fish, milk, cheese , anchovies, salmon,
NP1 sardines
 Primary Health Care and CHN
 MDG target- reduction of maternal mortality
by 80/100,000 live births (mdg5)
 2/3- reduction of child mortality rate (mdg4)
 Mdg 5- TARGET 2015
 SDG 3– HEALTH and WELL being
Centered ( disease focus : HIV/AIDS ,
Malaria)
 SDG 6 – SANITATION centered
Transforming our world: the 2030 Agenda for
Sustainable Development.
17 goals target is 2030
 Goal 1: No Poverty
 Goal 2: Zero Hunger
 Goal 3: Good Health and Well-
being (health centered related)
 Goal 4: Quality Education
 Goal 5: Gender Equality
 Goal 6: Clean Water and
Sanitation(sanitation centered)
 Goal 7: Affordable and Clean Energy
 Goal 8: Decent Work and Economic Growth
 Goal 9: Industry, Innovation and
Infrastructure
 Goal 10: Reduced Inequalities
 Goal 11: Sustainable Cities and
Communities
 Goal 12: Responsible Consumption and
Production
 Goal 13: Climate Action
 Goal 14: Life Below Water
 Goal 15: Life on Land
 Goal 16: Peace, Justice and Strong
Institutions
 Goal 17: Partnerships for the Goals
 chronic disease that usually affects the
 SDG- 17 GOALS – 2030
 Spacing of pregnancy - 3-5 years
 iron- prevent anemia of pregnancy- liver
products, red meat and internal organs,
munggo, green leafy vegetables
 Vit.D for calcium absorption prevents
RICKETS in children and osteomalasia in
adult- sources dairy products ,cod liver oil,
 VIT C prevents SCURVY
 Solutions like alcohol must be must be
placed in the center of the Public health
Bag
 IRON- 60 mg per tablet once a day and 400
mcg of folic acid for 6 months
 Vitamin A for postpartum – 200,00 IU one
dose
 Vitamin A for pregnant– 10,00 IU 2x a
week starts at 4 months
 Vitamin A for Children 12 months and
above – 200,00 IU dose every 6 months
 Vitamin capsule colors: RED
 Vitamin A treatment of Xeropthalmia
and Measles
 Beta-carotene in vegetables such as carrots
and sweet potatoes is the most common
provitamin A.
 Dairy products (such as cheese and fortified
milk), eggs, cod, liver oil and halibut are
rich sources of preformed vitamin A.
 Plant-based sources of provitamin vitamin A
include pumpkin, broccoli, and dark green,
leafy vegetables.
 Signs of long-term vitamin A toxicity are
coarse hair, thinning eyebrows, dry skin,
cracked lips, weakness, and severe
headache.
 One major sign of vitamin A toxicity is
carotenosis, a condition in which the palms
of the hands and soles of the feet appear a
deep yellow or orange color.
 BP cuff , Paper lining must be OUT of
the PHN bag
 Tuberculosis / PTB- a highly infectious
lungs.
Causative Agent: Mycobacterium
Tuberculosis (acid fast bacteria)
 Robert Koch- German physician and
scientist, presented his discovery of
Mycobacterium tuberculosis, the
 bacterium that causes tuberculosis (TB),
on the evening of March 24, 1882
 Sign/Symptoms:
 cough for more than 2 weeks
 afternoon fever
o Swelling lyphnodes
 weight loss
 night sweat
 blood stain sputum - hemoptysis -
***late sign
Preventing Tuberculosis  BCG
vaccination
 Case finding – Direct Sputum Smear
Microscopy and X-ray examination of TB
symptomatics who are negative after 2 or
more sputum exams
 Sputum smear and culture or DSSM -
confirms the diagnosis
 Tuberculin test (Mantoux test- detects the
presence of antibodies
(Results read within 48-72 hours from skin
testing, posistive if within duration of 10mm
or more.
Below 5 y/o - > or = 10 mm is positive,
Older than 5 y/o > or = to 5 mm is positive)
 Mantoux test- A positive reaction means
that the client has been
exposed to TB
 DOTS- declared in 1996
 Inhale or deep breath then cough up 3-5ml
sputum proper way to collect
 Hemoptysis is contraindication of sputum
collection
 3x in a month – collection of sputum for
case finding
 Bcg – do not give to immunosuppressed
baby- with leukemia and hiv
 A positive reaction consists of palpable
swelling and induration of
- 10mm and above for normal
- 5mm and above for immunocompromised.
 Chest x-ray - determines the presence and
extent of disease
 the primary diagnostic tool in TB case
finding is DSSM
 The only contraindication for sputum
collection is hemoptysis
 Direct Observed Treatment Short Course
– comprehensive strategy to detect and cure
TB patients.
 DOTS (Direct Observed Treatment Short
Course)
 Category I - 6 months treatment
o -new smear (+) PTB
-new smear (-) PTB with extensive
lesions on CXR
-EPTB
-Severe concominant HIV disease 2
o -DOTS: 2months RIPE
maintenance: 4months RI
 II -treatment failure
-relapse
-return after default
-intensive: 2 months RIPES/1 month RIPE
Maintenance: 5 months RIE
 III -new smear (-) PTB with minimal lesion
on CXR
o -DOTS: 2months RIPE
maintenance: 4months RI
 IV -chronic Refer to specialized facility or
DOTS Plus Center
Refer to Provincial/City NTP Coordinator
 Rifampicin causes urine discoloration.
Isoniazid give Vit. B6 or pyridoxine to
prevent peripheral neuropathy
Pyrazinamide - causes G.I upset.
Ethambutol causes-
-not given to children under 6 years or
younger because they cannot reliably
monitor vision –
 Streptomycin causes- tinnitus and auditory
impairment/ OTOTOXICITY.
 FDC – Fixed Dose Combination
 4 FDC or 4 drugs combined in a blister pack
– R.I.P.E
 3 FDC or 3 drugs combined i a blister
packs – R.I.P or the new drug R.I.E.
 2 FDC or 2 drugs combined i a blister packs
– I.E or the new drug R.I.
 Streptomycin – only TB drug in Vial
 Leprosy
 RA 4073- Liberization and Treatment of
Leprosy (February as Leprosy Month)
• Hansen's disease - BACTERIA
• •Multi-Drug-Therapy (MDT)
• LEPROMATOUS TYPE is the most
disfiguring type of LEPROSY
CHOLERA
 In August of 1854 Soho, a suburb of
London, was hit hard by a terrible outbreak
of cholera. Dr. Snows himself lived near
Soho, and immediately went to work to
prove his theory that contaminated water
was the cause of the outbreak.
 In 1883 a German physician, Robert Koch,
took the search for the cause of cholera a
step further when he isolated the
bacterium Vibrio cholerae, the “poison”
Snow contended caused cholera.
 Dr. Koch determined that cholera is not
contagious from person to person, but is
spread only through unsanitary water or
food supply sources, a major victory for
Snow’s theory. The cholera epidemics in
Europe and the United States in the
19th century ended after cities finally
improved water supply sanitation.
 John Snow to be the pioneer of
public health research in a field known
as father of MODERN
EPIDEMIOLOGY in part because of his
work in tracing the source of a cholera
outbreak in Soho, London, in 1854
 Cholera is an acute diarrhoeal infection
caused by the bacterium Vibrio cholera of
serogroups O1 or O139.
 Humans are the only relevant reservoir,
 What is Cholera?
 Answer: It is an opportunistic infection,
caused by enterotoxin - producing strains of
the bacterium Vibrio cholera
 VERY common in RAINY SEASON
 How is Cholera transmitted?
 Answer: Transmission to humans occurs
through eating food (seafood) or drinking
water contaminated with Vibrio cholerae
from other cholera patients
 Where is the major reservoir for cholera?
 Answer: The major reservoir for cholera
was long assumed to be humans themselves,
but considerable evidence exists that aquatic
environments can serve as reservoirs of the
bacteria.
 In its most severe form what effect does
Cholera have?
 Answer: Severe drop in blood pressure
Infected patients may die within three hours
if medical treatment is not provided
It colonize in the intestine and produce
toxin, it makes intestinal cell secrete water,
you die from shock.
 What is the most common scenario for
Cholera?
 Answer: In a common scenario, the disease
progresses from the first liquid stool to
shock in 4 to 12 hours, with death following
in 18 hours to several days, unless oral (or,
in more serious cases, intravenous)
rehydration therapy is provided.
 What is the major symptom of Cholera?
 Answer: Massive, rice-water diarrhea
(Contains mucus) (up to 10 liters per day!)
Fluid & electrolyte loss -> K+ depletion ->
death
 What is the treatment for Cholera?
 Answer: Treatment - oral rehydration
therapy
 How is Cholera prevented?
 Answer: Prevention - Modern
plumbing/sanitation and clean drinking
water
 Where did Cholera originate from?
 Answer: Originally came from India from
Ganges delta.
It was transported by ships.
 What does serogroup refer to?
 Answer: "Serogroup" refers to the structure
of lipopolysaccharide or LPS, and O-
antigens expressed
 What is does biotype mean?
 Answer: Biotype - further classification
based on phenotypic characteristics
 Who was John Snow?
 Answer: One of the fathers of
epidemiology, because of his work in
tracing the source of a cholera outbreak in
Soho, England, in 1854.
Found that Cholera came from contaminated
drinking water.
 How many cases of Cholera are there in a
year?
 Answer: Approximately 500,000 cases per
year
 Where is the Cholera endemic present?
 Answer: Endemic (always present) in
Africa and SE Asia (Indian subcontinent)
 What is the causative agent of Cholera?
 Vibrio Cholerae
 Answer: What are the bacterial
characteristics of Cholera?
 It is gram negative, motile, curved rod
Very sensitive to low pH <6
 What is the environmental cycle for
Cholera?
 Answer: They usually cling to biofilm
before heavy rain fall from monsoon
season.
They are a aqueous virus.
You can screen out the zooplankton with
using clothes to filter water.
It is only 50% effective, it only filters out
stuck zooplankton
 What are the Cholera virulence factors?
 Answer: Cholera Toxin (CT)
Toxin Co-regulated Pilus (TCP)
 What is Cholera Toxin?
 Answer: A-B enterotoxin (1 A & 5 B
subunits)
Causes symptoms of disease
 What is Toxin Co-regulated Pilus ?
 Answer: Involved in colonization of human
intestine
Bacterial-bacterial interactions
Also serves as a receptor for the
bacteriophage that encodes cholera toxin
 What are characteristics of Vibrio Cholerae?
 Answer: It is motile because it has a
flagella.
Not in a host it is does not express Cholera
toxin
The host is used for amplification.
BUBONIC PLAQUE – BLACK DEATH
 When did the Black Death Occur? - 1347 –
1350 ( 1348)
 In what century did the Black Death Occur?
- 14th
 Describe the definition of the Black Death- A
widespread epidemic of the Bubonic
Plague the occurred in the 14th century,
killing millions of people.
 What helped the spread of the Black
Death?- Trading routes on both land and
sea
 True/False: The rat spread the disease by
biting humans (False)
- It was the flea that bit the human, the rat
only carried the flea.
 What fraction of Europe died during the
Black Death?- about 1/3
 What type of flea carried the Disease?- The
oriental rat flea
 What was the most common strain of the
Black Death?- The Bubonic Plague
 How many strains of Plague were there?- 3
 Name the strains of the Black Death:-
Bubonic, Pneumonic and Septicaemic
COURSE of INFECTION
1. Flea drinks rat blood that carries the
bacteria
2. Bacteria multiply in flea's gut
3. Gut clogged with bacteria
4. Flea bites human, regurgitates blood
into open wound
5. Human is infected
 What bought the Black Death from Asia to
Europe?- Rats and their fleas traveling on
trade routes
 Where did the Black Death Originate?- Asia,
predominantly China
 Where did the Black Death first arrive in
Europe?- Messina, Italy
 When did the Black Death reach Southern
Italy?- December 1347
 When did the Black Death reach Marseilles
in Southern France?- January 1348
 When did the Black Death reach England?-
September 1348
 when did Egypt become infected with the
Black Death?- 1347
 By ____ the Black Death had spread
through Northern Africa- 1348
 In what season were the fleas most active?-
Summer
 What did the Pope do to protect himself
from the Black Death?- He sat in between
two fires, killing the fleas because of
extreme heat.
 What was also happening during the Black
death that caused it to spread even
quicker?- Widespread famine
 What is another name for the Black
Death?- the Bubonic Plague
 in what desert is the Black Death thought to
have originated?- The Gobi Desert
 What were some of the symptoms of the
Black Death?
 -High fever
-Extreme fatigue
-Aching limbs
-Lymph nodes (The smaller black swellings)
-Bubo's
 bubo
 the apple-sized, pus-filled lumps that grew
on the armpits and groins of sufferers
 What were the symptons of the pneumonic
plague? - Coughing up blood
 Helminths - most common is ascariasis ,
hookworm ,trichuris (whipworm) ****
EXCEPT = Taeniasis
 Beef tapeworm - Taenia saginata- ingestion
of undercooked beef
 Ancylostomiasis/Hookworm – causes
anemia - penetration of skin - walking
barefooted
 Pinworms/ enterobiasis .- best way to
diagnose this infection is through a tape test.
 Hepatitis A , E or Infectious Hepatitis: oral-
fecal route
 Hepatitis B or Serum Hepatitis: blood-borne,
oral-oral
 Red tide poisoning- first aid Drinking pure
coconut milk
 Rabies/ Lysa Mgt.
 observe the dog for 14 days. If it dies or
shows signs suggestive of rabies, consult a
physician.
 Rabies - hydrophobia, a morbid fear of
water
 Licking of intact skin
 Observe the dog for 14 days
 CATEGORY II
 Abrasion, laceration, punctured wound on
the lower extremities
 Give active vaccine
- Observe dog for 14 days
 CATEGORY III
 Abrasion, laceration on upper extremities,
head and neck.
 Dog is killed, lost died, stray
 Give active vaccine plus Passive vaccine
ACTIVE IMMUNIZATION –
PCEC (Purified Chick Embryo Vaccine),
RABIPUR and the new cheap drug
VEROWELL
 Viral Infection
Varicella (Chicken Pox)
- Varicella Virus
Communicable 1 day before eruption of
vesicles to 6 days after first crop of
vesicles have formed
• Antiviral agents – acyclovir
 Fifth’s Disease
 Symptoms
 Classic rash of erythema on face (cheeks),
“slapped face appearance”
 Rubeola (measles)
• Viral infection
• RNA virus of the genus Morbillivirus
within the family Paramyxoviridae
• Communicable just before the rash
appears
 Pre-Eruptive Stage:
• fever, coughing, sneezing, and running of
nose and redness of eyes.
• Koplik spots—bluish-gray specks or
“grains of sand” on a red base—develop
on the buccal mucosa
 Mumps - PAROTITIS
• Viral infection
• Transmitted by direct contact of saliva and
respiratory droplet
• Communicable immediately before
swelling begins
 Rubella(German measles)
• Viral Infection
• Communicable 7 days before to 5 days
after rash
**Pregnant people must avoid infected
child=fetal death
 Pertussis (whooping cough)
• Bacterial infection
 Diptheria- bacterial cause-
corynebacterium diphtheria-
pseudomembrane
 Zika virus
• a virus transmitted by Aedes mosquitoes.
 Causes microcephaly baby in pregancy
 Census- mass population collection of data
 9 cotton balls – thermometer technique
 IPV – IM
 IPV- killed bacteria
 Measles route – SQ
 Measles insertion 40-50 degree
 Give every child a dose of Vitamin A every
six months from the age of 6 months.
 Give every child mebendazole every 6
months from the age of one year.
 6 weeks DPT+HIB-1** Hep B1 OPV1
RTV1**** PCV1*****
 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2
PCV2
 14 weeks DPT+HIB-3 Hep B3 OPV3 RTV3
PCV3
 Pneumococcal conjugate vaccine (PCV) –
start to be given at 6 weeks
 9 months Measles ***
 12 months MMR
 ****Rotavirus Vaccine – 2-3 doses
antidiarrheal
 Cholera- tetracycline- Cotrimoxazole
 Tetracycline: permanent green teeth
staining of baby if used by pregnancy
 Pneumonia, Acute ear infection,
Mastoiditis (Drug: Amoxicillin – 1st line,
Cotrimoxazole – 2nd line)
 in IMCI standard for fever is > 38.5oC or
hot to touch - give Paracetamol evry 4-5
hours- analgesic and antipyretic
 Census is for gathering data in mass
population or groups
 COPAR - Community Organizing
Participatory Action Research
 BAWANG – Cholesterol and hypertension
 LAGUNDI – cough , colds fever, and
dysentery
 NIYOG NIYOGAN – traditional medicine
act as ANTIHELMINTHIC, to expel worms
and parasites
 LEVEL 2 WATER FACILITY – STAND
POST and communal faucet
 HBMR – home based mothers record
 HBMR – is a tool used to render prenatal
care consisting the risk factors and danger
signs of pregnancy
 PANEL 2 of HBMR – contains the risk
factor and danger signs of pregnancy
 OPV-- SABIN VACCINE
 ORESOL is administered EVERY 4
HOURS
PLAN C in dehydration treatment --
insertion of IVF
 IVF – for severe dehydration
 COURTESY CALL is done in -- PRE
ENTRY PHASE of COPAR
 HYDROCEPHALUS and mental retardation
is a form of HEALTH DEFICIT –
 POSTPARTUM BLUES- common normal
2-3 days postpartum,
 Oxytocin- uterine contraction, given after 3rd
stage of labor
 CATEGORY1 - NO RESTRICTION....NO
CONDITION WHICH CONTRADICTS
THE USE OF THE METHOD...
 CATEGORY 4--- Method not to be used-
A condition which represents an
unacceptable health risk if the contraceptive
method is used ( may sakit)
 DEPO PROVERA – 3 months injectables,
assess weight gain
 feso4- 1 gram per singleton pregnancy- start
at 5 months to 2 months postpartum
 site of bbt – AXILLARY
 Hand washing/ hand hygiene – 40-60
seconds
 Scurvy – Vit C
 Dpt interval. – 4 weeks
 Post Partum homevisit – home delivery is
within 24 hours….. hospital delivery- within
1st week or between 3-5 days after delivery
 vitamin A,deficiency –Xeropthalmia and
bitots spot
 BP cuff not included inside PHN/ OB bag
 7160 LGU – DEVOLUTION CODE
 Vibrio cholera or El tor – common in rainy
season
 vit. A IU postpartum mother – 200,000 IU..
 Sabin – OPV – live attenuated virus
 Defrost freezer if ice build up of refrigerator
is 2-3 cm or 1inch or more
 Bcg – 0.05 (.05ml) – ID
 TB - SCC means short course
chemotherapy
 Einc protocol 3x- Drying thoroughly
 Cretinism – iodine deficiency
 Measles – infectious before rashes appear –
4th day
 TT1 protection - no protection
 6000 TOTAL POPULATION TARGET
FOR EPI – 180
 Sabin - opv
 Blindness – Vit. A
 Ampalaya – DM type 2
 Endometrial cancer s/s – unusual discharges
or vaginal bleeding
 CBR Crude birth rate
 koplik spots – measles
 Unang yakap- dry the baby
 BMI- Obese- ≥30.00--------Normal
range - 18.50 - 24.99--------Overweight -
≥25.00
 Cheesy discharges and pruritus vulva –
candidiasis, moniliasis
 Cauliflower cells – condylomata – HPV
 Clue cells – bacterial vaginosis
 Strawberry cervix – trichominasis
 Foul fishy discharges – bacterial vaginosis
 FROTHY DISCHARGES –
TRICHOMONIASIS
 PID – CAUSED BY GONORRHEA AND
CHLAMYDIA
 Hiv – attacks CD4 cells
 And HIV/AIDS .– attacks immune sytem
 Family Planning
 VIT.D- RICKETS
 Family Planning – PD 965 – july 20 1976
 RH bill – 10354
 IUD – REVERSESSIBLE LONG TERM
 T cu 380 – 10 YEARS PROTECTION
 COLD CHAIN – a system that maintains
potency of vaccine
 RABIES – saliva of rabid animal
 Rabies – is known as lysa
 PTB – Koch disease
 BREASTFEEDING – the 3 E (Early,
Exclusive, Extended)
 Aqua privies is level 1
Breast self exam is a secondary level of
prevention
 Cretinism is iodine deficiency
 Iron must be with vit. C
 Calcium is with vit D
 IRON is in chicken liver and MONGO
 brown vials of vaccines protects against
sunlight to maintain potency
 Thick creamy cheese substance –
candidiasis
 *Breastmilk stool-mashy,golden yellow –
sweet sour smell
 *lactalbumin- breastmilk easily digestible
protein
 *Content of colostrum - antibody IgA
(immunoglubolin antibody A)
 *Tetanus neonaturum- cord care mangement
- alcohol and hand hygiene or handwashin
 -hand hygiene - to break chain of infection
 *Dosages of immunization- Dpt Opv
,Hep.b- 3 doses
 Vaccines must be exposed only in room
temperature up to 3 x
 3rd exposure – discard vaccine
 FEFO- First expiry first out
 Cold chain by dictrict level – 3 months
 Half life packs shelve of measles- 6 hours
 Half life packs shelve of Dpt, opv, bcg- 4
hours
 Half life packs shelve of Tt, heap b- 8 hours
– discard if not used up within the end of
your shift
 Dosages- 0.5 ml IM( DPT,HEP. Penta,
PCV)
 0.5 ml SQ(Measles)
 0.05 ml ID(BCG)
 2 DROPS ORAL ( ROTA & OPV)
 4 months or a 16 months baby completed the
doses of 1 bcg dpt1-3 opv1-3 hepb1-3
 *Crude birthrate- TOTAL LIVEBIRTHS
÷TOTAL POPULATION x 1000
 *Crude death rate - Total deaths ÷total
population x1000
 *Chain of infection- handwashing
 Weakest link- mode of transmission
 Benedict's and acid test – performed in
community to pregnant mothers in home
visit to test glycosuria and proteinuria
 Roll over test- Sims or sidelying
 Severe abdominal pain - 90 degree angle or
Fowler's also
 Feeding in bed - 90 degree or fowlers
 2nd degree burn - painful and blister
 Syphilis bacteria is in the painless ulcers or
sores
 *Iron- chicken liver, monggo
 *Vit A- squash, papaya, yellow camote,
yellow corn, banana
 *Cretinism or mental retardation / Iodine
 *TB - intensive phase category 1&2
 *COPAR - courtesy call at pre entry,
(immersion or integration at ENTRY,)
 IFR* individual funding request.
 *IMCI/ danger signs – Convusion, Unable
to drink or breastfed, Vomits everything,
Abnormally sleepy or difficult to awaken)
 Stridor/chest indrawing - severe pneumonia
 Fast breathing (0-2 mos= 60cpm ,, 2-12 mos
= 50 ,, 12-5 years old = 40 ** pneumonia
 Pneumonia first line antibiotics - amoxicillin
 Cholera- vibrio eltor and cholerae in rainy
season- Dirty water
 Salmonellosis – caused by food poisoning in
canned goods Or spoiled proteins
 HIV attacks CD4 T helper cells in immune
system
 Measles* cough, runny nose, conjunctivitis
and maculopapular rashes
 Koplik spots also in buccal mucusa
 Airborne transmission - measles
 *Post partum management/ *foul lochial
discharge- puerperal sepsis or endometritis
 *Cold chain- system to maintain potency of
vaccine
 *Colustrum – rich in maternal antibodies –
thick yellow or dirty white
 *Storage of breastmilk-4-6hours if room
temperature
 *Prolactin - hormone that influences
milk production
 *Prenatal visit- at least 4 visits
 36 weeks to term is everyweek
 Home based mothers record - panel 1-
maternal obstetrical history and info
Panel 2- present pregnancy, danger signs,
TT, FESO4, LAB RESULTS
 *BSE- 7 DAYS AFTER MENSTRUATION
 (COPAR) - Community Organizing
Participatory Action Research
Pre-entry /Preparatory Phase
 Profiling of community
 Ocular survey/ Site selection
 PAy courtesy call to community leaders.
 Entry Phase
Integration with the community
 Self Awareness Leadership T raining
 Organization phase
 core group formation
social preparation
spotting & developing potential leaders
 A-R-A-S (Action- Reflection- Action-
Session)
 community diagnosis
 Action Phase
 Organization and training of (BHWs):
 PIME of health services (Project
Implementation Monitoring and Evaluation)
 Setting up of linkages/ network/ referral
systems
 Sustenance and Strengthening Phase
 Formulation of by-laws
 Identification and development of “
secondary” leaders
 Setting up of a financing scheme
 Rates- relationship between a vital event and
those persons exposed to event
 Ratio- relationship between two (2)
numerical quantities
 Infant Mortality Rate- good index of the
general health condition of a community
 Swaroops index- is the proportion of deaths
of people aged 50 years and up.
 3 CRITERIA FOR LAM use:
 Amenorrhea
 Fully or nearly fully breast feeding her
infant
 BF on demand basis (evey 2-4 hrs during
the day, 4-6 hrs at night
 Infant is less than 6 mos
 Gonorrhea
Male:
purulent yellow penile discharge
 Females: - Greenish vaginal discharge
 Genital Human Papillomavirus
HPV
 condylomata, cauliflower-like warts
 Acetic acid swabbing (will whiten lesion)
 Condylomata acuminata
 Hepatitis B
 Spread through infected blood and bodily
fluids such as semen
 HIV – AIDS
 Retrovirus (HIV1 & HIV2)
 Attacks and kills CD4+ lymphocytes (T-
helper)
 Sexual intercourse (anal and vaginal)
 Exposure to contaminated blood, semen,
breast milk
 Needlestick injuries
 HIGH RISK GROUP – BLACK and
HISPANIC (MEN)
 Homosexual or bisexual
 Sexual contact with HIV+
  Intravenous drug users
 HIV TEST
 Elisa – Enzyme Link Immunosorbent
Assay ( first test conducted)
 Western Blot - confirmatory test
  HIV+
2 consecutive positive ELISA and
1 positive Western Blot Test
  Full blown AIDS- CD4 is less than 200/ml
 Pelvic Inflammatory Disease
 Cause by CHLAMYDIA – primary agent
 Gonorrhea is also secondary agent
 Most common affected – OVIDUCTS or
Fallopian tube
 Chronic pelvic pain, fever, flu-like
symptoms, pain during or after
intercourse(CBQ), vaginal bleeding, foul
smelling discharge, tenderness in lower
abdomen, and chills
 Can cause ectopic pregnancies, infertility
and abscesses in the pelvis. Can be life
threatening - very serious.
 8. Candidacies
 Yeast infection
 With white cheesy patches
(moniliasis)(CBQ)
 Oral trush in the newborn (CBQ)
Medications:
 Nystatin
 Trichomoniasis
strawberry cervix
frothy, foul-smelling ("fishy" smell
) vaginal discharge
 Trichomona vaginalis, single cell
protozoan
S/sx: Females: Yellow gray frothy
discharge
Dx:
- elevated vaginal pH 5.5+ ( alkaline
Mgmt: Metronidazole (Flagyl);
 Bacterial vaginosis
foul, fishy smelling, thin gray vaginal
discharge
 presence of CLUE CELLS (CBQ)
LOI 949 - legal basis of PHC
 Goal of PHC:
 Health for ALL Filipinos and Health in the
Hands of the People by the Year 2020
Mission of PHC: SELF RELIANCE
 PHC- is universal and it extends even to
people in the hospital, both sick and well.
-Accessible
-Available
-Affordable
-Acceptable
-Appropriatene
 Four Cornerstones/Pillars in Primary Health
Care
 Intra and Inter-sectoral Linkages
 Use of Appropriate Technology
 Support mechanism made available
Department of Health (DOH)
 Active Community Participation
 Primary level- Villagers/Grassroots workers
- BHW - frontline worker in community
- Traditional birth attendants – traditional
Hilots- traditionally acceptable to deliver
pregnancy in community
- Arbularyo or healers – uses herbs for
treatment of illnesses
 Secondary- Intermediate workers
Public Health Nurse – supervisor of the
midwife in RHU
Midwives – frontline worker in RHU level
 Health deficits- TB, DM, hydrocephalus,
polio,leprosy
 Health Threats – lack of immunization, no
or lack prenatals
 Foreseeable crisis – Abortion - Divorce or
separation Marriage -Entrance at school –
newborn - Death of a family member
 Malaria
Causative Agent: - PLASMODIUM
(protozoa) P. Falciparum (most fatal)
Vector
 Anopheles female mosquito
 Signs & Symptoms:
 Chills to convulsion,
 Elevated temperature
Treatment: chloroquine
 Schistosomiasis
Causative Agent: Schistosoma japonicum
Snail : oncomelania quadrasi
Signs & Symptoms: Bulging abdomen,
Abdominal pain, Loose bowel
 movement(black tarry), Low grade fever,
Seizure
 Preventive measures
Proper excreta disposal
Agricultural & vegetation improvement
Let water stand 2-3 days before usage
Mollucides use
Educate in Hand hygiene
Rubber boots use
 Treatment: Praziquantel (drug of
choice)
 Expanded Program for Immunization (EPI)
Wednesday - immunization day
 FULLY IMMUNIZED CHILD
 before the child's first birthday.
 fully immunized child must have
completed
 BCG 1
 DPT 3
 OPV 3
 HB 3
 measles vaccines to complete FIC
 Bacillus Calmette-Guérin - Birth or anytime
after birth
 Diphtheria-Pertussis-Tetanus Vaccine
6 weeks(DPT 1)
10 weeks (DPT 2)
14 weeks (DPT 3)
  Oral Polio Vaccine – SABIN -
 6 weeks(OPV 1)
 10 weeks (OPV2)
 14 weeks (OPV3)
 OPV- Number of doses per vial/amp: 20
 HEPA B , Measles & BCG
Number of doses per vial/amp: 10
 Hepatitis B Vaccine - At birth – RNA
RECUMBINANT, PLASMA
 Upper outer portion of the thigh, Vastus
Lateralis (R-L-R)
  Measles Vaccine - 9 months old – SQ -
Upper outer portion of the arms, Right
deltoid
 85% of measles can be prevented by
immunization at 9 MOS.
  VVM or Vaccine vial monitor - a
thermochromic label put on vials which
gives a visual indication of vaccine potency
 Cold Chain  is a system used to maintain
potency of a vaccine from that of
manufacture to the time it is given to child
or pregnant woman.
  Timeframes for the storage of vaccines
◦ 6months- Regional Level
◦ Not more than 5days - Health centers using
transport boxes. .
  “Eligible population”
- group of people targeted for specific
immunizations susceptible to EPI diseases.”
 Rotavirus vaccine- 6 WEEKS – ORAL
 -GIVEN BEFORE 8 MOS 2 DOSES
 PENTA – 6 WEEKS – IM
 MMR- 12 MOS-SQ
 Maternal and child health
 Home Based Mother’s Record (HBMR)
Tool used when rendering prenatal care
containing risk factors and danger signs
- guide in the identification of risk factors
 Fe supplementation: 60 mg with 400
mcg of Folic Acid once a day
 Postpartum visit- Home deliveries
- 1st visit - 24 hours after delivery
 Health care facility
1st- within 1 week
  3 C of Home delivery
CLEAN Hands
CLEAN Surface
CLEAN Cord
  Vitamin A Supplement to Infants,
Preschoolers (6mos – 7 yeas and Mothers
 Pregnant women - 10, 000 IU 2x a week
starting on the 4th month of pregnancy
 Do not give vit. A supplementation before
the 4th month of pregnancy. It might
congenital problems in the baby.
 Postpartum women - 200, 000 IU - 1 cap; 1
dose only within 4 weeks after delivery
 Viamin A Deficiency (CBQ) -
XEropthalmia – night blindness
 Water Supply
 Level 1 (Point Source) - protected well or
developed spring
 Level II - With a source, reservoir, piped
distribution network and communal faucets
 Level III - Individual House Connections
 or Waterworks System - With a source,
reservoir, piped distributor network and
household taps
 Toilet or sewerage
 Level I - pit latrines , pour flush toilet &
aqua privies
 Level II - with septic vault/tank disposal -
water-sealed and flush type
 Level III - connected to septic tanks and/or
to sewerage system to treatment plant.
 Bag technique-a tool making use of public
health bag (open bag 3x only)
 Public health bag - is an essential and
indispensable equipment of the public health
nurse
Removed BP Cuff inside bag
 Home visit - is a family-midwife contact
which allows the health worker to assess the
home and family situations in order to
provide the necessary nursing care and
health related activities
*****cleanest to dirtiest dapat
****priority sunod sunod na to – pregnant –
newborn – postpartum – last ang may mga
sakit
 Epidemiology - the study of disease
occurrence and distribution
 Infection- entry and development or
multiplication of an infectious agent in the
body of man or animals.
 Contamination- presence of an infectious
agent on a body surface, on or in clothes,
beddings, toys, surgical instruments or
dressings, or other articles or substances
including water and food
 4 types of disease distribution
 1. Epidemic- “The unusual occurrence in a
community of disease- sudden outbreak of a
disease in a short period of time
2. Endemic- constant presence of a disease
or infectious agent within a given
geographic area or population group.
3. Pandemic- worlwide
distribution….geographic area such as a
section of a nation, the entire nation, a
continent or the world
4. Sporadic- “scattered about”. The cases
occur irregularly, The cases are few and
separated widely in time and place
- On and off scattered cases –habitual
occurence
 Nosocomial (hospital acquired) - urinary
tract infections.
 Carriers- “an infected person or animal that
harbors a specific infectious agent in the
absence of discernible (visible) clinical
disease and serves as a potential source of
infection to others.
 Leptospirosis – Vector is Rat
Causative Agent: - bacteria--- Leptospira
interrogans
 Sign/Symptoms: High fever, Chills,
Vomiting, Red/ orange eyes, Diarrhea,
Severe headache, muscle aches, may include
jaundice (yellow skin and eyes), abdominal
pain
Treatment: PET - Penicillins G,
Erythromycin, Tetracycline, Doxycycline as
prophylactic drug
 Dengue - mosquito-borne infection
 Vector is female aedes aegypti mosquito,
day biting, low flying, satagnant clear
water,stripes black white body.
 Agent is a Virus.. dengue virus 1,2,3,4
- female aedes aegypti in stagnant water
treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion
 DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or
Rumpel Leads Test), a presumptive test
which is positive in the presence of more
than 20 petechiae within an inch square,
after 5 minutes of test
 TOURNIQUET TEST - (BP Cuff):
o fluids (most important treatment) like
oresol and IV
o paracetamol ( do not give aspirin)
o for nose bleeding, flex the neck lean
forward to prevent aspiration
o avoid unnecessary movement
o assist in the management of shock.
Dorsal recumbent to trendelenburg
position
 What is hepatitis?
 Hepatitis is an inflammation of the
liver. The condition can be self-limiting
or can progress to fibrosis (scarring),
cirrhosis or liver cancer.
 from family member to infant in early
 Hepatitis viruses are the most common
cause of hepatitis in the world but other
infections, toxic substances (e.g. alcohol,
certain drugs), and autoimmune diseases
can also cause hepatitis.
 There are 5 main hepatitis viruses,
referred to as types A, B, C, D and E.
 B and C - most common cause of liver
cirrhosis and cancer.
 Hepatitis A and E are typically caused
by ingestion of contaminated food or
water.
 Hepatitis B, C and D usually occur as a
result of parenteral contact with
infected body fluids.
 Common modes of transmission for
these viruses include receipt of
contaminated blood or blood products,
invasive medical procedures using
contaminated equipment and for hepatitis
B transmission from mother to baby at
birth, from family member to child, and
also by sexual contact.
 Acute infection may occur with limited or
no symptoms, or may include symptoms
such as jaundice (yellowing of the skin
and eyes), dark urine, extreme fatigue,
nausea, vomiting and abdominal pain.
 Hepatitis A virus (HAV) is present in
the feces of infected persons and is most
often transmitted through consumption
of contaminated water or food.
 transmitted mainly through the fecal oral
route. (foodborne)
 Certain sex practices can also spread
HAV.
 symptoms often include nausea, pain in
upper right quadrant of the abdomen,
fever, joint pain, loss of appetite and
jaundice
 Hepatitis B virus (HBV) is transmitted
through exposure to infective blood,
semen, and other body fluids.
 HBV can be transmitted from infected
mothers to infants at the time of birth or
childhood.
 Transmission may also occur through
transfusions of HBV-contaminated blood
and blood products, contaminated
injections during medical procedures, and
through injection drug use.
 HBV also poses a risk to healthcare
workers who sustain accidental needle
stick injuries while caring for infected-
HBV patients. Safe and effective
vaccines are available to prevent HBV.
 Hepatitis C virus (HCV) is mostly
transmitted through exposure to
infective blood.
 Hepatitis C is the most common blood
borne virus in the USA. It is considered
to be the most serious of the hepatitis
viruses
 This may happen through transfusions of
HCV-contaminated blood and blood
products, contaminated injections during
medical procedures, and through
injection drug use.
 Sexual transmission is also possible, but
is much less common.
 There is no vaccine for HCV.
 Hepatitis D virus (HDV) infections
occur only in those who are infected with
HBV.
 The dual infection of HDV and HBV can
result in a more serious disease and worse
outcome.
 Hepatitis B vaccines provide protection
from HDV infection.
 Hepatitis E virus (HEV) is mostly
transmitted through consumption of
contaminated water or food.
 HEV is a common cause of hepatitis
outbreaks in developing parts of the
world and is increasingly recognized as
an important cause of disease in
developed countries.
 transmitted mainly through the fecal oral
route. (foodborne)
 FHSIS/Record & Report:
Objective:
 1.Provide summary of data on health service
delivery & selective program.
2. Provides data w/c combined w/data from
other sources.
3. to provide standardized facility level data
base
4. to ensure data reported is useful &
accurate;timely & easy to use fashion.
5. minimize recording & reporting
burdens;to
allow more time for patient care and
promotive activities.
 Components:
1. Family tx record = Daily
2. Target Client list = weekly
3. Reporting forms = monthly
4. Output reports = quarterly;annually
 *Family tx record - fundamental building
block; foundation of FHSIS
*Target client list - 2nd building block
 The Primary focus of CHN is Health
Promotion & Disease Prevention
 Primary goal - self reliance in health or
enhanced capabilities
 Ultimate goal - raise level of # of citizenry
 Philosophy of CHN- Worth and dignity of
man - by the nature of her work has the
opportunity & responsibility for evaluating
the health status of people & groups &
relating them to practice.
 CHN practices -to benefit the individual,
family, special groups & community • CHN
is integrated and comprehensive
 1. The comm. is the patient in CHN,
 the family is the unit of care and the
 4 levels of clientele are:
 a. Individual
 b. Pop. group ( those who share common
char, dev stages & common exposure to the
problems ex. Children, elderly)
 c. Family
 In CHN, the client is considered as an
ACTIVE partner NOT PASSIVE recipient
of care-participatory approach Client- active
participant, full involvement recipient care
 ROLES OF THE PHN
 ❖ Clinician who is a health care provider,
taking care of the sick people at home or in
the RHU.
 ❖ Health educator, who aims towards
health promo & illness prevention thru
dissemination of correct info; educating
people
 ❖ Facilitator, who establishes multi-sectoral
linkages by referral system
 ❖ Supervisor, who monitors & supervises
the performance of midwives
 ROLES OF THE PHN
 ❖ Clinician who is a health care provider,
taking care of the sick people at home or in
the RHU.
 ❖ Health educator, who aims towards
health promo & illness prevention thru
dissemination of correct info; educating
people
 ❖ Facilitator, who establishes multi-sectoral
linkages by referral system
 ❖ Supervisor, who monitors & supervises
the performance of midwives
 Community Diagnosis:
o Descriptive research
o Profile general picture of comm., a
direct health indicator
o Process by which the people in the
conn & H team assess the comm. H
problems & needs as bases for H
programs devt.
o A learning process for the comm. to
identify their own H problems &
needs
o A profile that deposits the H
problems & potentials of the comm.
 2 Types of Community Dx
• Comprehensive- provides the
general health profile of the
comm.
• Specific or problem oriented-
yields a comprehensive
profile of a particular H
problem.
 Method of Survey: Questionnaire
• Census (100%) : Most ideal,
enumeratx of data conducted
6 mos.
 • Sample Survey : Most
practical study representative
of a comm. Size matters in
terms of validity
• Interview method
• Instrument- interview guide/
schedule
 Records review •
Instrument: checklist
 Ocular inspection/
observation •
Instrument: checklist
 Participant
observation
• Finalize sampling design &
methods
 Probability: Equal
chances- random- (
simple, stratified,
cluster)
 Non- probability:
Everyone will not
have equal chances
 STATISTICS Statistics: A science-
collection, organization, analysis,
interpretation of numerical data.
Biostatistics: refers to the application of
statistical method to the life science like
biology, medicine.
 Demography: Study of pop size,
composition & spatial distribution as
affected by births, deaths & migration.
 Phenomenon of Variation - Tendency of a
measurable character to change from 1
individual or 1 setting to another or from 1
instant of time to another within the same
individual or setting
 Types of Data:
• Constant- value remains the
same from person to person,
time to time, place to place
Ex. Minutes/ hour, speed
• Variable- Ex. Temperature
Qualitative- categories are
simply used to label to
distinguish & group to
another, rather than a basis
for saying that 1 group is
greater, higher than the other.
Ex. Sex, Religion, Color
 Quantitative- numerical • Can be measured •
Discrete- whole number or integral values •
Continuous- fractions, decimals, can attain
any decimal
 Common Epidemiologic Studies:
 Retrospective (Past)
 Cross- Sectional (Present)
 Prospective Cohort (future)
 *Independent variable (Cause) - The one to
be manipulated ( symbol is “y”)
 *Dependent (Effect) - Will always be the
interest of the researcher ( symbol is “X”)
 . Primary Level Of Disease Prevention -
Keep people healthy - Prevention of disease
- Risk factors & threats present
 Through People Ex.
o Immunization: Method of health
promotion
o Chemoprophylaxis: Intake of drugs
Ex. Vit C to avoid URTI
o Reproduction & Sexual Health
o Responsible Parenthood
 Through Environmental Control
o Safe Water Supply - Physical
characteristics - Chemical
characteristics-with minerals in
H2O- hard water (better - Biological
(-) for e.coli Common household
water function = Boil H2O Boil with
low fire, wait 5 mins after boiling
Filtration- from ascariasis due to
airborne solid block Water supply-
25 meters away from toilet, pig pen,
poultry refuse disposal system
o Food Sanitation/ Good Food
Hygiene Ensure the Health of the FF:
 Sources of raw food- without pesticides
 Food handlers
 Environmental sanitation
 Safe excretal disposal (toilets)
 Water No water Needs Transplant Cistern
flush with sewage system
 Flying saucer-pail system (bucket latrine)
 No Transplant Cistern flush with septic tank
 PIT- privy > Antipolice, bore hole, compost,
twin > Ventilate 1 improved pit- less smell >
Reed odorless earth closet (ROEC)
 Overhung latrine (batalan) – bangin
 Cat-hole latrine
 Reuse Management:
- Solid & semi-solid waste excluding human
excretal
Garbage- fruit peelings, left over food-
biodegradable
Rubbish- broken glass, plastic- non-
biodegradable
Acceptance of Reuse Management:
1. Open burning
2. Composting
3. Burial
Community Level
a. Sanitary Landfill
Problem: Prone to scavenging
b. Incinerator- no residue, pure smoke
4. Vector animal reservoir control
5. Disinfestations & Sterilization
6. Good living & working condition
7. Health education -Health promotion best
source of prevention
2. Secondary Level Of Disease Prevention
- Early diagnosis & prompt intervention to
halt pathological process to shorten duration,
severity &
return to normal functioning at earliest
possible time.
a. Screening Methods
• Mass Screening: Should be simple &
inexpensive
• Case Finding: Positive cases of leading
causes of morbidity
Gold Standard for TB test: Culture and
Sensitivity
Sputum smear microscopy- TB test
• Contact Tracing: Pt. with disease & check
source of infection from family • Multiple
Screening: HIV test • Surveillance
1. Pre-Test Counseling- risk appraisal for
disease prevention
Risk situation, Risk behavior
2. ELISA I
3. Post Test Counseling
Behavioral modification- IMPT
Uniqueness of individual
Risk factor: increase probability of
disease
4. ELISA II
5. Western Block Test- (-) or (+) result with
post counseling (Confirmatory DX)
Characteristics Of An Ideal Screening Test:
1. Sensitivity:
True positive rate or strength of association
bet. presence of disease & Sx
2. Specificity
 Tertiary Level Of Disease Prevention -
Applied in symptomatic phase & defects or
disability is present already.
 Starts when the individual seeks medical
help - Rehabilitation is the goal, resting to
an optimum level of functioning within the
constraints of disability
• Diagnosis During
symptomatic phase
• Treatment
• Management
• Rehabilitation – starts when
the individual enters the
facility
 Bag technique-a tool making use of public
health bag (open bag 3x only)
 Public health bag - is an essential and
indispensable equipment of the public health
nurse
Removed BP Cuff inside bag
 Home visit - is a family-midwife contact
which allows the health worker to assess the
home and family situations in order to
provide the necessary nursing care and
health related activities
*****cleanest to dirtiest dapat
****priority sunod sunod na to – pregnant –
newborn – postpartum – last ang may mga
sakit
 Epidemiology - the study of disease
occurrence and distribution
 Infection- entry and development or
multiplication of an infectious agent in the
body of man or animals.
 Contamination- presence of an infectious
agent on a body surface, on or in clothes,
beddings, toys, surgical instruments or
dressings, or other articles or substances
including water and food
 4 types of disease distribution
 1. Epidemic- “The unusual occurrence in
a community of disease- sudden outbreak
of a disease – IN A SHORT PERIOD OF
TIME
 Nosocomial (hospital acquired) - urinary
tract infections.
 Carriers- “an infected person or animal that
harbors a specific infectious agent in the
absence of discernible (visible) clinical
disease and serves as a potential source of
infection to others.
 Leptospirosis – Vector is Rat
Causative Agent: - bacteria--- Leptospira
interrogans
 Sign/Symptoms: High fever, Chills,
Vomiting, Red/ orange eyes, Diarrhea,
Severe headache, muscle aches, may include
jaundice (yellow skin and eyes), abdominal
pain
Treatment: PET - Penicillins G,
Erythromycin, Tetracycline, Doxycycline as
prophylactic drug
 Dengue - mosquito-borne infection
 Vector is female aedes aegypti mosquito,
day biting, low flying, satagnant clear
water,stripes black white body.
 Agent is a Virus.. dengue virus 1,2,3,4
- female aedes aegypti in stagnant water
treatment is supportive therapy.
 Intravenous fluids
 A platelet transfusion
 DENGUE DIAGNOSIS:
- Tourniquet test (capillary fragility test or
Rumpel Leads Test), a presumptive test
which is positive in the presence of more
than 20 petechiae within an inch square,
after 5 minutes of test
 DENGUE ns1 – ANTIGEN CAPTURE -
CONFIRMATORY
 TOURNIQUET TEST - (BP Cuff):
o fluids (most important treatment) like
oresol and IV
o paracetamol ( do not give aspirin)
o for nose bleeding, flex the neck lean
forward to prevent aspiration
o avoid unnecessary movement
o assist in the management of shock.
Dorsal recumbent to trendelenburg
position
 Leading New Cancer Cases in 2010, Both
Sexes, Philippines (GLOBOCAN 2008).
 Cancer Sites Number Percentage
1. Breast 12262 cases 15 %
2. Lung 11458 cases 14 %
3. Liver 7331cases 9 %
4. Colon/Rectum 5787cases 7 % ✔ ✔ ✔
✔
5. Cervix Uteri 4812cases 6 %
 lung cancer was the most common cancer
in men
 In Females, breast cancer was the most
common
****Smoking (including passive smoking)
is the most important factor.
 The Philippine Health Agenda Framework
2016-2022
 Financial Protection: Filipinos, especially
the poor are protected from high cost of
health care.
 Better Health Outcomes: Filipinos attain the
best possible health outcome with no
disparity.
 Responsiveness: Filipinos feel respected,
valued and empowered in all of their
interaction with the health system.
 new health agenda framework will be
attainable through the ACHIEVE strategy:
 Advance health promotion,
 A
primary care and quality
 Cover all Filipinos against
 C
financial health risk
 Harness the power of
 H
strategic HRH
 Invest in eHealth and data for
 I
decision-making
 Enforce standards,
 E accountability and
transparency
 V  Value clients and patients
 Elicit multi-stakeholder
 E
support for health
 RH Law, otherwise known as Republic
Act 10354 or the Responsible Parenthood
and Reproductive Health Act
 10-point Socioeconomic Agenda of the
Duterte Administration:
 Macroeconomic policies
 Tax reform
 Increase competitiveness and the ease of  Wait for the dog to pass or slowly back
doing business. away.
 Accelerate annual infrastructure spending to  Remain motionless (e.g., "be still like a
account for 5% of GDP, with Public-Private tree") when approached by an unfamiliar
Partnerships playing a key role. dog or attempt to sit.
 Promote rural and value chain development  Avoid retrieving objects from the dog's
toward increasing agricultural and rural mouth
enterprise productivity and rural tourism.  Do not disturb the dog while the animal is
 Ensure security of land tenure to encourage eating.
investments, and address bottlenecks in land  Curl into a ball with your head tucked and
management and titling agencies. your hands over your ears and neck if a dog
 Invest in human capital development, knocks you over.
including health and education systems, and  Immediately let an adult know about stray
match skills and training to meet the dogs or dogs that are behaving strangely.
demand of businesses and the private sector.  *Head (NERVOUS SYSTEM)- most
 Promote science, technology, and the affected part and most fatal or dangerous
creative arts to enhance innovation and site for dog bite
creative capacity towards self-sustaining,
inclusive development.  Post-exposure prophylaxis (PEP)
 Improve social protection programs, 
including the government’s Conditional  Categories of  Post-
Cash Transfer program, to protect the contact with exposure
poor against instability and economic suspect rabid prophylaxis
shocks. animal measures 
 Strengthen implementation of the
Responsible Parenthood and  Category I –
Reproductive Health Law to enable touching or
especially poor couples to make informed feeding
choices on financial and family planning. animals, licks
 RABIES PREVENTION AND CONTROL on intact skin  None 
PROGRAM  Category II –
 RA 9482 or “The Rabies Act of 2007”, nibbling of
rabies control ordinances shall be strictly uncovered
implemented. skin, minor  Immediate
 March as the Rabies Awareness Month scratches or vaccination
 September 28 as the World Rabies Day. abrasions and local
 Stop walking or moving. without treatment of
 Stay still and be calm. bleeding the wound 
 Do not panic or make loud noises.
 Category III –
 Avoid direct eye contact with the dog. single or
 Say "No" or "Go Home" in a firm, deep multiple
voice. transdermal  Immediate
 Stand with the side of your body facing the bites or vaccination
dog. scratches, and
 Avoid facing a dog directly since it can 
licks on administratio
appear aggressive to the dog. broken skin; n of rabies
 keep your body turned partially or contamination immunoglob
completely to the side. of mucous ulin; local
 Slowly raise your hands to your neck, with membrane treatment of
your elbows in. with saliva the wound
 from licks,
 Examples of active vaccines are PCEC
contacts with
(Purified Chick Embryo Vaccine),
bats.
RABIPUR and the new cheap drug
 Head is the most fatal site for dog bite VEROWELL
 Legs are the most common site for dog  - It will give 2 years immunity against rabies
bite if the dose is completed
 Rabies vaccine is an artificial active  Postexposure Prophylaxis for Non-
 given on days 0, 3, 7, 14, 30, and 90, immunized Individuals
 avoid gluteal area
 Rabies vaccine should be administered in  Treatment  Regimen
the deltoid muscle
 In both pre-exposure and post-exposure any remaining
immunization, the full 1.0 mL dose should volume should be
be given 9 intramuscularly administered IM
 Sanofi Pasteur created both antirabies and at an anatomical
antidengue vaccine site distant from
 antirabies horse serum vaccine
 HRIG is from human serum administration.
Also, RIG should
 Examples of active vaccines are PCEC
not be
(Purified Chick Embryo Vaccine),
administered in
RABIPUR and the new cheap drug
the same syringe
VEROWELL
as vaccine.
 - It will give 2 years immunity against rabies Because RIG
if the dose is completed might partially
 Postexposure Prophylaxis for Non- suppress active
immunized Individuals production of
antibody, no more
 Treatment  Regimen than the
recommended
 Wound  All postexposure dose should be
cleansing prophylaxis should given.
begin with
immediate  Vaccine  HDCV or
thorough cleansing PCECV 1.0 mL,
of all wounds with IM (deltoid area
soap and water. If ), one each on
available, a days 0 , 3, 7, and
virucidal agent 14. – AVOID
such as povidine- GLUTEAL
iodine solution INJECTIONS
should be used to  A 5th dose on day 28 may be recommended
irrigate the for immunocompromised persons.
wounds.
 Postexposure Prophylaxis for Previously
 RIG  If possible, the full Immunized Individuals
dose should be
infiltrated around  Treatment  Regimen
any wound(s) and
  EBOZ or ebola ZAIRRE strain is the
 Postexposure Prophylaxis for Previously most deadliest strain
Immunized Individuals
 RESTV or EBOR (ebola reston) species,
found in Philippines and the People's
 Treatment  Regimen Republic of China, have been found to
infect humans but they do not cause illness
 Wound  All postexposure or death
cleansing prophylaxis should  Diagnosis
begin with
 ***antibody-capture enzyme-linked
immediate
immunosorbent assay (ELISA)
thorough cleansing
of all wounds with
soap and water. If
available, a
virucidal agent  Herbal Medicine  USES
such as povidine-  Niog Niogan  Anti-helminthic
iodine solution (Quisqualis Indica) every 6 months
should be used to 2 hours p
irrigate the supper
wounds.  No to less than 4
y/o
 RIG  RIG should not be  Tsaang Gubat  Diarrhea
administered. (Carmona Retusa)
 Ampalaya  DM Type 2-
 Vaccine  HDCV or PCECV (Momordica obesity
1.0 mL, IM Charantia)
(deltoid area), one
each on days 0 and  FOR PROPHYLAXIS IN HIV
3. CONFIRMED OR EXPOSED CHILD:
 Ebola: Mapping the outbreak  ANTIBIOTIC FOR PROPHYLAXIS: Oral
From the section of WEST Africa Cotrimoxazole
Ebola crisis
The hunters breaking an Ebola ban on  OPV (Oral Polio Vaccine)
bushmeat- FRUIT BATS  “Sabin vaccine”
 Primary source = fruit bats or flying foxes ,  polio vaccine that is taken by mouth and
old world bats contains the three serotypes of poliovirus in
 Other sources: a weakened live state—called also Sabin
o Chimpanzees oral vaccine
o Gorillas  Measles- Subcutaneous
o fruit bats  Cold Chain under EPI
o monkeys o 6months- Regional Level
o antelope o Not more than 5days- Health
o porcupines centers using transport boxes.
o symptomatic humans  Most sensitive to heat: Freezer (-15 to -25
 Ebola largest outbreak in West Africa degrees C)
was first reported in March 2014, o OPV
 discovery in 1976. o Measles
The total number of reported cases is more 
than 28,607. Rubeola (measles)
 Virus is named after the ebola river
 There are 5 strains of EBOLA virus
 Communicable just before the rash
appears to 4-5 days after rash
appears=highly contagious
 The first sign of measles is usually a high
fever (often >104o F [40o C]) that typically
lasts 4-7 days.
 Koplik spots—bluish-gray specks or “grains
of sand” on a red base—develop on the
buccal mucosa opposite the second molars
 First 24 hours
o Fever, malaise, cough, coryza,
conjunctivitis
 In 48 hours
o “Koplik spots” (small, irregular,
red spots with minute bluish-white
center) first seen on buccal mucosa
 Diphtheria
 Diphtheria is an acute infection caused by
 bacteria Corynebacterium diphtheriae.
 The throat infection causes a gray to black,
tough, fiber-like covering, which can
block your airways
 Shick test for susceptibility to diphtheria:
A + shicks means no immunity or
suceptible; (antigen test)
 Moloney test – for sensitivity of diptheria
 Tetanus
 caused by the bacterium Clostridium tetani,
the spores of which are widespread in the
environment
 present with trismus (“lockjaw”), which is
the inability to open the mouth secondary to
masseter muscle spasm.
 Nuchal rigidity and dysphagia are also early
complaints that cause risus sardonicus, the
scornful smile of tetanus, resulting from
facial muscle involvement
 generalized muscle rigidity with intermittent
reflex spasms in response to stimuli (eg,
noise, touch).
 Tonic contractions cause opisthotonos (ie,
flexion and adduction of the arms, clenching
of the fists, and extension of the lower
extremities).
 ZIKA-
 The Zika virus was detected for the first
time in a rhesus monkey
 Virus was named after a forest
in Uganda in 1947. A year later, it was
isolated in an Aedes mosquito from the same
region.
 The first human cases appeared in 1952
Anthrax
 (Splenic fever, Siberian ulcer, Charbon,
Milzbrand)
 Bacillus anthracis.
 most common in wild and domestic
herbivores (eg, cattle, sheep, goats, camels,
antelopes)
 B anthracis spores can remain viable in
soil for many years.
 Raw or poorly cooked contaminated meat is
a source of infection for zoo carnivores and
omnivores; anthrax resulting from
contaminated meat consumption has been
reported in pigs, dogs, cats, mink, wild
carnivores, and people
 Specific diagnostic tests include bacterial
culture, PCR tests, and fluorescent antibody
stains to demonstrate the agent in blood
films or tissues
 Treatment
 Oxytetracycline given daily in divided doses
also is effective.
 Ciprofloxacin,Amoxicillin, Gentamicin,
,Erythromycin Doxycycline, Streptomycin,
 Middle East respiratory syndrome
coronavirus (MERS-CoV)
- CAMEL FLU or SARS of MIDDLE
EAST
 a viral respiratory disease caused by a novel
coronavirus (MERS‐CoV) that was first
identified in Saudi Arabia in 2012.
 1st case - april 2012
2nd case - sept. 2012
 1st Outbreak
- SAUDI ARABIAN PENINSULA
 MERS COV IS A CLADES "B" VIRUS
 Republic of South Korea is the largest
outbreak outside of the Middle East year
2015
 Source of the virus
originated in bats and was transmitted to
camels sometime in the distant past.
 camels - major reservoir host for MERS-
CoV and an animal source of MERS
infection in humans
 Where is the virus thought to have come
from?
 Thought to have originated from bats, due to
the high degree of adaptive evolution within
their DPP4 gene.
 Host- humans, camels, maybe bats
 Distribution- Middle East, esp. Saudi
Arabia.
Transmission- human-to-human contact
 Highest Risk : IMMUNOSUPRESSION
(CANCER)
 Symptoms- Mild-severe respiratory illness
Gastrointestinal symptoms
Complications-pneumonia, kidney failure
 Is person to person transmission possible?
- Only if in close personal contact.
 What is a 'Silent Mers CoV' case? How
frequent are these cases?
 An asymptomatic sufferer who carries Mers
CoV antibodies within their bloodstream. It
is estimated to occur in 20% of cases.
 Timeline of current outbreak?
 2012 outbreak in Saudi Arabia. Bat ->
Camel -> Human. Man consumed milk/meat
of infected camel.
 Signs and symptoms
A- airway problems
B- breathing difficulty
C- cough and colds
D- diarrhea
E- elevated temperature
 Treatment: No specific treatment
 No vaccine or specific treatment is currently
available.
 avoid contact with camels, drinking raw
camel milk or camel urine, or eating meat
that has not been properly cooked.
 Avoid contact to camel droplets
 Cover your nose and mouth with a tissue
when you cough or sneeze, then throw the
tissue in the trash.
 Avoid touching your eyes, nose and mouth
with unwashed hands.
 Avoid personal contact, such as kissing, or
sharing cups or eating utensils, with sick
people.
 Severe Acute Respiratory Syndrome
(SARS) is an acute respiratory illness
caused by infection with the SARS virus.
 Fever followed by a rapidly progressive
respiratory compromise is the key
complex of signs and symptoms, which also
include chills, muscular aches, headache and
loss of appetite.
 greater than 50% in persons aged 65
years and older (WHO Update ). – mostly
affected
 The etiologic agent of SARS is a
coronavirus which was identified in
March 2003. The initial clusters of cases
in hotel and apartment buildings in Hong
Kong
 Attack rates in excess of 50% have been
reported.
 virus is predominantly spread by droplets
or by direct and indirect contact.
Shedding in feces and urine also occurs.
 Medical personnel, physicians, nurses, and
hospital workers are among those commonly
infected.
 NO drugs or a vaccine for SARS,
 control of this disease relies on the rapid
identification of cases and their appropriate
management, including the isolation of
suspect and probable cases and the
management of their close contacts.
 Supportive care is of primary importance.
Immunomodulation by steroid treatment
may be important
 The SARS outbreak of 2003
 According to the World Health Organization
(WHO), a total of 8,098 people worldwide
became sick with SARS during the 2003
outbreak. Of these, 774 died. In the United
States, only eight people had laboratory
evidence of SARS-CoV infection. All of
these people had traveled to other parts of
the world with SARS. SARS did not spread
more widely in the community in the United
States.
 Symptoms of SARS
 SARS begins with a high fever
(temperature greater than 100.4°F
[>38.0°C]).
 headache, an overall feeling of discomfort,
and body aches.
 Some people also have mild respiratory
symptoms at the outset. About 10 percent to
20 percent of patients have diarrhea.
 After 2 to 7 days, SARS patients may
develop a dry cough. Most patients
develop pneumonia.
 Examples of close contact include kissing or
hugging, sharing eating or drinking utensils,
talking to someone within 3 feet, and
touching someone directly. Close contact
does not include activities like walking by a
person or briefly sitting across a waiting
room or office.
 The most important greenhouse gas which is
released whenever people burn fossil fuels
to do everyday activities like driving cars,
heating buildings, and making electricity.
Answer: Carbon dioxide
 Among which is not a gas produce by green
houses
Answer: oxygen and Carbon monoxide
 What can we do to stop climate change?
Answer:
1.Turn off the lights when you leave a room.
2.Turn off your computer and other
electronic devices when you're not using
them.
4.Drive less. Instead, walk, ride your bike,
or use public transportation if you can.
6.Use less water.
7.Create less waste.
8. Recycle used paper, cans, bottles, and
other materials
9. Plant more trees and prevent
deforestations.
 What are the disease commonly seen
because of climate change
Answer: mosquito borne, vector borne and
food borne diseases
 What are the most visible signs and
synptoms of climate change?
Answer:
1. average sea level around the world has
risen by nearly 7 inches in the last 100 years
2.glaciers all over the world are shrinking
4. many bird species are shifting northward.
5. most obvious changes are happening in
the Arctic, where the amount of ice in the
ocean has decreased dramatically.
 The most abundant greenhouse gas, but
importantly, it acts as a feedback to the
climate.
Answer: Water vapor
 What are the important actions in the fight
against global warming.
 Answer: Preventing deforestation as well as
planting trees, through reforestation and
afforestation
 The principal forcing greenhouse gases are:
 Carbon dioxide (CO2)
Methane (CH4)
Nitrous oxide (N2O)
Fluorinated gases
 The main feedback greenhouse gas is: Water
vapor
o Top 10 green house gases
 1. WATER VAPOR
2. CARBON DIOXIDE
3. METHANE
4. NITROUS OXIDE
5. OZONE
6. TRIFLUOROMETHANE
7. HEXAFLUOROETHANE
8. SULFUR HEXAFLUORIDE
9. TRICHLOROFLUOROMETHANE
10. SULFURYL FLUORIDE
 Climate forcing refers to
processes that disrupt Earth's heat balance
forcing the climate to change
 Greenhouse effect refers to
B ability of certain atmospheric gases to trap
heat and keep the planet relatively warm
 These are the surgical and medical cases,
and the corresponding fixed rates or
payments/reimbursements by Philhealth.
Medical Cases:
Dengue Fever and DHF Grades 1 and 2 —
8,000 pesos
DHF Grades 3 and 4 — 16,000
Asthma — 9,000
Newborn care package (NCP) — 1,000 —
increased to 1,750
 Surgical Cases:
1. Radiotherapy — 3,000 pesos
2. Hemodialysis — 4,000
3. Normal delivery or maternity care
package (MCP) in maternity or lying-in
clinics — 8,000
Normal spontaneous delivery (NSD) in
Level 1 hospitals — 8,000
Normal spontaneous delivery (NSD) Levels
2 to 4 hospitals — 6,500
Delivery by caesarian section (CS) —
15,000 — increased to 19,000
Appendectomy — 26,000 — decreased to
24,000
* Note: For SURGERIES, the Case Rates
payment will apply only to cases managed
in Levels 2 to 4 hospitals, with certain
exceptions.
 to avail of your PhilHealth benefits
 Payment of at least 3 months’ worth of
premiums within the immediate 6 months of
confinement.
 And 9 months’ worth of contributions in the
last 12 months is needed for pregnancies,
availing of the newborn care package,
dialysis, chemotherapy, radiotherapy and
selected surgical procedures, .
 Confinement in an accredited hospital for 24
hours due to illness or disease requiring
hospitalization.
 Attending physician(s) must also be
PhilHealth accredited.
 Claim is within the 45 days allowance for
room and board.
HOME VISIT is a family-nurse contact which allows the
health worker to assess the home and family situations in
order to provide the necessary nursing care and health
related activities.
Purposes
1. To give care to the sick, to
a postpartum mother and her newborn with the
view teach a responsible family member to
give the subsequent care.
2. To assess the living condition of the patient
and his family and their health practices in
order to provide the appropriate health
teaching.
3. To give health teachings regarding the
prevention and control of diseases.
 4. To establish close relationship between the
health agencies and the public for the
promotion of health.
5. To make use of the inter-referral system and
to promote the utilization of community
services
Principles
The following principles are involved when performing a
home visit:
1. A home visit must have a purpose or
objective.
2. Planning for a home visit should make use of
all available information about the patient
and his family through family records.
3. In planning for a home visit, we should
consider and give priority to the essential
needs of the individual and his family.
4. Planning and delivery of care should involve
the individual and family.
5. The plan should be FLEXIBLE.
Steps
1. Greet the patient and introduce yourself.
2. State the purpose of the visit (Question after
Greeting the patient and introducing
yourself what is your next action? = State the
purpose of the visit)
3. Assess or Observe the patient and determine
the health needs.
4. Put the bag in a convenient place and then
proceed to perform the bag technique.
5. Perform the nursing care needed and give
health teachings.
6. Record all important date, observation and care
rendered.
7. Make appointment for a return visit.
BAG TECHNIQUE is a tool by which the nurse,
during her visit will enable her to perform a
nursing procedure with ease and deftness, to save
time and effort with the end view of rendering
effective nursing care to clients.
PUBLIC HEALTH BAG is an essential and
indispensable equipment of a public health nurse
which she has to carry along during her home visits.
Principles
 will minimize, if not, prevent the
spread of any infection.- most important
central feature
 It saves time and effort in the
performance of nursing procedures.
 The bag technique can be performed in a
variety of ways depending on the
agency’s policy, the home situation, or as
long as principles of avoiding transfer
of infection is always observed.
Contents
 Extra paper for making waste bag
 Plastic/linen lining
 Apron
 Hand towel
 Soap in a soap dish
 Thermometers (oral and rectal)
 2 pairs of scissors (surgical and bandage)
 2 pairs of forceps (curved and straight)
 Disposable syringes with needles (g. 23
& 25)
 Hypodermic needles (g. 19, 22, 23, 25
ONLY)
 Sterile dressing
 Cotton balls
 Cord clamp
  Micropore plaster
 Tape measure
 1 pair of sterile gloves
 Baby’s scale
 Alcohol lamp
 2 test tubes
 Test tube holders
 Solutions of:
o Betadine
o 70% alcohol
o Zephiran solution
o Hydrogen peroxide
o Spirit of ammnonia
o Ophthalmic ointment
o Acetic acid
o Benedict’s solution

*BP apparatus and stethoscope are carried

separately and are never placed in the bag.

4 C Points to consider
COMPLETE- contain all the necessary
articles, supplies and equipment that will
be used to answer the emergency needs
CLEAN - contents should be cleaned
very often, the supplies replaced and
ready for use anytime.
CONTENT protection- contents should
be well protected from contact with any
article in the patient’s home.
*Consider the bag and its contents clean and
sterile, while articles that belong to the
patients as dirty and contaminated.
CONVENIENT- arrangement of the
contents of the bag should be the one
most convenient to the user, to facilitate
efficiency and avoid confusion.

Initial step in bag technique : Upon arrival at the

patient’s home, place the bag on the table lined
with a clean paper. The clean side must be out and
the folder part, touching the table Steps