Primary Health Care for Midwives

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Public Health Programs

Sets of interventions put together to operationalize policies and standards directed towards the prevention of certain public health problems

Family Health
1. Improve the survival, health and well being of the mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal and post natal stages 2. Reduce morbidity and mortality rates for children 0 9 years old 3. Reduce mortality from preventable causes among adolescents and young people 4. Reduce morbidity and mortality among Filipino adults and improve their quality of life 5. Reduce morbidity and mortality of older persons and improve their quality of life Every effort has to be made to provide packages of health services to the family for a ______________________________________________

Reproductive Health
NATIONAL FRAMEWORK: A way of life, throughout life INTERNATIONAL FRAMEWORK: Quality of life GOALS: Achieve healthy sexual development and maturation Achieve a couples reproductive intention To avoid illness, injuries, disabilities related to sexuality and reproduction To receive appropriate counseling and care of RH problems REASONS for GOALS Every pregnancy must be intended Every birth should be healthy Every sexual act must be free from coercion and infection Achieve the desired family size REASONS FOR DEATH Too frequent pregnancies Too many births Too young or too old

The Family Planning Program

OVERALL GOAL: to provide universal access to family planning information and services wherever and whenever these are needed OBJECTIVES Addresses DESIRED FAMILY SIZE within context of RESPONSIBLE PARENTHOOD Ensure that quality FP services are available in all health facilities Family planning aims to contribute to: a. ________________________________________ b. ________________________________________ c. ________________________________________ d. ________________________________________ Rights: 1. ___________________________ 3. ___________________________ 2. ___________________________ 4. ___________________________ 1

Natural methods
_________________________________________ - no sexual intercourse during fertile period Benefit: _______________________________________________ Disadvantages: Requires a lot of discipline Disrupts sexual activity _________________________________________ - combination of BBT and Cervical Mucus Method ________________________________________ - TEMPORARY POST PARTUM METHOD of postponing pregnancy as based on physiologic infertility of BREASTFEEDING WOMEN Criteria 1. _____________________________________________________________ 2. _____________________________________________________________ 3. _____________________________________________________________

Artificial methods
_______________________________________ - alters the environment of the uterus Increases the risk for:___________________________________________ Viability: _________________________________________________ Schedule of check-up:______________________________________________ Alert for: P _________________________________________________ A _________________________________________________ I __________________________________________________ N__________________________________________________ _______________________________- blocks and immobilizes sperm Schedule:_______________________________________________ Viability:________________________________________________ __________________________________ - thin sheet of latex rubber Advantage: __________________________________________________ Used to manage: ______________________________________________ The only artificial birth control method used to prevent ______________________________ Shelf life:____________________________________ Should be stored in _________________________________________ _________________________________________ when removing it ___________________________________ - Advised for women who are ANEMIC - reduce menstrual flow ___________________________________ - for over 35 years old, have headaches, HPN, varicose veins, leg pain, gain weight w/combination pills ___________________________________- begin anytime during the 1st 5 days of their menstrual cycle ___________________________________ - begin on 1st or 2nd day of cycle Alert for: A - _________________________________________________ C - _________________________________________________ H - _________________________________________________ E - _________________________________________________ S - _________________________________________________ Take pills at _________________________________________ ______________________________ - in 1 packet ________________ - active pills ________________ - no hormones ; contains _____________________ 2

Schedule: One missed pill:_______________________________________________________________ Two missed pills: ______________________________________________________________ Three missed pills: _____________________________________________________________ ______________________________________________ - Prevents ovulation and thickens cervical mucus Pregnancy is ______________________________________ after discontinuing use Schedule: ______________________________________________ May be given : ___________________________________________________ May be delayed: _________________________________________________

Surgical methods
________________________________________ - OPD PROCEDURE, 10-20mins. 3cm incision, cuts both fallopian tubes (isthmus) ___________________________________ - Cutting of the VAS DEFERENS to prevent the passage of sperms Put seminal fluid in a _____________________________ Bring _______________________________________________to keep it warm Bring to the laboratory ____________________________

Other Natural Methods

Calendar method Subtract _________________ from the shortest cycle Subtract _________________ from the longest cycle _____________________________ -The couples use COLOR CODED BEADS to mark the fertile and infertile days of the menstrual cycle Users with menstrual cycles bet. 26 and 32 days are counseled to ABSTAIN from sex on __________________________ Total number of beads: _________________________ _______________ - 1st day of menstruation _____________________ - infertile _____________________- fertile _____________________ - infertile

Misconceptions about Family Planning

Some FP method cause abortion Using contraceptives will render couples sterile. Using contraceptive methods will result to loss of sexual drive

The Maternal Health Program

CAUSES OF MATERNAL DEATH: 1. Hypertension 2. Postpartum hemorrhage 3. Pregnancy with abortive outcomes OVERALL GOAL: to improve survival, health and well being of mothers and the unborn STRATEGIES: BEMOC - ________________________________ Improve quality of prenatal and postnatal care - Pregnant women should have at least ___________ Reduce womens exposure to health risks Allocation of health services for the mother and the unborn - LGUs and NGOs 3

Antenatal Registration
_________________________ - Used when rendering prenatal care Guide in identification of RISK FACTORS and danger signs in pregnancy Standard prenatal visits: Prenatal visit 1st visit 2nd visit 3rd visit Every 2 weeks Period of pregnancy

Tetanus Toxoid Immunization

Tetanus toxoid immunization is important for pregnant women and child bearing age women A series of _________________ of TT vaccination must be received before delivery to protect the baby from neonatal tetanus A mother with complete shots of TT is termed __________________________________________

Micronutrient Supplementation
Common deficiencies in pregnancy are: _________________________________ IRON SUPPLEMENTATION - Schedule:________________________________ - Dosage: ___________________ orally per day for ________________ days GOITER ENDEMIC AREAS - All pregnant women: ________________________ every year MALARIA INFESTED AREAS - Prophylaxis for pregnant women :__________________________________ - 2 tabs per week for the whole pregnancy

Clean and Safe Delivery Qualified for Home Delivery

Full term Less than 5 pregnancies Cephalic presentation Without existing diseases ex.diabetes, hpn No history of complications like hemorrhage during previous deliveries No history of difficult delivery prolonged labor Adequate pelvis Abdominal enlargement is appropriate for age of gestation

High Risk Pregnancies 5th pregnancy onwards Previous CS delivery or abdominal surgery 35 years old and above, 17 years old and below HISTORY of PIH, HPN, PID, DM, goiter, premature contractions, spontaneous abortions, anemia, malnutrition & TB. Twin pregnancy Steps 1. 2. 3. 4. 5.

Do a quick check upon admission for emergency signs Make the woman comfortable Assess the woman in labor Determine the stage of labor Decide of the woman can safely deliver 4

6. 7. 8. 9. 10. 11.

Give supportive care throughout labor Monitor and manage labor Monitor closely within one hour after delivery and give supportive care Continue care after one hour post partum. Keep watch closely for at least ______________ Educate and counsel on FP and provide FP method if available Inform, teach and counsel the woman on important MCH messages

Post Partum check-up 1st visit 2nd visit Post partum check up of the newborn: 1. ____________________________________ 2. ____________________________________

The Child Health Programs (Newborns, Infants, and Children)

1. 2. 3. 4. 5. 6. 7. 8. Infant and Young Child Feeding Newborn Screening Expanded Program on Immunization Management of Childhood Diseases Micronutrient Supplementation Dental Health Early Child Development Child Health Injuries

MAIN GOAL: to reduce morbidity and mortality rates for children 0 9 years STRATEGIES: Develop local capability to deliver the whole range of essential health packages for children. Implement programs and projects that favor disadvantaged populations Apply the REB___________________________________ strategy for immunization to reach every child Intensify health education and information campaigns Enhance medical, nursing and midwifery education - ______________________________________ Pursue the implementation of laws Infant and Young Child Feeding OVERALL OBJECTIVE: improve survival of infants and young children NATIONAL PLAN OF ACTION GOAL: Reduce child mortality by 2/3 by 2015 OBJECTIVE: to improve health and nutrition status of infants and young children OUTCOME: To improve exclusive and extended breastfeeding and complementary feeding KEY MESSAGES 1. Initiate breastfeeding within __________________________ 2. Exclusive for the ______________________________ 3. Complemented at _______________________________ 4. Extend breastfeeding up to ____________________________ COMPLEMENTED FOOD SHOULD BE: 1. _________________________ 2. _________________________ 3. _________________________ 4. _________________________ LBW - ______________________________________________

FLUID NEEDS OF THE YOUNG CHILD 5

1. _____________________ is good for thirst. _____________________________ may cause diarrhea and may reduce the childs appetite for food 2. ______________________________________ may actually make the child thirstier. ______________________ are not suitable for young children 3. _________________________________ reduce the iron that is absorbed from foods. 4. Drinks should not replace food or breastfeeding 5. A non breastfed child aged 6 24 months of age needs approximately ___________________ per day in a temperate climate and ___________________ per day in a hot climate REMEMBER! The ____________ of the child is the best indicator of growth and development Schedule of weight taking and plotting: 1ST YEAR ___________________ 2nd YEAR ___________________ 2-6 YEARS _______________________ LAWS 1. EO 51 - _____________________________________________ 2. RA 7600 - ____________________________________________ 3. RA 8976 - _____________________________________________

NEWBORN SCREENING TEST

DISEASES: 1. ______________________________________ 2. ______________________________________ 3. ______________________________________ 4. ______________________________________ 5. ______________________________________

EXPANDED PROGRAM on IMMUNIZATION

GENERAL PRINCIPLES: 1. It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body. 2. Measles vaccine should be given as soon as the child is _____________________ 3. The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or years. 4. NON CONTRAINDICATIONS a. _______________________ b. _______________________ c. _______________________ d. _______________________ e. _______________________ f. _______________________ 5. ABSOLUTE CONTRAINDICATIONS a. _____________________________________________________________________________ b. _____________________________________________________________________________ 6. It is safe and effective with mild side effects after vaccination. 7. Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the antibody response 8. NEVER RECONSTITUTE FREEZE DRIED VACCINE IN ANYTHING OTHER THAN THE DILUENT SUPPLIED WITH THEM 9. Use ___________________________________________________________ during vaccination Every ________________________ is designated as immunization day In a barangay health station immunization is done ____________________ In far flung areas, it is done ________________________ FULLY IMMUNIZED CHILD (FIC) 1 dose BCG 3 doses of Hepa B 3 doses of OPV 1 dose of measles 3 doses of DPT Vaccine Minimum Age Number of Minimum Reason 6

Interval BCG

doses

interval between doses

DPT

OPV

HEPA B

MEASLES

Vaccine BCG DPT OPV MEASLES HEPA B TETANUS TOXOID

Content

Administration of Vaccines Form and Route Site Dose

Side Effect

Vaccine TT1 TT2 TT3 TT4 TT5

Tetanus Toxoid Immunization Schedule for Pregnant Women Minimum Age / Percent of Protection Duration of Protection Interval

__________________________________ - A system for ensuring the POTENCY of VACCINES from the time of manufacture to the time it is given Officers: _________________________________ ________________________________

Timeframe for Storage of Vaccines Regional level Provincial level District level Health Centers (with refrigerator) Using transport boxes Mark unopened vials / ampules o X single exposure o XX double exposure o 3rd exposure - discard Remember! Transport boxes - _______________________________ Standard vaccine carrier - ___________________________ Measles & OPV - ________________________________ BCG, DPT, TT, HEPA B - _____________________________ Oh My Dudung Have Big Titi! O M D H B T Most sensitive to heat: Freezer ( _______________ C) __________ __________ Sensitive to heat and freezing (body of ref _____________ C) __________ __________ __________ __________

________________________________________ is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines. Role of a MIDWIFE in improving delivery of immunization services in the community Actively ________________ infants eligible for vaccination in the community Observe _________________________ on immunization and use one syringe and one needle per child Dispose syringe and needles properly by using ___________________ and disposing it in ____________________ to prevent health hazard Inform, educate and communicate with parents Identify and actively search cases and deaths of EPI target diseases following standard case definition

Half life with packs _____ hours- BCG, DPT, Polio _____ hours- Measles, TT, Hepa-B 8

Nutrition Program
COMMON NUTRITIONAL DEFICIENCIES 1. ___________________________ 2. ___________________________ 3. ___________________________ GOAL: Improve quality of life of Filipinos through better nutrition, improved health and increased productivity PROGRAMS and PROJECTS 1. Micronutrient Supplementation Twice a year distribution of VITAMIN A CAPSULES through the ARAW NG SANGKAP PINOY (ASAP), known as GARANTISADONG PAMBATA (GP), or CHILD HEALTH WEEK 6 71 months old Iron supplementation among children under five years old 2. Food Fortification Mandatory fortification of staples Flour: ______________ Cooking oil and refined sugar: ________________ Rice: _________________ SANGKAP PINOY SEAL: ___________________________________________ 3. Essential Maternal and Child Health Service Package 4. Nutrition information, communication and education 5. Home, School and Community Food Production 6. Food Assistance 7. Livelihood Assistance
PD 491 ___________________________ RA 832 ___________________________

Protein Energy Malnutrition (PEM) is the most common and widespread form of malnutrition in the country. Affected groups include _________________________ __________________________ __________________________ PEM may be fatal if not resolved. Even if treated, there is still a possibility that this may result in failure of children to reach their full potential of intellectual and psychological development. _______________________ is caused by protein deficiency among 1-3 years old, when children change from breastmilk to high carbohydrate diet. Manifests anorexia, growth failure, edema, muscle wasting, zebra sign (striped appearance of hair). _______________________ is a deficiency of all food groups. It is a form of starvation mostly among infants. They are always hungry and will suck at any object offered them. ________________________is the best treatment for malnutrition. _______________________ may lead to goiter, cretinism in newborn.

Nutrients
Carbohydrates Fats (lipids)

Functions
Main source of energy Provides essential fatty acids and energy Absorption of vitamins (A,D,E,K) Growth and repair of tissues Provides energy Normal vision, skin and bone health Calcium and Phophorus absorption Bone mineralization Prevents cell damage anti oxidant Blood clotting Protein and iron absorption 9

Food Sources
Starch, sugar, fiber Fats, oils, meat, dairy products

Deficiency
Marasmus

Protein Vitamin A (____________) Vitamin D (Cholecalciferol) (Ergosterol) Vitamin E (_____________) Vitamin K (Phylloquinone) Vitamin C

Meat, fish, vegetables Yellow and green vegetables Fish, milk and eggs

Vegetable oils Liver, meat, dark leafy vegetables Citrus fruits

Marasmus Kwashiorkor Night Blindness, Xerophthalmia ___________ in children ______________ in adults RBC destruction Bleeding Scurvy, bleeding gums

(________________) Vitamin B1 (_______________) Vitamin B2 (_______________) Vitamin B3 (______________) Vitamin B6 (Pyridoxine) Vitamin B9 (_______________) Vitamin B12 (Cyanocobalamin) Calcium Phosphorus Magnesium Sodium Potassium Chloride Iron Iodine

Muscle nerve function Energy metabolism, skin health Releases energy from nutrients Neurotransmitter synthesis Formation of DNA and new blood cells Formation of new cells, nerve function Bone and teeth mineralization Bone and teeth mineralization Bone and teeth formation Fluid balance, nerve transmission Fluid balance, nerve and muscle function Acid base balance Hemoglobin component, RBC maintenance Component of thyroid hormone, for mental and physical growth Formation of bone and teeth Growth factor, making of sperm

Yeast, grains and milk Green vegetables, liver, milk and eggs Fish, liver, red meat Whole grains, spinach, broccoli Liver, green leafy vegetables Liver, red meat Milk products Milk products, meat, poultry Whole grains, nuts, legumes Salt Bananas, Coconut water Salt, soy sauce Red meat, egg yolk Seafood, iodized salt, BURBURTAK Fluorinated water, toothpaste, seafood Meat, fish, poultry

Beri beri Inflammation of the tongue, dermatitis Pellagra Anemia, convulsion, nausea Megaloblastic anemia Pernicious anemia Osteoporosis Demineralization of bones Weakness, growth failure Muscle cramps, weakness Muscle weakness, fatigue Muscle cramps Anemia Goiter, Physical and mental retardation Tooth decay, fluid imbalance Growth failure, reproductive failure

Fluoride Zinc

Garantisadong Pambata 4:1 4 Bs implemented Oct. 2006 by the DOH 1. B BREAST FEEDING 2 years and beyond Initiate full breast milk production 1 hour after delivery 2. B BULATE Give Albendazole 200mg 12 24 months 200mg 24 71 months 400mg 3. B BITAMINA Give Vitamin A o 6 11 months 100,000 iu o 12 71 months 200,000 iu 3 Ts o Today, Tomorrow, Two weeks o 6 months and 6 months thereafter 4. B BAKUNA DOH provide the vaccines

LGU provide the syringes

Environmental Health and Sanitation ______________________________ 10

Branch of public health that deals with the study of preventing illnesses by managing the environment and changing peoples behavior to reduce exposure to biological and non biological agents of disease and injury ______________________________ - The study of all factors in mans physical environment, which may exercise a deleterious effect on his health, well being and survival ______________________________________ - Responsible for the promotion of healthy environmental conditions and prevention of environmental diseases through appropriate sanitation strategies Sanitation Code of the Philippines: _________________________ Water Supply and Sanitation Program Approved types of water supply facilities Level 1 ______________________ - Protected well or developed spring with an outlet but without a _______________________ - Normally serves around ______________________ households and its outreach must not be more than ____________ meters from the farthest user Level 2 _______________________________________________________ - A system composed of a source, a reservoir - Piped distribution network and _______________ faucets - Designed to deliver to an average of ______________ households with one faucet per 4 to 6 households - Generally suited for rural areas where houses are _____________ Level 3 _______________________________________________________ - A system with a source, a reservoir, a piped distribution network, and household taps - Generally suited for densely populated urban areas - Requires minimum treatment or disinfection Unapproved types - Water from doubtful sources Require quality standards that meet provisions of the National Standards for drinking water set by _________________________ The examination of drinking water shall be performed only in private or government laboratories duly accredited by _________________________________ Certificate of potability of an existing water source is issued by _______________________________ or his duly authorized representative (local health authority) Proper Excreta and Sewage Disposal Approved types Level 1 _______________________________________ - no water is necessary to wash the waste into the receiving space. (pit latrines, reed odorless earth closet) Toilet facilities requiring small amount of water to wash the waste into the receiving space. (pour flush toilet and aqua privies) Level 2 On site toilet facilities of the water carriage type with water sealed and flush type with _______________________ disposal facilities Level 3 Water carriage types of toilet facilities connected to ___________________ and to _________________________ Food Sanitation Program Policies: Inspection of all food sources, containers, transport vehicles Compliance to ________________________ requirement of all Food establishments 11

Provision of updated _______________________ for all food handlers Destruction or banning of food _____________________________________

Food establishments shall be rated and classified as follows: Class A Class B Class C Four rights in Food Safety: _____________________________________ _________________________________________ _____________________________________ _________________________________________ When in doubt of water source, boil water for at least _____________________(running boiling) Always buy _________________ milk Cook food thoroughly to ensure that the temperature should reach __________________ centigrade Eat cooked food ______________________ __________________________ thoroughly before and after eating All cooked food shall be left at room temp for not more than _________________ to prevent multiplication of bacteria Use _____________________________ for storing food Be sure to store food under hot conditions ( above ______________) cold conditions (below _______________) Food for infants should always be ____________________ and not to be stored at all Do not ________________________ the refrigerator Rule in food safety: ___________________________________________

Laws on Sanitation __________________ - Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990 __________________ - Clean Air Act of 1999 __________________ - Ecological Solid Waste Management Act of 2000 __________________ - Clean Water Act of 2004

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