at doses normally used in humans.
(WHO)
 Adverse event following deworming
(AEFD) is a medical event that happens
after ingestion of deworming drugs. While
the drugs are safe and effective against
helminths, adverse reactions which are
usually mild and transient may occur within
8-12 hours after ingestion.
Department of Health
National Center for Disease Prevention and Control Program
 Definition of Terms
 Serious Adverse Experience (SAE) is
defined as an adverse experience
following treatment with a drug that results
in any of the following: death, life-
threatening condition, in-patient
hospitalization or prolonging of an existing
hospitalization, persistent or significant
disability/incapacity, congenital anomaly.
(WHO)

Department of Health
National Center for Disease Prevention and Control Program
 AEFD and its Management
COMMON ADVERSE HOW TO MANAGE
EFFECTS
LOCAL SENSITIVITY or ALLERGY Give ANTIHISTAMINE
MILD ABDOMINAL PAIN Give ANTISPASMODICS
DIARRHEA Give ORS
ERRATIC WORM MIGRATION Pull out the worms
Parents/caregivers are allowed to manage
the adverse reactions, but if these reactions
persist, a doctor shall be consulted and any
of AEFD team shall be informed

Department of Health
National Center for Disease Prevention and Control Program
Precautionary
Measures on  The target clients or their
Deworming caregivers shall be
adequately informed of the
possible adverse reaction to
the drug and how to manage
this in case it occurs.
 Adverse reaction shall be
accurately recorded and
proper authorities (AEFD
team) shall be informed.
 Health personnel at the
community level shall be
informed of the on-going
deworming activity.
Department of Health
National Center for Disease Prevention and Control Program
Persons not to take
deworming drugs

 Seriously ill child/individual

 Child/individual with abdominal pain
 Child/individual with diarrhea
 Child/individual who previously suffered
hypersensitivity to the drug
 Severely malnourished (underweight) child
Department of Health
National Center for Disease Prevention and Control Program
AEFD Team
 Municipal Level:
 a. MHO
 b. MESU
 c. STH Coordinator
 d. DOH
representative

Department of Health
National Center for Disease Prevention and Control Program
 AEFD Team
 Provincial Level
 a. Provincial Health Officer
 b. PESU
 c. STH Coordinator
 d. DOH representative
 Regional Level
 a. Regional STH Coordinator
 b. RESU
 c. DOH representative
Department of Health
National Center for Disease Prevention and Control Program
How to Report
NCDPC / NEC
Recommends appropriate action

RESU / Regional Coordinator

Confirm initial findings and submits report to next higher
level;
Assist in investigation if needed ;
Recommends appropriate action

Municipal/ Provincial/ City Health Office

Conducts initial investigation using adverse reaction
reporting form and submits to next higher level

Health Worker/ Parent/ Teacher

Reports any AEFD in the area to higher level
Department of Health
National Center for Disease Prevention and Control Program
 Department of Health
National Center for Disease Prevention and Control Program
“If God is my Boss , and I’m His employee,
I’m very thankful of my everyday salary
called “LIFE”

God bless us all!

Dr. Amelia D. Dumaoang, MM-HSM

Head, Infectious Disease Cluster
DOH-CHD1
AGREEMENTS: August 7, 2013

1] Reporting
1-5years old :RHU
6-14 years old: DepEd
2] sharing of master list
October: School Nurse will coordinate with RHU
3] Monthly RHU meeting *invite DepEd nurse
4] Inventory
a. DepEd: based on enrolment
b. RHU: based on target
total pop * 13.5 % * 10 % buffer stock
5] Delivery of Logistics
RHU; the district nurse will get logistics from CHD then distribute
them to RHU
DepEd direct from Division Office
6] Mapandan DepEd Nurse will coordinate with RHU [August 8, 2013]
7] DepEd Nurse will coordinate with the RHU regarding the schedule of
deworming
8] DepEd: 66% 2012 to 85% by 2014