Community ö a group of people with common characteristics or inherent living together within a territory or geographical boundary. ö place where people are found. COMMUNITY AS THE CLIENT/PATIENT IN CHN ö client- well; patient- sick World views on Community: 1. Family, community, and society Levels of Contradictions: Individual  Intrapersonal Family  Intrafamilial/ Interpersonal Community- Intracommunity/ Interfamilial Society  strong regional, parochial, Intrasocietal/ Intercommunity 2. Contraindications/ conflicts 3. Change COMMUNITY AS SETTING IN CHN PRACTICE - place where people under usual or normal conditions are found (ex. Schools) - outside of purely curative institutions (hosp is not a part of population) HEALTH1. illness continuum model ö degree of client wellness ranging from optimum wellness to death ö dynamic state, matters as a person adopts to changes in internal & external envi Coital debut- sex before age 20- increase cervical CA 2. high level wellness model- maintain a continuum balance & purposeful direction with envi ö progress to a higher level of fxn to live to the fullest potential 1978- UNICEF & WHO- Alma Ata, Russia ö Global health situation ö Strategy/ approach: PHC ö Goal: HEALTH FOR ALL BY 2000 (old) 1994- Riga ö HEALTH FOR ALL BY 2000 AND BEYOND! 1979  Alma Ata declaration ö PHC as the thrust of DOH VISION of DOH ö HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE PEOPLE BY 2020 MISSION of DOH ö In partnership with the people, provide equity & access & quality health services especially to the marginalized segment of the population VISION & GOAL- same with DOH, PHC program 3. Agent-host environment model- (EPIDEMIOLOGIC) ö interplay of agent (causative etiologic factor)


1. Health belief model –preventive ö relationship bet. a person’s belief & his behavior in health ex. HIV infectn (commercial sex farers, sea workers, medical team Susceptibility, possible MOT (mode of transmission)--- unprotected sex- occupational hazard Prevention: A bstinence B e faithful C orrect, consistent, continuous use of condom D o not penetrate (SOP) HIV infected age groups Males age 40-49 Seafarers ratio: 1: 5 Anal sex- won’t get pregnant, common in rural Females 20-29 Vaginal: 1: 1000 Anal: 1: 200 2. Evolutionary based model- illness & death serve an evolutionary fxn- survival of the fittest 3. Health promotion model- directed at increase clients well-being 4. WHO definition Health- a state of complete physical, mental, & social well-being and not merely an absence of a dse, illness or infirmity WHO: health is a social phenomenon ö it is a result of interplay of diff societal factors: -biological - Physical- heat, temp - Ecological- adaptation to envi - Political - Economic - Social cultural ö it is an outcome of many theories Descartes – dualism Multi Casual theory- holistic- General systems theory Community health ö Part of paramedical & medical intervention/ approach concerned on the number of the whole population AGENT (Etiologic)- virus, bacteria 1. bio infections- fungi, protozoa, helminthes, ectoparasites 2. chemical- carcinogens, poisons, allergens ex. GMO’s – carcinogen MSG- poison 3. mech- car accidents, etc 4. environmental/physical- heatstroke 5. nutritive- excess or deficiency 6. psychological HOST Intrinsic factors and environmental factors 1. Increasing age 2. sex (m or f) F- weak emotional; morbidity: common diseases M- mortality ( killer dses) 3. behavior4. educational attainment- occupation 5. prior immunologic- response Extrinsic factors 1. natural boundaries- physical environmental, geography 2. biological envi 3. socioeconomic envi- political boundary


Aims: 1. Promotion of health 2. Prevention of illness 3. Mgt of factors affecting health INDIVIDUAL: Anatomy Physio Patho APPLIED STUDY: Structure Function Malfunction Community: Demography- study of population Sociology Epidemiology- study of dses

COMMUNITY HEALTH / PUBLIC HEALTH WINSLOW ö sci and art of preventing dse, prolonging life, promoting health & efficiency through organized community effort ö To enable each citizen to realize his birth right of health and longevity. ö Major concepts: i. Health promotion ii. People’s participation towards self-reliance HANLON ö most effective total dev & life of the indiv & his society PURDOM ö applies holism in early years of life, young, adults, mid year & later ö prioritzes the survival of human being Nursing- assisting sick individual to become healthy and healthy individual achieve optimum wellness Early years- fetus- 12 years/ younger adults- 12-24 years Orem- self care, autonomy, independent patient Theoretical bases of CHN practice Theories and principles: 1. Nursing 2. PH Community health nsg—by Maglaya ö the utilization of the nsg process in the diff levels of clientele- indiv, families, pop grps, and comm. concerned with i. promotion of health ii. prevention of dses iii. disability and rehab Goal: to raise the level of health of the citizenry by helping comm. & families to cope with the discontinuities in & threats to health in such a way as to maximize their potential for high-level wellness. WHO CHN ö Special field of nursing that combines the skills of nsg, PH, and some phases of social assistance & functions as part of the total PH program for the: 1. promotion of health 2. improvement of the conditions in the social and physical envi 3. rehab of illness asnd disability CHN is learned practice discipline with the ultimate goal of contributing, as individual and in collaboration with others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care. CHN is service rendered by a professional nurse with the comm., grps, fam, and indiv at home, in H ctrs, in clinics, in school, in places of work for the ff: 1. promo of health 2. prevention of illness

Jacobson ö Freeman ö


3. care of the sick at home and rehab Philosophy ö ö Dr. Margaret Shetland philo of CHN is based on the the WORTH AND DIGNITY of man

Basic concepts of CHN 1. primary focus/ emphasis- health promo 7 dses prevention primary goal- self reliance in health or enhanced capabilities ultimate goal- raise level of # of citizenry Philo of CHN- Worth and dignity of man 2. CHN practices -to benefit ( indiv, fam, special pop, comm.) - CHN is integrated and comprehensive 3. CHN are generalists- matter of comm. health work 4. all types and levels of HC Levels of HC: PHC- comm. SHC- regional, provincial, district, municipal, and local hosp (complicated sx) THC- sophisticated med ctr—heart ctr, QI, KI 5. Nature of CHN practice requires knowledge on biological, social sciences 6. Implicit in CHN is the nsg practice (ADPIE) Basic principles of CHN: (adopted fr Gardner, Cobb & Jones) 1. The comm. is the patient in CHN, the family is the unit of care and the 4 levels of clientele are: a. indiv b. pop grp ( those who share common char, dev stages and common exposure to the problems ex. Children, elderly) c. family d. comm. 2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care-participatory approach Client- active participant, full involvement recipient care 3. CHN practice is affected by devts in Health technology, in particular, changes in society, in general. 4. The goal of CHN is achieved through multisectoral efforts- coordinated with other sectors. 5. CHN is a part of health care system and the larger human services system.- Nsg practice, human service Nsg fxn 1. Independent- without supervision of MD 2. Collaborative- in collaboration with other H team ( interdisciplinary, intrasectoral) Basic Concepts of CHN (fr DOH bk) 1. Primary focus is on health promotx. The comm. H nurse by the nature of her work has the opportunity & responsibility for eval the health status of people & groups & relating them to practice. 2. CHN practice is extended to benefit not only the indiv but the whole family and community. 3. Community health nurses are generalists in terms of their practice through life’s continuum- its full range of health problems and needs. 4. Contact with the client and/or family may continue over a long period of time which includes all ages and all types of health care. 5. the nature of CHN practice requires that current knowledge derived fr the biological and social sciences, ecology, clinical nsg, and community health organizations be utilized. 6. The dynamic process of assessing, planning, implementing and intervening, provide periodic measurements of progress, eval, and a continuum of the cycle until the termination of nsg is implicit in the practice of CHN. Summary: 1. Primary focus/ emphasis – health promotion & dse preventx Primary goal: self reliance in health or enhanced capabilities of people Ultimate goal: raised the level of healthe of citizenry Philosophy of CHN- worth and dignity of man


6. accurate recording/ reporting serve as eval & guide for future actions Who supervises the nurse in 1..H problems Community dx with people (people’s participation) Active and full involvement of people in decision making. sp grps. Implicit in CHN is the nsg process w/c is an independent nsg action ADPIE Key principles in CHN (page 19) 1. provincial. ö Focus of care: indiv.vital parts of CHN Health educator.Mayor a. Knowledge and understanding of agency objectives & policies facilitates goal achievement Planning: 1. Lung Ctr.) Data analysis.managed H problems regional. Nature of CHN practice requires knowledge on biological. Mgt. Indiv. special pop. families. & admin concerns. Recognized needs of indiv families and common provider is the basis for CHN practice CHN process Assessment. NCMH.mgt at the level of comm. must actively participate in decision making 11. Project/ program implementation –MD 3.2.integrated and comprehensive 4.counselor—have the same goal: behavioral change Difference bet: Health educator – gives advice Counselor. supervision of nsg service by qualified personnel 12. ö Secondary HC. district. comm. Major d. goal setting 3. CH Nsg practice. evaluation/ outcome indicators –criteria/ standard ö measure outcome ö Criteria/ obj 3.comm. objectives 4.upgrade msg practice 9. Indegenous and existing Appropriate technology. Periodic and containing evaluation is necessary 8. comm. scientifically sound. social sciences. Heart Ctr.sophisticated medical centers. ö Attitude: non-judgmental 5. prioritization 2. CHN are generalists. 5. MD b. options (never gives direct advice) collectx (fam. actions 5. Continuing staff educ.experimentation 2. 2. Family is unit of service 4. Health educ and counseling.RN supervision 2. fam. All of them 5 .to benefit indiv. All types and levels of HC ö Primary HC. Respect values. municipal & local hosps (for complicated pregnancies) ö Tertiary HC. comm. 3. socially acceptable 10.methods & tech that are: 1. & comm. RN supervisor c. Collaborative working rel with health team facilities goal achievement ö nurse coordinator of health services 7. customs and beliefs of clients Implementation ö pt/ ct. CHN Practice.

allocates.interview and observations. or places of work ö provide continuity of patient care 3. Comm organizer.multisectoral app 4.analysis of data 6 . Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on accomplishments 4. 5. ö formulates nsg component of H plans ö In doctorless areas.identifies needs. hilots who aim towards H promo & illness prevention through dissemination of correct info. Trainer/ Health educator/ counselor.  Health educator.research—to improve HC 5.conducts training for RHMs.coord with other health team & other gov’t org (GOs & NGOs) to other health programs as envi sanitation health educ. Researcher. Requisitions. who aims towards health promo & illness preventx through dissemination of correct info. memoranda. based referral network The CHN Process 1. Planner/ programmer. Coordinator of Health Services. who establishes multi-sectoral linkages by referral system  Supervisor.provides direct nsg care to the sick. Conduct research relevant to CHN services to improve provision of health service. objective: measurable. intrn) . Assessment –collection of data ( subjective: expressed by client or SO. BHWs. she is responsible for the formulation of the municipal health plan ö Provides technical assistance to rural health midwives in health matters like target setting. fams. 2. org.formulates care plan for the: 4 Clientele: a. 6. Interprets and implements programs. the PHN will take charge of the MHO’s responsibilities Roles of the PHN II and III Qualifications: BSN + RN in the Phil 1. ö educating people 7.sensed. & comm. Provider of Nsg care.coordinates with govt & NGOs in the implementation of studies/ researches ö Participates in the conduct of surveys studies & researches on Nsg and H related subjs. schools. policies. taking care of the sick people at home or in the RHU. distributes materials (meds & medical supplies & records & reports equips b. disabled in the homes. educating people  Facilitator. who monitors & supervises the performance of midwives  In the event that the Municipal Health Officer (MHO) is unable to perform his duties/fxns or is not available.motivates & enhance community participation in terms of planning. dental health & mental health. implementing and evaluating H programs/ services. Provide opportunities for professional growth and continuing educ for staff devt. Responsibilities of CHN 1. Manager/ supervisor.Roles of the PHN  Clinician who is a health care provider. Maintain coordination/ linkages of nsg service with other health team members NGO/GO in the provision of PH services. clinics. & circulars c. its implementation & eval for comm. priorities & problems if indiv. 2. Sources of CHN standards: BON & PNA Multisectoral approach: ö other sectors ö intersectoral linkages ö own sector ö intrasectoral linkages ö comm. Provide quality nsg services to 4 levels of clientele 3. Be a part in delivering an overall health plan.

7.balancing time and energy to meet demands of work. Nsg Dx Planning Implementation Evaluation. Process recording.Obj 4.married/ common law wife male. Stage 5.. income changes & living arrangements physiologic aspects of aging. civil status) live-in. fxnal.Middle Aged Families . 9. or grandparents relations ö members of household in relation to head ö demographic data (sex.Beginning family . Stage 1.income given to wife • division of labor – joint parenting • socialization of family members • reproduction.measurable outcome or objective 4 tools/ instruments for data collection: 1. reestablishing marital dyad. sex educ. death of spouse. adjustment to roles. childbearing. problem r/t etiology ( somethind that we can intervene) Planning-goal Implementation Evaluation DEVELOPMENTAL MODEL by Evelyn Duvalll Stages of Family Dev’t. age. grandchildren.discipline.indication family’s success • maintenance of motivation and morale Structural fxnal Model ( Ruth Freeman) Initial data base Family structure and characteristics nuclear. poisoning.continuous maintenance of fam rel. peer relations.Families with teenagers . new career. 8. divorce/ separatx. adults social interests.Families with school age children .rebuilding marriage & maintaining satisfying rel with aging parents children with their families. Lab. recruitment & release • maintenance of order. CD Stage 4. children’s needs & activities. menopause Stage comm.changing roles.Obj 3. 10.. parenting Stage 3. harmony in marital & in-laws relations. retirement plans.obj (analyzed by RN) Data analysis Group data.Early childbearing .Launching ctr .male or female. Stage 6.releasing children as adults. identifying post parental interest. pre-natal educ.cues.high crime rate • placement of members in larger society. continuing intimacy in marital relation. Nursing history – subj 2. communication.matriarchal 7 .basic family extended. Stage 8 – Aging ( retirement & old age) . Stage problem Nsg Dx.marital & sexual adjustment. 8 Family tasks or Basic Tasks: • physical maintenance • allocation of resources. accidents. health.patriarchal female.Families with preschool children .

colorblindness. & transportatx facilities Health assessment of a member. dev’tl lag) ö -ex. polio. pregnancy. hormonal. gigantism. disability.conditions conducive to dse. Health Deficits. board exam 8 .eating salty foods  personal behavior.instances of failure in health maintenance ( dse. excessive drinking  inherent personality char.# of rooms for sleeping ö kind of neighborhood ö social & health facilities available ö comm.short temperedness.hereditary like DM. Family hx of illness. Entrance in school  adolescents (circumcision. puerperium  death  unemployment. pubarche  courtship (falling in love.smoking. short attn span  short cross infectx  poor home envi  lack/inadequate immunization  hazards.economic & cultural factors ö resources & expenses ö educ attainment ö ethnic background ö religious affiliations ö SO ( do not live with the family but influences decisions) ö Influences to larger comm. sexual practices.PE Value placed on prevention of dse ö immunization ö compliance behavior First Level Assessment 1. deafness  dev’tl problems like mental retardatx. marasmus. self-medication.URTI. transfer or relocation  graduation. scabies. falls. dwarfism 3. breaking up)  marriage. abortion.ö ö ö type & structure of family dominant members in health general family relationship Assessment: Family ö initial data base ö 1st level assessment ö 2nd level assessment Socio. Health Threat. or accidents  family size beyond what resources can provide 2. HPN  nutritional drugs. menarchs. Dse/ illness. Stress points/ Foreseeable crisis Situations ö anticipated periods of unusual demand on indiv or fam in terms of adjustment or family resources ( nature situatxs) ö ex. Environmental factors ö housing. edema  disabilities. accidents or failure to realize one’s health potential ö healthy people ö ex.

composed of indivs Vulnerable grps: or “High Risk Groups” (before) ö infants & young children – dependent to caretakers 9 . 2 x 1= 0.immediate action) Moderate (serious not immediate) Low (not felt) =3 =2 =1 A. Ex. B. = 2 pts.5 2 wt. = 1 pt. 1 x 2 = 1 2 B. 3 x 1 = 1 3 wt. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit. 2 x 2 = 2 2 A. =3 =2 =1 =2 =1 =0 =2 =1 =0 A. 3 x 1 = 1 wt. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit ö problem prioritization Nature of the problem Health deficit Health threat Foreseeable crisis Preventive potential (ability) High Moderate Low Modifiability Easily modifiable Partially modifiable Not modifiable Salience High (serious. 1 x 1 = 0. 3 B. Inability to provide care to a pregnant member with anemia as a health deficit r/t knowledge deficit.Second Level Assessment ö Recognition of the problem  decision on appropriate health action  care to affected family member  provision of healthy home environment  utilization of comm.= 1 pt. 0 x 1 = 0 2 B. Score= add all ( the higher the score.61 3 B. 3 x 1 = 1 3 A. A. the higher the problem) Formula: _________given score_______ x weight Increase possible score Who to visit last? Health D A – adolescent with psychological problems Health D B – DM Health D C – pregnant Health D D – typhoid (RN shd practice aseptic technique) Clue: identify nature of problem first Top Priority Health case A unemployment HD B anemia in pregnancy HD C scabies HT D poor home environment Population groups. resources for health care Family Health Nursing Diagnosis ö combination of health problems and health Ex.

Comprehensive. to identify their own H problems & needs ö A profile that deposits the H problems & potentials of the comm. enumeratx of data conducted 6 mos.descriptive research ö profile general picture of comm. Statement of obj. School Health Nsg. Specialized fields: 1. social psychology. psychology.application of Nsg principles & procedures in conserving H of workers in all occupations. Ocular inspection/ observation 10 .location of 1st criteria poor community.most neglected adolescents – identify crisis. Method of survey. mental health.the application of nsg theories & principles in the care of the school pop Components: School H services. increase mental wellness of people Psychiatric Nsg. Community Mental Health Nsg.most practical study representative of a comm. Preparation if the community need to identify dse. linkage. 2 types of community dx 1.maintain school clinic.instrument: checklist D.focus: mental dse preventx Focus: mental dse preventx. H problems & needs as bases for H programs devt. community networks and the basic sciences.questionnaire .instrument. puerperium) males – too macho to consult old people – degenerative dse. Aims: Health promotion & prevention of dses & injuries From industrial to service 2. Identify methods & instruments for data collection A. Steps: Preparatory phase 1.dependent of comm.Sample survey. ö A learning process for the comm. dx 4.visual. Size matters in terms of validity B. organizer ASSESSMENT OF COMMUNITY HEALTH NEEDS Community Dx. scoliosis Health instruction.a unique process which includes an integration of concepts fr sanitation. Vulnerable to educ/ counselor direct & undirect Healthful school living. Occupational H Nsg.provides the general health profile of the comm. screening all children.yields a comprehensive profile of a particular H problem. . Site selection.indentify dse & shorten dse process 1. Specific or problem oriented.ö ö ö ö ö schoolage.bec. ö process by which the people in the conn & H team assess the comm.substance abuse.census (100%) most ideal. hearing.H problem free from other agency 2. sexual H ö environmental health. Records review .comm. HIV mothers – 1/3 of pop health problem (pregnancy. water supply. delivery. safe toilet ö school comm.interview guide/ schedule C. safe monitor ö mental health. Focus: mental H promotion. 2. Interview method .

Non. Development of a health plan 8. Sample survey 2. Data organization/ collation 3. interpretation of numerical data. tubular. Variable. Phenomenon of variation ö tendency of a measurable character to change from 1 indiv or 1 setting to another or from 1 instant of time to another within the same indiv or setting Types of data: 1. Religion. speed 2.probability. cluster) B. medicine. Ex. Participant observation 5.categories are simply used to label to distinguish & group to another.whole number or integral values ö continuous.ex.everyone will not have equal chances/ not equal 6. A. Other records & registration systems Sources of data on health 1. Identification of health problems 6. Temperature Qualitative. report in Manila regardless of place of residency—report to that place b. Data Presentation (narrative. place to place Ex.used computers to monitor their birth record. Vital registration records ö RA 3753 ( Civil Registry Law) registration of births. Process evaluation 2.(science) collection.equal fr place of origin De Facto0 registration where it happened Ex.numerical ö can be measured e.( simple. can attain any decimal Sources of Demographic Data: 1. Make a timetable Implementation Phase 1. analysis. deaths and migration. Validation and feedback.refers to the application of statistical method to the life science like biology.instrument: checklist E. Finalize sampling design & methods A. Minutes/ hour. graphical) 4. stratified. rather than a basis for saying that 1 group is greater. deaths to local registrars (city health officer or municipal treasurer) 11 .presentation of results Evaluation Phase 1. Census Types: De Jure. decimals. Continuing Population Registers. Survey a. Sex.value remains the same from person to person. Prioritization of health problems of pop size. organization. Probability. time to time. Data collection 2. Constant. Demography. If death happened at PGH. temp ö discrete. Data Analysis 5. Biostatistics. Product evaluation Statistics. 3.. higher than the other. composition & spatial distribution as affected by births. Color Quantitative.fractions.random.

shd have interval.unreported death 2. Growth Rate Crude birth rate/ 1000 – crude death rate/ 1000= current growth rate/ 1000 Ex. Sex ratio – number of males for every 100 females Males x 100 Females = SR = 100 (M-F) SR > 100 ( M) SR < 100 ( F) 5.visayan %.double bar graph depicting the age & sex structure of the pop of pop size. deaths and migration. HIV ö Problems: under reporting. severe & acute diarrhea. employment records. 26/1000. Age distribution – percent in terms of age grp 2. Indiv.Problem: under registration & de facto registration Unreported birth. Health records/ family records ö birth cert.tetanus neonatorum. hosp records. accurate estimation ö 4. school clinic records.SR= 105 (birth) SR = age SR = poor countries SR = rural communities 0-1 vulnerable age for boys 0-6 7. concept in health.6/1000= 20/1000 pop growth rate Population Composition: 1. Population census. sx. syndromic approach. other charactestics: ö occupational groups ö economic grps ö educ attainment ö ethnic grps. bicolano % 12 . composition & spatial distribution as affected by births. Median age – middle most age MA 20yo 50%= 20yo 50%= 20yo MA younger 3. health facility logbooks. dx. Dependency ratio= number of dependent (0-14) +65 100 indiv in the prod age ( 15-64 yo) 4. health ctr records.. Publications Demography.crisis oriented. Components: Population Size: 5. Natural increase (NI) NI= birth – deaths 6. Public health. Population pyramid. Weekly reports fr field health personnel RA 3573 ( Law on reporting of notifiable dse) ö report to provincial & duty health office ö midwife reports – under supervision of the nurse ö report within 24H –measles or polio ö report within a week. 3. Net migration (NM) NM= in-migrants – outmigrants (immigrants) (emigrants) 7. death cert 5.

relative pop due to births Total number of births in a calendar year CBR= Birth x 1000 Pop ex. GRF=32 There are 32 births in every woman in 15-44 Mortality Rates 1. VS= numerator x factor Denominator 1. General Fertility Rate (GFR) . Factor.rural. death morbidity. CDR= 6 there are 6 in every 1000 pop 13 .000 Ex.% of pop in urban .1000 (100%) – 100. of cases B. Numerator A.0064 births/indiv = 6. CBR There is 0. Numerator is always < denominator Quotient is always < 1 decimal no.Crude Death Rate ____ x 1000 Decrease in pop due to death CDR= death x 1000 Pop Ex. NCR region Urban 100 % 27 Rural 0 % 73 shows the proportion of people living in urban compared to rural areas 2.Population Distribution 1. Crowding the ease by which a CD can be transmitted fr 1 host to another susceptible host fertility rate – specific segments of pop that is fertile GFR= ________Birth___________ x 1000 Pop of women (15 to 44 yo) Ex.4 X 1000 How to read: there are 6 births in every 1000 pop There are ANS (numerator) in every factor (denominator) Fertility Rate 1.% of pop in rural Ex. of indiv or Square km indiv 2 Km determines congestion of the place Vital Statistics ö direct health indicator ö the application of statistical measures to vital events (births or fertility. fertility. Population Densityno. CBR (Crude birth rate). 20 = 4/rm Room for sleeping 4 . illness and health services of a community.number of birth mortality. of household members ex. Urban.8= CBR There are 26 births in every 1000 pop 25. C. and common illnesses or morbidity) that is utilized to gauge the levels of health. deaths or mortality.

SMR (males) = death (males) x 1000 pop of males b. heart dse. 52 are males PMR = deaths 0-1 x 100 0.92  Proportionate Mortality Rate = PMR ( for any grp) PMR= death from a particular grp x 100 total death Ex. & puerperium x 1000 Births Ex. delivery. Swaroop’s Index = SI SI = death of 50 yrs & up x 100 total deaths The SI. 30 are due to TB  Case Fatality Rate (CFR) ö How is survival rate.2. 52% PMR of males = deaths of males x 100 total deaths In every 100 death. Birth 200 NMR= 20 Death – 28 to 1 NMR + PNMR = IMR 20 + 10 = 30 (ANS) 2_ x 1000 = 1000 = 10 200 100  Maternal Mortality Rate (MMR) MMR= death of women r/t pregnancy.1 total deaths PROPORTIONATE MORTALITY INDICATOR A. SMR (females) = death of females 15-44 pop of females 15-44  Infant Mortality Rate: IMR= Death 0 -1 year x 1000 Births  Neonatal Mortality Rate: NMR= deaths 0-28 days x 1000 Births  Post Neonatal Mortality Rate: PNMR = deaths 28 days to 1 year x 1000 Births NMR + PNMR = IMR Neonatal deaths + Post neonatal deaths= Infant deaths Ex. how strong is killing power. the better the situation is! B. IMR = 30 There are 30 infant deaths in every 1000 births NMR = 20 There are 20 neonatal deaths in every 1000 births PNMR = 10 MMR = . Specific Mortality Rate.can apply to any pop grp SMR = death from or particulare grp x 1000 Pop of that grp a. prognosis CFR= death due to part cause x 100 14 . Relative importance of a killer ( TB. diarrhea) Death due to TB x 100 total deaths PMR = 30% TB --In every 100 deaths.

envi 2. CFR HIV ___death HIV___ x 100 Total cases of TB In every 100 cases of HIV.transfer. PR = 326 TB There are 326 cases of TB out of 100.quick to come. Incubation prd.serial. breast feeding 15 .  Incidence Rate IR= ___new cases___ x 100. ö distribution means the frequency of dses and physiologic cond in terms of who gets sick where and when.000 pop there are 320 deaths due to TB =320  Prevalence Rate = (Morbidity rate) ö Rank as a common dise PR = old and new case of TB x 100. source.% of immune cases Ex.000 TB Ex. there are 98 deaths = 98  Cause-of-death Rate (mortality rate) ö Rank as a killer C of DR= death due to particular cause x 100.some indiv are immune Dengue.aedes – daytime C Arthropod malaria – water. quick to go Natural.nighttime L E A Neem tree Types of Immunity 1.propagated fr host to host every of pathogens up to appearance of the 1 st s/sx 4. Basic Concepts: 1.000 population. Herb Immunity. Passive. transmission of CD – common vehicle.Agent. C of DR TB In every 100.000 pop at risk Epidemiologyö study of distribution of dse or physiologic condition among human pop & the factors affecting such distribution. Epidemiologic Triad.000 total pop Ex.000 TB total pop PR = old & new case of TB x 100.

contacts ö people far fr medical assistance ö people in areas with endemic dse ö people at certain times Attack Rate.sectional (Present) Prospective Cohort (future) 16 .on and off _______________  Pandemic.extrinsic factors. susceptibility or response to agents.8th month (before delivery) ---. Person ö exposure. ö influenced by intrinsic characteristic ö genetic/ family. 20-30 dses that you don’t know Current number of cases exceeds the usual expectancy. cyclic pattern.Patient epidemic. . Place.getting the dse itself Artificial. sex. physiologic status Some identified increase risk grps.intermittent . and young children ö school children.regular pattern seasonal cydicity – annual cydicity secular dycylicity – every other year typhoid.fluctuations . bigger pop -.slow to come.a situation when there is a high incidence of new cases of a specific dse in excess of the expected.4th month --------------------------TT1 --. old people.TT3 ( 1st booster dose) Preg 3 -------------------------------------------. slow to go Natural active.time of day . antitoxin 2.incidence of illness among exposed pop Number of cases x 100 Pop at Risk 2.causative factor is constantly available or present to the area Ex. existence of etiologic factors & exposure & susceptibility of human host influenced by extrinsic factors. 3. antiserum. prior immunologic experience ö age.  occurrence of a dse. ö mothers.tetanus toxoid Preg 1 --.Habitual presence of a dse in a given geographic location accounting for the low number of both immunes and susceptible. Occurs every now and then affecting only a small number of people relative to the total pop .fluctuations of incidence a.dse.days of the week b.TT2 Preg 2 --------------------------------------------.Artificial. constant  Sporadic. . measles Patterns of dse occurrence  Epidemic. human behavior.temporal patterns.serum globulin. Active.when the proportion of the susceptible are high compared to the proportion of the immunes. ethnic grp.TT4 (2nd booster dose) Preg 4 -----------------------------------------------TT5 (3rd booster dose) Factors affecting distribution of Dse 1. infants. .easily the person can identify the cause _______________ Common Epidemiologic Studies: Retrospective (Past) Cross. Malaria.ex. Time. short term.

2. 8. pneumonia 3.3 Global indicator for IMR : 50 Increase IMR. 6. 3. HPN 6.get prevalence of dse (Lung CA) .decrease MCHS (poor nutrition and child health service) 10 Leading Causes of Infant Deaths (1998) 1.under nut of 0-6 yo Commerciogenic malnutrition 1998. 2. diarrhea 2. 2. dses of the heart 9. 7. 3. 8. 5. varicella 1997 diarrhea pneumonia bronchitis influenza TB malaria dses of the heart measles varicella dengue 1. 5. Basic Health Indicators Nutrition Disease Patterns Leading causes of Morbidity Context of CHN: health situation Nutrition. 5. 9.get prevalence of risk factor (smoking) Independent variable (cause) Dependent (effect) National Health Situation Health Indices I. 4. malaria 8. 7.48% of filipinos 58 % are pregnant women 2001-1999 diarrhea bronchitis pneumonia influenza HPN TB dses of the heart malaria measles varicella 10 Leading Causes of Morbidity 1998 1. 10. 6. 2. bronchitis 4. 10. 10. 9. 8. 7. 1995 dses of the heart dses of vascular system pneumonia malignant neoplasm TB accidents COPD DM other respiratory dse nephritis II. 6. 5. 1. 9. 3. TB 7. 6. influenza 5. Other indicators A. 10.Case control study prevalence study. 4.7 17. 1998 dses of the heart dse of the vascular system pneumonia malignant neoplasm accidents TB COPD DM other pesp dse nephritis 1. 4. Pneumonia 17 . 8. 4. 9. dengue 10. 7. Respiratory conditions of fetus and NB 2.6 out of 10 fil (0-6) are undernourished Anemia.95 in 1998 DOH 18. 3.old and new cases . Infant Mortality Rate UNICEF 53. 10 Leading causes of Death 1.

CBR. Plan and establish arrangements for the public health systems to achieve economies of scale—Phil Health 5. Maintain a medium of regulations and standards to protect consumers and guide providers —Sentrong Sigla. multi-level and and infrastructure Local Gov’t Units RA 7160 Local Govt Code – local health board. Pregnancy with abortive outcome 5. problems.Governor ö Municipal health officer. Birth injuries and conditions r/t difficult labor 5. and concerns of the people. 3. products. and services which address the health needs.The Philippines is an agricultural country.approach behavior Health Prevention.55% E. Ensure a minimum level of implementation nationwide of services regarded as public health goods – family threats. HPN complicating pregnancy. Measles (complications underlying cause of death) Increase IMR= decrease MCHS Poor maternal child health service B. complex. Ensure equal access to basic health services 2.identified health problem. Septicemia orgs 18 .1 years . and puerperium 2. CDR.” FOUR QUESTIONS: Who are served?—only a few bec only a few can afford Who provides the services? –health professionals Where are the services given? – hospitals. Meningitis (no BCG) 9.____ 2. non. human resources. delivery. Avitaminosis & other nutritional deficiencies What is the focus of care? – curative Participation in the production process _____ ability to satisfy basic need health status 5 Major Functions: 1.municipal ö Provincial health officer Health Promotion. Diarrheal dse 7. Crude rates 1.avoidance behavior Private Sector ö composed of both commercial and business orgs. equipments. no risk.20.mayor ö Assist ____ . Congenital Anomalies 4. Ensure formulation of nat’l policies for proper division of labor & proper coordination of operations among the government agency jurisdictions. Post partum hemorrhage 4. facilities.____ HEALTH CARE DELIVERY SYSTEM “The totality of all policies. childbirth and puerperium 3.access physical inaccessibility. ____. Hemorrhage r/t pregnancy Life expectancy at birth—life span either: age specific or sex specific Median Age. Normal delivery and other complications r/t pregnancy occurring in the course of labor. EPI. _____ 4. It is large. Maternal Mortality Rate Leading causes of maternal deaths 1.

which marks the beginning of its journey towards DOG vision.NGOs Assumes the ff roles: ö Policy and Legislative Advocates ö Organizers. Primary Health Care as the Key Approach 19 . Strategies and Methodologies ö Strategies and Health Status Targets to Achieve Objectives Strategies to promote equity in health: --priority for the vulnerable and marginalized Marginalized people. activities of the DOH for the year 1993. and maintenance of a safe envi. low maternal mortality.those who live geographically and culturally isolated areas. Health Link” ö a national and multi-sectoral health promotion strategy aimed at conveying health messages to people wherever they are aimed at building supportive environments through advocacy. “Health Sector Reform Agenda” ö emphasizing on improvements in health care delivery by maximizing people’s participation in health “ Sentrong Sigla Movement” ö pertains to development & implementation of standards to provide quality health services to the people. and less disability through measures that will guarantee access of everyone to essential HC. and effective one in the provision of solutions to changing the health needs of the population  Promote active and sustained people’s participation in HC. are victims of poverty.To enable the Filipino pop to achieve a level of health which will allow Filipinos to lead a socially and economically-productive life. youth and adolescents and the elderly (65 and above). Human Rights Advocates ö Research and Documentation ö Health Resource Dev Personnel ö Relief and Disaster Mgt ö Networking THE NATIONAL HEALTH PLAN National Health Plan. “ Health for more in ‘94” ö activities in 1994 focused on Cancer prevention. “ Health Focus in 1995” – “ Think Health. reproductive health. community action and networking. dynamic and highly efficient.a long-term directional plan for health. with longer life expectancy. armedconflict. man-made and naturall disasters and poor envi conditions. projects. This is the blueprint defining the country’s health. Broad Objectives:  Promote equity in health status among all segments of society  Address specific health problems of the population  Upgrade the status and transform the HCDS into a responsive. MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” ö refers to the 23 programs. PROBLEMS POLICIES STRATEGIES THRUSTS Goal: (To improve the health situation) . Vulnerable sector of the pop—composed of infants (0mo-1yr) and children (1-4yo). mental health. women or reproductive age (15-44 yo). low infant mortality.

family wellness 3.intake of drugs. societies . Acapulco. good nutritx 3.DISEASE PREVENTION: PRIMARY LEVEL OF DSE PREVENTION -Still healthy .Goals: wellness level – no risk factor. no problems Pathway of dse---recovery Permanent Death 2. Ideal age to get pregnant: 20-30yo ( Less than 18-20=with risks) ( more than 30-35 with risks) ideal number of pregnancies= 3 (4 kids._______ Family solidarity Safe motherhood Child survival responsible parenthood (child spacing # of preg ideal thing) women health safe motherhood child survival. families. Through people ex. malunggay. provision of adequate housing. and amenable working condition HEALTH PROMOTION AND DISEASE PREVENTION IN THE CONTEXT OF A PATHOGENESIS Health promo Healthy person-----------time--------------------- healthy person (pathway of health) No risks. health educ 2. no threats Differences with Dse Prevention: ö not dse/ dysfunction or health problem specific ö approach _____ behavior not “avoidance behavior” ö risk to expand positive potential for healthful prevention thwarts the occurrence of pathogens with ____ __ health & well-being. Vit C to avoid URTI 3. madre de cacao 2.consists of activities directed towards increasing the level of well-being & actualizing the health potentials of indiv. Indiv wellness 2.kalachuchi. communities. recreation. chemoprophylaxis.1. ex. environmental wellness 5. RSH ( reproduction and sexual health. every year= with risk) what to discuss: basic human sexual response ö ö ö ö ö 2 types of family planning method 20 .with risks. no threats.method of health promotion s/sx-self-medication -health seeking behavior kuto. societal wellness Methods of health promotion: 1.prevention and dse . immunization. >4 increase risk) ideal interval= 3 years (every 2 years with risk. Health Promotion. community wellness 4. Levels of Health Promotion 1. 1. personality dev.risk factors and threats present A.grooming and hygiene 4.

privy> antipolo. severity & return to normal fxn at earliest possible time. Refuse Management. permanent method B. PIT.fruit peelings. environmental sanitation 4.biological. Health educ Health promotion best source of prevention Secondary prevention. Good living & working condition 8.early dse prompt intervention to halt pathological process to shorten duration. plastic. pig pen. composting 3. Through Environmental Control 1. spacing # of preg ideal timing 2.coli Common household water fxn= boil H2O Boil with low fire. Sanitary Landfill problem: prone to scavenging ascariasis due to airborn solid block Water supply.(-) for e.25 meters away fr toilet. young -typhoon & night – dangerous 4. bore hole. safe excretal disposal (toilets) a. Safe water supply . Vector animal reservoir control wait 5 mins agter boiling SedimentationAeration Filtration. little mineral in water( soft water) . 21 . overhung latrine (batalan) – bangin 3. twin > ventilate 1 improved pit. sources of raw food.chemical characteristics-with minerals in H2O. maintenance -very residue. no need for H2O water Cistern flush with sewage system -cistern flush with septic tank No water Flying saucer-pail system (bucket latrine) 1.less smell > reed odorless earth closet (ROEC) 2. compost.hard water (better!).1. Disinfestations & sterilization 7.disadvantage.without pesticides no double dead meat 2. open burning 2.physical characteristics . food handlers 3. burial No-no: open dumping Community Level a.broken glass. left over food. cat-hole latrine Needs transplant No transplant Consider culture of the peoplePublic toilet. incinerator. Food Sanitation/ good food hygiene Ensure the health of the ff: 1. poultry refuse disposal system 2.non-biodegradable Acceptance refuse mgt 1.solid and semi-solid waste excluding human excretal Garbage. needs H2O b.biodegradable Rubbish. pure smoke 5.

Community Organizing – CO Levels of Awareness: Political socialization. obj analysis of objective conditions 2.TB test .case finding. resting to an optimum level of functioning within the constraints of disability . Specificity Tertiary Prevention. risk behavior b.risk factor: increase probability of dse d. self-willed changes will have more meaning ___ then imposed changes – fear tactics don’t work (imposed) Context of CO: 22 . pre-test counseling.risk appraisal for dse prevention .highest level of a.behavioral modification. from the people for the people & with the people subj of CO= people 4.surveillance a. crying.(-) or (+) result with post counseling . swearing due to a problem. Post test counseling .mass screening. people want to change 5.multiple screening. People recognizes the prob & expresses it Culture of silence/ tracing.dse of leading causes of morbidity Gold Standard for TB test: Culture and Sensitivity Sputum smear microscopy.shd be simple & inexpensive . people with common problems/concerns will mobilize . ELISA I c.check source of infectx fr family .lowest/ low salience to existing with dse.people recognized problems & ___ diff ways. wailing.IMPT . ex. Sensitivity. *identifies a common problem Interest articulation. basic trust on people & on their inmate potentials & capabilities 3. Western block test. Battered wife Key concepts and Principles of CO: 1.defects or disability is present .test of unity & will lead as guide to future actions Political mobilization-common Interest aggregation – people with problems will grp together & relate to one another.true positive rate or strength of association bet presence of dse & sx is goal.HIV test . People are not aware “naturalizing” but not considered as a problem.Ochar Characteristics of an ideal screening test: 1. ELISA II e.during symptomatic phase .uniqueness of indiv .rehab states when indiv enters facility Methods: People’s participation People’s participation (continuous & sustained) Awareness raising Organizing Mobilizing Awareness ability to identify or ____ personal concerns & troubles to bigger context 3.Screening methods .risk situation.

.essential care based on scientifically sound & socially acceptable methods & technology made universally available to ___. It is a strategy aimed to provide essential HC that is C ommunity-based A ccessible P art and parcel of the total socio-economic dev effort of the nation A cceptable S ustainable at an affordable cost Health Care System (HCS) vs. PHC was declared in the ALMA ATA CONFERENCE in 1978. CO is given to the poor. Families & communicates at a cost they can afford at any given stage of dev’t through their full participation towards self-reliance and self-determination.brgy health workers professionals . Criteria: F easible A cceptable. Affordable C omplex E ffective S afe S cope.component of __ & health component .wise Ex.many Providers. deprived & oppressed Goals of CO: -equal chance/ access for people CO in health: HSO (health sector organizing) establish communication based health programs .community DOH framework: People’s empowerment & partnership is the key strategy to achieve the goal “Health for All Filipinos by the Year 2000 and Health in the Hands of the People by the year 2020”. Appropriate Technology .a few .thrust is PHC 4. PRIMARY HEALTH CARE (PHC) . PHC Recipients. 23 . Multi-sectoral approach Intersectoral linkages Intrasectoral linkages B. Community Participation Phases of CO in health: C. WHAT DOES ESSENTIAL HC IN PHC MEAN? It stands for: E ducation of prevailing health problems L ocally-endemic dse prevention and control E xpanded program of immunization M aternal and child health and family planning E nvironmental sanitation and safe water supply N utrition and food supply T reatment of communicable and non-communicable dses/conditions S upply and proper use of essential drugs and herbal med D ental health promotion A ccess to and use of hospitals as centers of wellness M ental health promotion Pillars (major elements): A.method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost.hospitals .CO is class based.Current situation. as a strategy to community health dev.

tanglad. cough & colds S ambong. anti-cancer drug-. asthma. cough.fungal infection. toothache.sambong. sibuyas. sambong.talampugay. decoction. poultice. let dry. the part of the plant to be used 3. oils. infusion. pugo-pugo. Policies: 1. preparation of a. kalachuchi.ascariasis T saang gubat.has volatile oil for tx of fever. skin problems--Acapulco.asthma. aches & pains-.bitter.can cause psychosis 4. 1 tbsp chopped bawang Shake 10 mins for 1 week – good for superficial wounds Tanglad. manzanilla. tanglad. colds U lasimang bato. astringent-tasting.tapal (may add oil) c. patola. oregano. makabuhay.cough and colds.arthritis. ___ or petals of sampaguita. scabies RA 8423. burn it—good insect repellant 5. damong arya e. HPN B awang. of gin.tsitsirika d. depressants. Luya.fixed oils. atajuo kahol.uric acid.HPN B ayabas. ointment.with wax 24 . swollen gums.diuretics—kagon.has tannin & pectin for diarrhea & wound A vocado leaves B ayabas leaves K amilo leaves D uhat leaves S aging leaves (saba cut into chips. kakawati. itchiness and gas pain.diarrhea A capulco.lasts for 3-5 days e. dita. bawang. lanzones. yerba Buena.shd not be taken on an empty stomach Elixir. lagundi. stones.meis hairm. betel nut or bunga. seeds. renal stones A mpalaya. tubo. makahiya c.palay 10 Medicinal Plants: L agundi. TSB 2. jasmine & rosal Luya. balanyog. cough. HPN.______ Shake week after week—tx for TB Bawang crush 1 ear & drink it Tincture of bawang 1:5 Add 5 tbsp. malunggay. aromatic.Herbal Medicine 1. anti-helmentics. pansit-pansitan or ulasimang bato. put hyper people to sleep--dapdap. inakabuhay not throw peelings instead. ipil-ipil.niyug-niyogan (urine). syrup. squash seeds.for fever. grass family. buto-butones.lemon grass—for fever Sambong—stomachache Suha/kalamansi. mansanilya extract f. luya.add sugar and for storage. colds. gatas-gatas. the indications/ uses of plants 2.laga/boil b.utilization of medicinal plants as alternative for high cost medications.DM N iyug-nyogan.Diarrhea Y erba Buena. pulverize then add to _____) 3.tea at least 24H d. bitter-tasting a.

hx-taking.PE: weight.Oral/dental exam  Pre.Tetanus toxoid immunization . abd exam .Laboratory exam: heat-acetic acid test. utilization of HBMR (Home-Based Mother’s Record) as a guide in the identification of risk factors . Major program policies: 1. tincture alcohol h. referral services and supplies thru linkages with other sectors C H A R A C T E R I S T I C S HEALTH PERSONNEL OF FIRST LINE HOSPITALS Physicians with specialty area Nurses dentists  Establish close contact with the village and intermediate level health workers to promote the continuity of acre from hosp to community to home.all birth attendants shall ensure clean and safe deliveries at home or at the facilities ( RHUs/hospitals) . freedom of choice 3. elixir based D. and supervised by a personnel of the nearest BHS/RHU trained on maternal care. safe motherhood & child survival pregnancies and mothers must be immediately referred to the nearest institution .natal counseling  Provision of safe. training.  Provide back-up health services for cases requiring hosp or dx facilities not available in HC Strategies/ programs to promote health of the vulnerable sectors of the population  Maternal Care Program Strategies: A.untrained TBAs who actively practice must be identified. ht. Improvement of family welfare with main focus on women’s health. 1st contact of the community Work in liason with the local health service workers Provide elementary curative preventive health care measures General medical practiotioners Public health nurses Midwives  1st source of professional Health care  Attend to health problems beyond the competence of village health workers  Provide support to the frontline health workers in terms of supervision.Fe supplementation: given from 5th month of preg to 2 months postpartum (100-120 mg orally/day for 210 days) . BP-taking . trained. promotion of family solidarity and responsible parenthood (except birth control) Causes Possible Effects 25 .g. benedict’s test . health auxillary volunteer. delivery care . Support mechanism made available TYPES OF PRIMARY HEALTH WORKERS VILLAGE/ GRASSROOTS HEALTH WORKERS INTERMEDIATE LEVEL EX Trained community Health worker.Perform head to toe assessment. traditional birth attendant    Initial link. Provision of Regular and Quality Maternal Care Services  Regular and quality pre-natal care .

bronchitis.all vaccines are sensitive to heat Koch’s phenomenon. spermicides. sponge.vasectomy  EPI Goal of EPI. diaphragm. measles. red beads. physical defects LB wt. malnutrition. infant death. injectables) 3.5ml. k. spacing 2. SQ most sensitive to heat OPV – 2 gtts/PO Cold.ulcer after 12 wks Glandular enlargement.Short interval of pregnancies Pregnant before 20 or > 30 yo More than 4 deliveries MOM Bleeding. dental dams 4. bleeding. prolonged labor HPN.5 ml. hormones (pills. still birth.natural cervical mucus method .fever for a day . cervical CA BABY Pneumonia. rupture of uterus.incision and drainage Indolent ulceration. diarrhea.condoms (male/female). 26 .reduction of morbidity and mortality of immunizable dse Types and Schedule of Vaccines: AT BIRTH BCG 1 ½ months DPT1 OPV1 HEPB 1 2 ½ months DPT2 OPV1 HEPB 2 3 ½ months DPT3 OPV3 HEPB 3 9-12 months MEASLES BCG: infant – 0. fetal death.05ml – ID School entrants – 0.abscess 2-3 weeks abscess will leave scar 12 wks after DPT.abscess after a week or more.ok even if without consent of husband . barrier. cervical cup.standard days method.soreness at site within 3-4 days .tubal ligation. congenital deformities Low birth wt.incision and drainage i.inflammation of the site of injection after 2-4 days warm complex Deep abscess at site.1 ml ID (double dose) DPT: HepB TT . SQ – destroyed by freezing Measles . scientific family planning .start of mens 5. HPN Anemia. respiratory distress  FAMILY PLANNING PROGRAM Family Planning Method: 1. l.urban poor women. miscarriage. j.IUD. anemia. permanent method .

Mobilize political commitment and community involvement to provide support to basic HC delivery Remember the principles Even if the interval exceeded that of the expected interval. MALNUTRITION is not a contraindication. Prevention of unwanted pregnancies through family planning services E. Trainings for “hilots” must also be conducted C. continue to give the doses of the vaccine. F. Cold Chain – a system used to maintain the potency of a vaccine from that of manufacturer to the time it is given to child or pregnant woman. Upgrade reporting services H. midwifery thru trainings. Immunization can still be given until the child reaches 6 yo If there has been a reported epidemic of measles. measles vaccine can be given as early as six months BCG booster dose must be given to school entrants regardless of presence of BCG scar. Storage.not more than 5 days @ health ctrs. training shd be done on the use of proper filling-up or HBMR card  Proper referrals/endorsements must be done for future if-ups D.1 month @ main health centers ( with refrigerators) . and complications.2nd. Principles: 1. Improvement of the health personnel’s capabilities on NB care.( using transport boxes) Important points to remember: ♥ Arranging of stored vaccine according to: ≈ Type ≈ Expiration date ≈ Duration of storage ≈ # of times they have been brought out to the field ♥ The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST shd be distributed or used 1st.convulsions Measles.3rd. They shd follow the 3 CLEANS: CLEAN hands CLEAN surface CLEAN cord B. EXCEPT when the child had convulsions upon giving the 1 st dose of DPT. Improvement on the quality of care at the First Referral Level  Orientation. sx.1st postpartum visit for home deliveries must be done within 24H after delivery .fever 5-7 days after within 1-4 days . done 2-4 wks thereafter Attendants must be aware of the early signs.mild rashes Provision of quality postpartum care Proper schedule of follow-up must be followed: . but RATHER AN INDICATION for immunization since common childhood disease are often severe to malnourished children.. Promotion of appropriate health practices G. There is no contraindication to immunization.3 months @ the provincial/ district level . Prevention and management of STDs. 27 . done at least 1 week after delivery .it should not exceed: .6 months @ the regional level .

10-15 unformed stools/24H Severe.♥ It is a MUST to mark ampules/vials with an “X” mark each time they are carried to the field. it must already BE DISCARDED. A. (+) skin fold test. vaccines must be placed in a special cold pack during immunization sessions. Vaccine BCG DPT Polio Measles TT HepB Half life 4 hours 8 hours TARGET SETTING: . Handling Once opened or reconstituted. sunken fontanels and eyeballs.5-10 unformed stools/24H Moderate. cereals/ starchy foods mixed with meat or fish Fast Referral If child doesn’t get better in 3 days. or if danger signs develop-refer patient Danger signs: 28 . Oral Rehydration Therapy Diarrhea (Unusual frequency of bowel movements more than 3x/day) (Marked change in the amount of stool) (Increase in stool liquidity) 3 Classifications of diarrhea: Mild.10% weight loss Severe.lethargic. Growth and Health Monitoring (GMC) A standard tool used in health centers to record vital info rel to child growth and dev.“ELIGIBLE POP” consists of any grp of people targeted for specific immunizations due to susceptibility to one or several of the EPI dses.>15 unformed stools/24H with associated s/sx Dehydration ♥ Mild-first sign: thirst. bec if a VACCINE IS NOT USED on the 3rd trip. is irritable but conscious. (-) skin fold test Tx: give ORS for 4-6H then reassess after 4-6H < 2 yo= ½ cup rice H2O/ ___ or ½ glass of ORS 2 years and above= 1 cup rice water or 1 glass of ORS ♥ ♥ Moderate. normal blood glucose. Bar and Detect type scales are being used o All NBs must be enrolled for UFCP B.  UNDER FIVES CARE PROGRAM UFC Program (under five care program) A package of child health-related services focused on the 0-59 months old children to assure their wellness and survival. . almost (-) urine output. II. Transport Use of cold dogs III.comatose. dry tear ducts. to assess signs of malnutrition o Sallen “Ming Scale”.Iinvolves the calculation of the eligible pop. dry lips. (++) skin fold test-15% wt loss DIARRHEA MANAGEMENT AT HOME 3 F’s ◊ Fluids Oresol Rehydration Therapy ◊ ◊ Frequent feeding Continue breastfeeding With children over 6 mos.

29 . homemade soup ◊ ◊ ◊ and vegetables Mashed banana or any fresh fruit Feed the child at least 6x/day After diarrhea episode. > < = > < Formula CHO CHON (CASEIN) fats Linoleic acid content minerals F resh E motional bonding E asily established D igestible I mmunity N utritious G IT disorders are decreased * The high CHON and mineral content of cow’s milk may overwhelm the NB’s kidney.◊ Encourage/ensure intake of any fruit juices. thus it still needs to be diluted. feed 1 extra meal/day for 2 weeks ◊ ◊ ◊ ◊ ◊ ◊ ◊ ◊ Fever Sunken fontanel Sunken eyeball Frequent watery stools Repeated vomiting Blood in stool Poor intake of meals weakness ORS: 1 pack 1 liter of water Contains: Glucose for Na absorption NaCl for fluid retention NaHCO3 to serve as a buffer system KCL for smooth muscle contraction Home-made oresol: 1 L water 8 tsp of sugar OR 1 tsp salt 1 glass water 2 tsp sugar 1 pinch of salt REMEMBER: Infant must be given ¼. Casein is more difficult to digest. “lugaw”. BreastfeedingUnique characteristics of Breast milk: B R educed allegic reaction E conomical A lways available S afe/ maintains the stool soft T emperature always right Difference of breast milk from formula milk: Breastmilk CHO CHON (LACTALBUMIN) fats Linoleic acid content (3x) Minerals vs. C.½ cup every after LBM Child must be given ½ -1 cup every after LBM Adult must be given 1 or more cups every after LBM Measures on diarrhea preventx ö breastfeed infants ö Provide appropriate supplemental feeding ö handwashing ö utilize clean and potable water ö clean toilet and observe proper feces disposal ö immunize the child with measles * No antibiotics must be given to a diarrheic px except in infectious diarrhea like cholera. “am”.

Tx: refer Keep warm Give first dose of antibiotic 2. tx of fever (TSB) and wheeze (nebulize) 4. No pneumonia—assess for other problems. stridor. If worse. nasal flaring. cyanosis tx: 1. consume all meds finish the course of the treatment.stridor during inhalation . able to drink or stop feeding.LOC . fast breathing Tx: refer to hospital First dose antibiotics Keep warm 3.for 2 days & follow up after 2 days. Care of Acute Respiratory Tract Infections (CARI) Goal: identify and tx pneumonia Program: Assessment: History: age. cyanosis. 30 . provide home care _____ with sore throat __________ Sore throat in children: very light tea with syrup STANDARD ARI/PNEUMONIA Case Management (EO 110-E s. anti-malarial Severe pneumonia. stridor. fever. 1991)  Cotrimoxazole adult tabs Injectable penicillin should be regularly available in DOH facilities IM gentamycin IM chloramphenicol  No DOH fund shall be used to regularly provide cough meds except only for the ff emergency conditions: single ingredient cough suppressant for severe pertussis single antihistamine for confirmed allergic conditions such as allergic rhinitis.wheeze during exhalation . Immunization (see EPI) E. severe malnutrition. steam inhalation 2. sleepy. fever of 38 °C or hypothermia (<35.1st dose of antibiotics 3. very severe dse—stopped feeding well. abnormally sleepy. nasal flaring.if it improves. grunting tx: same with very severe but anti-malarial is not given Not severe pneumonia.malnutrition Diagnosis ♥ Infants 2 mos to 5 yrs .antibiotics.tsb. wheeze. home care.very severe dse not able to drink. duration.pneumonia-chest in-drawing. cough & duration. ♥ Infants less than 2 mos 1. severe malnutrition .one whole minute Fast breathing Less than 2 months—60/min 2 months.chest in-drawing. refer.fever . convulsion PE: RR. grunting.5°C).1 year—50/min 1-5 years old—40/min Observe for: -chest in-drawing . refer urgently to hospital 2. convulse.D. Pneumonia—severe chest indrawing. chest in-drawing and fast breathing Tx: 1. nutrition.

  O2 and flow meters must be regularly available in all gov’t hospitals. chronic. Objective of the Program To control TB by reducing the annual risk of infection (prevalence and mortality rates) Key Policies: Prevention  BCG vaccination under the EPI program  Annual identification of at least 45% of its prevalence  Public health education re: PTB mode of transmission. STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS  COMMUNICABLE DISEASE PREVENTION AND CONTROL Communicable Diseases Chronic communicable Tuberculosis Leprosy (LCP) vector-borne communicable diseases Malaria (MCP) Schistosomiasis Filariasis (FCP) H-fever (dengue) 1. Case finding  Direct sputum microscopy for identified TB symptomatics  X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam  Establishment of passive and active collection points for sputum samples of all identified TB symptomatics. as well as validation centers to ensure the standart & quality of sputum exam. wheezing. multi drug therapy PTB TREATMENT REGIMEN Categories: 6 SCC Patient will be: 2 months on Rifampicin Isoniazid Pyrazinamide Rifampicin + 4 months Isoniazid 31 . with O2 delivered properly according to Standard ARI/ Pneumonia Case Management Children found to have severe pneumonia. very severe pneumonia. otitis media. shall be given to all infiltrative but sputum negative.  All sputum positive and cavitary cases shall be given priority for short course chemotherapy or SCC for 6 mos. respiratory disease caused by TB bacilli. National Tuberculosis Control Program (NTBCP) “Tuberculosis is a highly infectious. SR: isoniazid and streptomycin sulfate SCC: Combo pack. except those with acute complications and emergencies. on ambulatory and domiciliary (home) basis. It is one of the 10 leading causes of morbidity and mortality in the Philippines.  Case finding and treatment services shall be made available in the BHS/RHUs Treatment  All TB cases must be treated for free. which is also known as “Koch’s Dse”.  Standard Regimen or SR for a year or intermittent SCC for 6 mos. methods of control. and impotance of early dx  Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive tx of contacts. streptococcal sore throat shd be referred to Municipal Health Officer (MHO) or hospital physicians for proper management according to the referral scheme.

shorten duration of treatment usually treatment lasts from 5-10 years.(+) extrapulmonary cases 8 SCC Patient will be: Rifampicin Rifampicin 2 mos on Isoniazid Ethambutol Streptomycin Indicated for those with relapse: .non-infectious Duration of treatment: 6-9 months Multibacillary (lepromatous and borderline). Intensive Phase Diagnostic: Sputum Exam If (+).eradicate and completely prevent the relapse of the dse Direct Observation Treatment of Short –Course Chemotherapy (DOTS) “Tutok-Gamutan” 2.infectious Duration of treatment: 24.(-) sputum smear. Maintenance Phase + 4 months on Isoniazid If still (+) TB colonies proceed to Rifampicin 3.prevent developing resistance against the tree drug combinations .30 months 32 .(+) sputum smear . (+) extensive lung lesion . Extensive Phase up to 12 mos on Isoniazid What is the purpose of SCC-MDT .Indicated for patients who are: . With SCC-MDT.Seriously ill .failures . proceed to 2. Leprosy Control Program Leprosy is a chronic dse of the skin and peripheral nerves caused by Mycobacterium Leprae WHO CLASSIFICATION OF LEPROSY Paucibacillary (tuberculoid and indeterminate).others 4 SCC Patient will be: 2 mos on Rifampicin Isoniazid Pyrazinamide Indicated for PTB minimal (-) sputum smear + 2 mos Rifampicin Isoniazid Isoniazid Pyrazinamide + 4 months Rifampicin Isoniazid Ethambutol +5 months 2 Phases of Treating a TB patient: 2 months Rifampicin Isoniazid Pyrazinamide Rifampicin 1. tx can be reduced to a minimum of 6 mos .

non-segregation of leprosy patients . Key Policies: .MDT as the core strategy for the National Leprosy Control Program .Reduce the stigma attached to the disease thru IEC .Identify all correctible deformities and institution of appropriate intervention . and splenomegaly 2 Major Strategies of the Program 1. daily at home Leprosy patients must be taught ways to prevent secondary injury caused by burns and rough sharp objs Emphasize importance of sustained therapy. IEC.Formulate research proposals on topics associated with leprosy. Malaria Control Program Malaria is a vector-borne disease caused by female Anopheles mosquito causing sx such as fever.counseling and guidance  LOCALLY-ENDEMIC DISEASE PREVENTION AND CONTROL 1. and training materials by CDCS . effects of drugs and the need for medical checkup from time to time Provide mental and emotional support to the families of leprosy patients Refer patients as needed.Vector Control 33 . intermittent chills. anemia. Rehabilitation:  Imbibe patient’s participation in occupational activities  Family and community health (PD 304) . MDT Treatment Regimen Paucibacillary Supervised dose: Rifampicin 600mg Dapsone 100 mg Taken once/month in the clinic Self-administered Dapsone 100mg Taken OD.Objectives of the Program: . . daily by the patient at home     Multibacillary Supervised dose: Rifampicin 600mg Lamprene 300mg taken once/mo in the clinic Self.Supervision and control of leprosy control activities Strategies: Prevention Treatment - health education BCG vaccination Case finding Validate old registered cases Early referral of suspected leprosy patients Epidemiologic investigation ambulatory domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment. sweating.provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the prescribed period.Procurement and supply of MDT Drugs.Health education . correct dosage.administered dose Lamprene 50mg taken OD.

mass blood smear exam . H-fever. ascites. caused by Aedes Aegypti.Detection and Early Treatment of Cases ≈ Early Recognition.acute febrile infection of sudden onset.encourage use of rubber boots for protection Environmental Sanitation-proper disposal of feces Snail Eradication. CONTROL AND REHABILITATION OF NON-COMMUNICABLE DISEASES 1. the aim of management is to relieve physical. This may be done thru: > Clinical >Microscopic .a parasitic infection caused by blood flukes inhabiting the veins of their vertebral victims transmitted thru skin penetration causing diarrhea. 1990 Provided the Guidelines for the Philippine Cancer Control Program specifying its program policy.chloroquine 1-2 weeks before entering an area then continuous until 4-6 weeks after leaving the area 2. Filariasis Control Programs SCHISTOSOMIASIS CONTROL PROGRAM Schistosomiasis. Philippine Cancer Control Program AO 89-A s.history of visit to and endemis area In the event that an imminent epidemic occurs. implementing guidelines and timetable. components. lymphedema and hydrocele > started in 1957 as an operational research of malaria. mental. the ff shd be done:  Mass blood smear collection  Immediate confirmation and follow-up of cases  Insecticide-treatment of mosquito nets 2. Schistosomiasis. vector mosquito FILARIASIS CONTROL PROGRAM > a mosquito borne dse caused by a tissue nematode attacking the lymphatic system of humans thereby causing elephantiasis. Eradication Service Three Filaria Control were established and later on integrated with the Regional Health Officers Activities: Case Finding Early reporting of any known case or outbreak Activities: Case finding Early reporting of any known case of outbreak Activities: Case Finding: surveillance of the dse Health educ. and Control of Malaria epidemics  identification of a patient with malaria as soon as he is examined.signs and sx . and spiritual distress Vital Task of the nurse: To help the patient maintain his dignity and integrity 34 .mosquito soap ≈ Chemoprophylaxis.Chemically treated mosquito nets Larva-eating fish Environmental clean-up of stagnant water Anti.use of moluscides  PREVENTION. Prevention. 6 Pillars:  Public Information and Health Education  Cancer Prevention and Early Detection  Cancer Epidemiology and Research  Cancer Treatment  Cancer Pain Relief In Cancer Nursing. hepatosplenomegaly H-FEVER (DENGUE) Dengue.

Smoking Control Program Health hazards of Smoking:  Lung Cancer  Cardiovascular diseases  COPD  Cancer of other body organs Program Objective: To decrease the prevalence of smoking-related diseases and subsequent premature deaths Program Components:  Information and Education on Campaign and Social Mobilization  Policy Development and Legislation  Training of Counselors in Smoking Cessation Clinics for Specialty Hospitals  Resource Management and Monitoring Strategies:  National Anti-Smoking Campaign o World No Tobacco Day o National No Smoking Month o Yosi Kadiri Campaign 3. 4. productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifestyle. women of child bearing age( also included are the pregnant and lactating mothers) and the elderly. Cataract National Focus: Cataracts Screening Week at DOH Centers OPLAN: Sagip-Mata > eye surgery for cataract and squint operations for cross-eyed children  NUTRITION AND ADEQUATE FOOD SUPPLY Goal: reduce M&M related to nutritional deficiencies The improvement of nutritional status. schoolers. Coverage: ____ energy ____. Vit A deficiency. 35 . Objectives: to decrease the morbidity and mortality rates secondary to Avitaminosis and other nutritional deficiencies among the population mostly composed of infants and children. Who are to be prioritized for health supervision?  Newly diagnosed cases  Post-op cases/discharge  Indigent cases needing continuity of hospital care  Terminal cases 2. pre-schoolers. iodine deficiency disorder Philippine Food and Nutrition Programs Directed to the provision of nutrition services to the DOH’s identified priority vulnerable groups: Infants.  Encourage adult Filipino to undergo urinalysis once a year. Renal Disease In “23 in ‘93” Preventive Cardiology and Nephrology  Enhance public awareness through health education regarding healthy lifestyles  Improve access to basic health services “Health for More in ‘94” “Buwan ng Buhay na Bato”  Requires urinalysis af ALL children entering grade 1 so as to detect childhood kidney infections which may lead to renal failure.Cancer care is multidisciplinary. Fe deficiency anemia.

Food Fortification Program “Health for More in ‘94” “Buwan ng Kabataan. Pag-asa ng Bayan’ National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy” -aimed to distribute vitamin A supplements. Tools utilized are anthropometric measurements: Weight for age Measures degree and presence of wasting or stunting Height for age Measures the presence of stunting < 90% of standard stunting or past chronic malnutrition Weight for height Determines the presence of muscle wasting Ideal body wt.11.10.a free enrichment program aimed to prevent deficiencies in vitamin A (blindness). suprailiac 36 .9. iodine (goiter. which involves periodic collection of data and analysis and dissemination of analyzed information. Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning. bulgur wheat and green where an adequately trained nutritionist were peas assigned (RA 422) Target population: Pre-schoolers Pregnant women Lactating mothers Akbayan sa Kalusugan (ASK Project) Aimed to provide rice and corn soya blend supplemented with local foods. biceps. Micronutrient Supplementation Program “23 in ‘93 Fortified Vitamin Rice .2 years Moderately and severely underweight Pre-schoolers not served by the DSWD and DA in Regions 2. It involves:  Incorporation of Monosodium Glutamate (MSG) with vit A to reduce clinical signs of Xerophthalmia  The use of FIDEL salt in lieu with the National Salt Iodization Program F ortification for I odine D efficiency EL imination 4.2 in men or 26.1. binilid enriched with essential micronutrients) 3. Nutrition Surveillanve System (operation timbang) .12  2. Target pop: 6 mos. mental retardation and delayed development) (1 cavan of rice + fistful processed. iodized oil for and seedlings of plants rich in Fe and other minerals. iron (anemia).8.a system of keeping close watch on the state of nutrition and the causes of malnutrition within a locality. reduction Skin Fold Measurement Indicates amount of body fat with the use of fat-caliper Sites: triceps. subscapular. Malnutrition Rehabilitation Program Targeted Food Task Force Nutrition Rehabilitation Ward Assistance Program Provision of food rations of Every hospital must have a Nurse ward.: 135 Body mass index(BMI)= wt in kgs Ht in meters If BMI is > 27.9 in women there is the need for wt.

meat (pork and chicken) blood.MUAC Estimates lean body mass or skeletal muscle reserves Protein Energy Malnutrition Marasmus. mango) .swollen legs.prominent ribs .disease of older children when the next baby is born. kadyos.Moon-shaped. weak hair . kamote tops.Enlarged abd .low intake of Vitamin A rich food -low intake of ___ and protein .night blindness due to Rhodopsin (visual purple) 2. always hungry tx: food high in protein and energy content  frequency of feeding  variety of food ___ Kwashiorkor.doesn’t want to eat .very poor wt gain .dark spots on skin . liver.___ plant sources yellow/orange veg (carrots & squash) . saluyot. to serious as stillbirth. mustard (mustasa).stillbirths Causes: Goitrogens and other environmental factors Low intake of Iodine rich foods or low content of iodine in food. This is usually ___ the child 1-3 years old . no fat .illnesses like measles. fish and shellfish leafy vegetables alugbati. _____ Sources: -Breast milk -animal sources. dried beans. eggs. congenital abnormalities. the more absorbable iron fr foods of animal origin Sources: Liver.enlarged abdomen .loose and wrinkled skin . nutritional blindness.meat -yellow/orange fruits ( leafy vegetables (malunggay. A capsule Iodine Deficiency Disorder.Muscle wasting . Supplementation: 37 . growth and mental retardation& physical and motor abnormalities Consequences: fetus: abortion or miscarriages -congenital abnormalities .child lacks food rich in CHON & energy ____ usually < 1 year old when malnutritionj starts .abnormalities __ get enough sores and skin is peeling . kangkong. monggo.apathetic Iron Deficiency Anemia. kangkong) .very thin. Abnormalities range from mild such as goiter. whole milk. abitsuelas Supplementation: FeSO4 iron supplement. petchay. fails to grow . unhappy face .no enough hemoglobin in the RBC bec of lack of Fe Causes: low intake of Fe-rich foods esp.Very thin. diarrhea. blindness.drink fruit juice enhance Fe absorption Vitamin A DeficiencyConsequences: 1. internal organs.Vit.anxious. arms. feet. and hands -Light colored.due do destruction of cell of the cornea Causes: .

labeling. a piped distributor network and household taps that is suited for densely populated urban areas. National Drug Formulary contains the list of essential drugs Generics Act of 1988 RA 6675 “Formally proclaims the state of promoting the use of generic terminology in the importation. well-being and survival.Reed Odorless Earth Closet septic vault/tank disposal sewerage system to . 3. Goal: to eradicate and control environmental factors in dse transmission through the provision of basic services and facilities to all households.” 2 types of drugs: Prohibited Regulated LSD Benzodiazepines Eucaine Barbiturates Cocaine/ codeine Opiates  ENVIRONMENTAL SANITATION Environmental Sanitation is defined as the study of all factors in man’s physical environment. Proper Solid Waste Management . treatment plant. 38 . a reservoir. Water must pass the National Standards for Drinking Water set by the DOH. Water Supply Sanitation Program 3 types of Approved Water Supply Facilities Level 1 Level II Point Source Communal Faucet system or stand posts A protected well of a developed A system composed of a source.Bored-Hole facilities. which may exercise a deleterious effect on his health. promotion and advertising. 2. areas where houses are clustered densely.” “Reinforces the NDP with regards to the assurance of the high-quality and rational drug use. a sprung with an outlet but reservoir.refers to satisfactory methods of storage.water carriage toilet facility: On site toilet facilities of the Water carriage types of . Refuse Level III Waterworks system or individual house connections A system with a source.” Dangerous Drugs Act RA 6425 “ The safe.Pit Latrines water carriage type with water toilet facilities connected sealed and flushed type with to septic tanks and/or to . manufacture. distribution. located at not more than rural areas where houses are 25 meters from the farthest house in rural thinly scattered. 1.Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space -pour flush -aqua privies Rural Areas. administration and transportation of prohibited drugs is punishable by law. prescribing and dispensing of drugs. Proper Excreta and Sewage Disposal System 3 types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non.“blind drainage” type of wastewater collection and disposal facilities shall be emphasized until such time that sewer facilities and off-site treatment facilities are available. collection and final disposal of solid wastes. a piped distribution network and without a distribution system for communal faucets.Compost . . SUPPLY AND USE OF ESSENTIAL DRUGS Essential drugs are medicinal preparations necessary to fill the basic health needs of the population. marketing.

Incineration 4. attitudes. Programs related to health-risk minimization secondary to environmental pollution These include the following:  Anti-smoke Belching campaign and Air Pollution Campaign  Zero Solid Waste Management  Toxic. Three aspects of Health education:  Information.Garbage Rubbish 2 ways to Refuse Disposal Household -Burial > deposited in 1m x 1m deep pits covered with soil.animal feeding .open burning .change in knowledge. judgement and action.composting . Education of prevailing health problems Accepted activitiy at all levels of public health used as a means of improving the health of the people through techniques which may influence people’s thought motivation. and skills Sequence of Steps in Health Education  Creating awareness  Creating motivation  Decision making action 39 . 3 points of contamination  Place of production processing and source of supply  Transportation and storage  Retail and distribution points 5. cooks  All ambulant vendors must submit a health cert to det presence of intestinal parasite and bacterial infection. helpers. Food Sanitation Program Policies:  Food establishment are subject to inspection (approved of all food sources containers and transport vehicles)  Comply with sanitary permit requirement  Comply with updated health certificates for food of information  Education. Hospital Waste Management Goal: To prevent the risk of contraction contracting nosocomial infection from type disposal of infectious. pathological and other wastes from hospital 6. located 25m away from water supply .grinding and disposal sewer Community -Sanitary landfill or controlled tipping > excavation of soil deposition of refuse and compacting with a solid cover of 2 feet .provision of knowledge  Communication. chemical and Hazardous Waste Management  Red tide Control and Monitoring  Integrated Pest Management and Sustainable Agriculture  Pasig River Rehabilitation Management 7.

Special Project for Vulnerable Groups Stresses in the environment of children such as times of disasters and natural calamities. functioning. and physical and sexual abuse and poverty have direct effects on physical and mental health. disintegration of the values. migration. drugs. acceptably in the community where he/she lives .A state of well-being where a person can realize his or her own abilities. GOOD LUCK! 40 . to cope with the normal stresses of life and work productively .Involves the promotion of a healthy state of mind amont the whole pop through ♥ Developing positive outlook in life ♥ Strengthening coping mechanisms Vulnerable group to the dev of Mental Illness: ♥ Women ♥ Street children ♥ Victims of torture or violence ♥ Internal refugees ♥ Victims of armed conflicts ♥ Victims of natural and man-made disasters Components of Mental Health Program A.The emotional adjustment the person achieve in which he can live with reasonable comfort. Drugs and Alcohol Abuse Rehabilitation C. structure and functions of the family and urbanization. Stress B. Treatment and Rehabilitation of Mentally-ill Patients D. HIV/ STI PREVENTION AND CONTROL Operational Strategies:  Promotion of health/ health education  Disease detection  Treatment program  Contact tracing  Clinical services Program components:  Case-finding  Case management  Training  Monitoring  Reporting system  Operations research  MENTAL HEALTH .

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