CHN – M4 – DOH PROGRAMS RELATED TO FAMILY HEALTH

□WHAT should be done when a baby has a (+)positive

🍏NEWBORN SCREENING (NBS) NBS result?
Definition
- simple procedure to find out if a baby has a congenital metabolic disorder; - should be referred @ once to the nearest hospital/
may lead to mental retardation & even death if left untreated specialist for confirmatory test & further management.
- Ideally done b/w 24 - 48 hrs from birth,.Some disorders are ✗t detected if the test is done earlier than 24 hrs
Purpose -If ✗ specialist in the area, the NBS secretariat office
Newborn Screening is important bc, tho most babies w/ metabolic disorders look normal @ birth, will assist the attending physician
it is ✗ easy to detect if baby has the disorder until the onset of Ss/Sxs.
At this time, more often, ill effects are already irreversible
Legal Mandate
🖸 Republic Act No. 9288 "Newborn Screening Act of 2004"
- an act promulgating a comprehensive policy & a national system for ensuring newborn screening.
Objectives
- Ensure that every newborn has access to NBS for certain heritable conditions that can result in mental retardation,
serious health complications/ death if left undetected & untreated Steps:
- Establish & integrate a sustainable newborn screening system w/in the public health delivery system #1. Informing/ Motivating the parents
- Ensure that ALL health practitioners are aware of the advantages of newborn screening - Inform Parents/ legal guardians abt the nature & benefits of NBS.
& of their respective responsibilities in offering newborns the opportunity to undergo NBS - Preferably during prenatal visits, mother’s classes, pre-marriage counseling, home visits.
- Ensure that parents recognize their responsibility in promoting their child's right to health & full development, - Use posters; brochures; video if available.
w/in the context of responsible parenthood, by protecting their child from preventable causes of disability & death thru NBS □The ff MUST be discussed:
>wat is NBS? >wat are the benefits to the newborn?
Procedure of NBS >wat disorders are being screened? >how is NBS performed?
○ Using the heal prick method, >why is NBS important? >cost of NBS?
a few drops of blood are taken from the baby heel & blotted on a special absorbent filter card.
The blood is dried for [4 hrs] & sent to the Newborn Screening Center. 🖸RA 9288 - Article 3 Sec. 7. Refusal to be Tested
□WHO will collect the sample for newborn screening? - A parent/ legal guardian may refuse testing on the grounds of RELIGIOUS BELIEFS, but shall ACKNOWLEDGE IN WRITING
Collection of sample may be performed by any trained health worker such as: their understanding that refusal for testing places their newborn @ risk for mental retardation/ death of undiagnosed heritable
i. Physician conditions.
ii. Medical technologists
iii. Nurses - A copy of this refusal documentation shall be made part of the newborn’s medical record & refusal shall be indicated in the
iv. Midwives national NBS database
□WHERE is NBS available?
- available in practicing health institutions (hospitals, Lying-in, rural health units & health centers) !! secure 2 duly signed copies
- If babies are delivered @ home, babies may be brought to the nearest institution offering NBS
- @PUBLIC hosp/ RHU → After 48 hrs[day 3], mother will pay for 1, 750php
#2. Collecting NBS Samples
□WHEN is NBS available? - Taking of Blood sample from the newborn to be used for the laboratory test
- NBS results = available w/in 3 wks [after the NBS lab receives] & tests the samples sent by the institutions. NBS shall be performed immediately after 24 hrs of life but ✗t later than 3 days from complete delivery of the newborn.
Results are released by NBS lab to the institutions & are released to the attending birth attendants/ physicians,
Parents may seek the results from the institutions were samples are collected MEMORANDUM 2014-002 PROTOCOL on COLLECTING BLOOD SAMPLE for NEWBORN SCREENING
- Result: (-) negative screen = normal & the baby is ✗t suffering from any of the disorders being screened. Dept of Health & Newborn Screening Reference Center directs that “NBS should be ideally done immediately after 24 hrs
from birth n Blood sample should be in the laboratory* ✗t later than 4 days old”
If (+) positive screen = NBS N. coordinator will immediately inform the coordinator of the institution
where the sample was collected for recall of Pts for confirmatory testing.

PROTOCOL on COLLECTING NBS SAMPLES of PRETERM, LOW BIRTH Wt. & SICK INFANTS
- 28th day of Life = 28 completed days & ✗t just 27 days & a few hrs
- Preterm = ↓37 completed weeks of gestation
- Low Birth Weight = ↓2000 grams @ birth
� SICK ------------------------------------------------------------------------------------------------------------------------
○Any baby admitted to the Neonatal Intensive Care Unit (NICU) & requires intensive care (i.e. intubated, CPAP, etc.)
○Intensive care given to the baby may be due to diagnosed/suspected illness & other medical/surgical probs
**For babies who qualify the abovementioned definition of “sick”, Dx MUST BE WRITTEN
[ @ the BOTTOM PART of the NBS FILTER CARD ]
Pt. =✗t SICK →then ✗Dx indicated on the filter card
� ✗t SICK ------------------------------------
○Pts admitted to the NICU & on antibiotics
only for suspected sepsis &
✗t needing intensive care are ✗t
CONSIDERED “SICK” BABIES
○Pts admitted to the NICU & under
phototherapy for physiologic jaundice are ✗t
CONSIDERED “SICK” BABIES
○Pts admitted to NICU for observation only &
✗t receiving intensive care are ✗
CONSIDERED “SICK” BABIES
� Blood Transfusion --------------------------
If BT = FFP, recollect after 48 hrs &
after 14 days
If BT = PRBC/ FWB, recollect after 48hrs,
after 14 days & after 120 days
since last BT.
□WHERE do u COLLECT the sample?
An area in the health facility designated for sample collection
□WHAT method to be used?
Heel Prick Method
- Preferred Method for collecting NBS Samples
- Venous blood maybe used only as an alternative when other blood works are done
- Umbilical Blood is ✗t recommended
- Make 2 punctures in quick succession on the [ lower {lateral} borders of the heel ]
Steps:
1. Prepare the necessary/ needed materials
i. NBS Filter card (properly filled out) – fill out the filter card completely
ii. Sterile Lancets (3mm)
2. WARM the baby’s heel
i. For sufficient & free flow of blood, hold the baby’s leg [ lower than the head ]
ii. WARM baby’s heel w/h warm towel for 3 mins OR, Gentle rubbing of the baby’s heel
3. CLEAN the puncture site - Clean the area thoroughly w/ 70% isopropyl alcohol/ sterile H2O swab
4. DRY the puncture site
- WIPE the prospective site w/ a DRY cotton ball to prevent contamination of specimen w/ alcohol/ sterile H2O
5. PRICK the heel- make 2 puncture in quick succession on the [ lower {lateral} borders of the heel ]
! Do ✗t puncture these sites:
○Arch of the foot ○Swollen area
○Previously punctured area ○Fingers
6. WIPE 1st drop of blood - w/ a dry sterile cotton to avoid contamination of blood samples
7. Apply intermittent pressure - to the surrounding area of puncture site.
• DO ✗t SQUEEZE the heel too hard as it may cause interstitial fluid to leak & contaminate specimen.
• If blood flow slows down, release grip & wipe puncture site again w/ DRY cotton to remove clot.
! (+)al REMINDERS in Blood Collection
○Avoid layering
○Do ✗ use alcohol/ lotion prior to pricking
○Consider the space b/wn the 2 pricks
○Maximize the use of the filter paper
8. DRY the samples
- DRY samples {horizontally} on drying rack @ room temp 25°C for @ least 4 hrs/ completely dry
- Dry on the drying rack in alternate manner
- Avoid exposure to direct sunlight, artificial light/ heating instruments
Even AirConditioner-> shown sa ppt
🍏NATIONAL IMMUNIZATION PROGRAM PNEUMOCOCCAL VACCINE 23
- In 1976, the Expanded Program on Immunization (EPI) was established - Only senior citizens (selected) in the community
- 6 vaccine-preventable diseases were initially included in the EPI: - Lasts for 5 yrs
TB, poliomyelitis, diphtheria, tetanus, pertussis & measles - Meeting & orientation among senior citizens
- Vaccines under the EPI: - Consent form ✗t needed
○BCG = Bacillus Calmette-Guerin →to prevent TB - Assessment
○Hepatitis B →to prevent Hepa B,.,. sumn Blood - Issuance of immunization card
○Oral Poliovirus Vaccine --- idk but its OPV vaccine types 1 & 3
○Pentavalent Vaccine ---- (DTP-HEPA B-HAEMOPHILUS INFLUENZAE TYPE B) →5 vaccines in 1
○Measles Containing Vaccines (Antimeasles Vaccine, MMR) ✰SCHOOL-BASED IMMUNIZATION PROGRAM
○Tetanus Toxoid. 1. HUMAN PAPILLOMAVIRUS (TYPES 6, 11, 16, 18)
- [ In 2014 ] Pneumococcal Conjugate Vaccine 13 was included in the routine immunization of EPI. “ RECOMBINANT VACCINE”
- ○ Inactivated Polio Vaccine (IPV) ---- yung type 1 ng OPV - 2 doses; 6 months interval [Sept-March]
- ○Measles, Mumps & Rubella (MMR) - Grade IV female students ages 9-13 y/o
- Meeting & orientation among parents of the students
- Consent form
- Assessment
- Issuance of immunization card

2. MEASLES RUBELLA &

TETANUS DIPHTHERIA VACCINE
- 1 dose MR on [ R arm ]; 1 dose TD on [ L arm ]
- Grade 1 & 7 students (PUBLIC)
- Meeting & orientation among parents of the students
- Consent form
- Assessment
- Issuance of immunization card
↓LOWER Infant & Child Mortality Rates
PROVISION of LOGISTICS If Filipino Children receive COMPLETE
& TIMELY IMMUNIZATION
Vaccines are provided to Provincial Health Offices on a
quarterly basis. Aside from vaccines, vaccination supplies
like→ Autodisable syringes, safety boxes, mixing syringes, Expanded Program on Immunization
Over-all Goal: To ↓reduce the morbidity & mortality among children against the most common vaccine-preventable disease cotton, alcohol, needle removers, vaccine carriers, - 1 of the DOH programs that have
transport boxes, and AEFI kits are being provided. already been institutionalized & adopted
Program Target: Achieve 95% Fully Immunized Child Coverage.
by ALL LGUs in the country

Fully Immunized Child (FIC) – b4 13 months, it received ALL the antigen listed in baby book
Completely Immunized Child (CIC) – w/in 12 mos tas 13 month na then INCOMPLETE sya
-on going, Ex. baby [2mos], received → 1 dose of BCG, 1 dose of Hepatitis B
Program Strategies:
1. Conduct of routine immunization for infants/ children/ women thru Reaching Every Purok Strategy
2. Supplemental Immunization Activities (SIA)
3. Vaccine-Preventable Disease Surveillance
Legal Mandate
🖸R.A. 10152 – Mandatory Infants & Children Health Immunization Act of 2011
- Immunization should be given FREE for infants & children up to 5 y/o.
- Infants born in health facilities should be administered with Hepatitis B w/in 24 hrs.
- Infants delivered by persons other than the physician, nurse/ midwife, must be brought to any available H. C. facility
so as to be immunized against Hepatitis B w/in 24 hrs after birth but ✗ later than 7 days.

🖸R.A. 7846 – Compulsory immunization against Hepatitis B for infants & children below ↓8 y/o
 □ SCHEDULE & ADMINISTRATION ANTIGEN: Oral Polio vaccine (OPV)
AGE: 6 weeks, 10 weeks, 14 weeks
ANTIGEN: BCG vaccine DOSE: 2 drops || ROUTE: Oral || SITE: Mouth
AGE: i. @ birth [ w/in 2 months ]
ii. booster [ school entrance ]
DOSE: @ birth & booster → 0.05 mL ANTIGEN: Anti-measles vaccine (AMV 1)
ROUTE: ID AGE: 9-11 months
SITE: @birth →[ [R] deltoid region (arm)] If w/ OUTBREAK: give as early as 6 months of age
Booster→ [ [L] deltoid] DOSE: 0.5 mL || ROUTE: SQ || SITE: [OUTER] part of the upper arm

ANTIGEN: Measles- mumps- rubella vaccine (AMV 2)

AGE: 12-15 months ;;;; 2 doses = recommended
2nd dose: given @ 4-6 yrs of age
DOSE: 0.5 mL ||ROUTE: SQ || SITE: [OUTER] part of the upper arm

ANTIGEN: Rotavirus vaccine

AGE: 6 wks, 10 wks
DOSE: 1.5 mL || ROUTE: Oral || SITE: Mouth

Rotavirus
- infects the [ Large intestine ]
- most common cause of diarrhea in infants & children
ANTIGEN: Hepatitis B vaccine - Children b/w the ages of 6 & 24 months = @ GREATEST risk for developing severe rotavirus infxn.
AGE: Hep B1 – @ birth, w/in 24 hrs 3 Doses (@ least 4 weeks apart; 3rd dose should ✗t be given earlier than 24 wks of age) - In PHs, @ least 30% of diarrhea-related hospitalizations are caused by rotavirus

DOSE: 0.5mL || ROUTE: IM || SITE: Anterolateral thigh muscle ANTIGEN: Tetanus & Diphtheria Toxoid
Sir! Injects @ UPPER quadrant ng [R]/ [L] AGE: 1 DOSE to High School Students ()
DOSE: 0.5 mL || ROUTE: IM || SITE: Buttocks/ @ Arm / ? @ {lateral thigh}

ANTIGEN: DPT – HepB-Hib (Pentavale vaccine)

AGE: 6 weeks, 10 weeks, 14 weeks GOALS of the EPI:
For DPT: For Hib: 1. To immunize ALL infants/children against the most common vaccine-preventable diseases
4th Dose: 12 months of age Booster Dose: 12-15 months of age 2. To sustain the polio-free status of the PHs
5th Dose: ✗t given if 4th was given @ 4 y/o 3. To eliminate measles infection (Presidential Proclamation No. 4 s.1998)
4. To eliminate maternal & neonatal tetanus elimination campaign starting [ 1997 ]
DOSE: 0.5 mL || ROUTE: IM || SITE: Anterolateral thigh muscle
5. To control diphtheria, pertussis, hepatitis B & German measles.-> “Rubella”
○Pentavale vaccine PREVENTS 6. To prevent extrapulmonary TB among children.
Hib (Haemophilus influenzae Disease)
1. Diphtheria
- bacterium responsible for serious illnesses, REMINDERS on the EPI
2. Pertussis
such as→ meningitis & pneumonia, o Receiving the antigens @ the earliest possible age ↓reduces the chance of the child
3. Tetanus
w/ almost all cases younger than ↓5 yrs, getting infected/ sick of the immunizable diseases
4. Hepatitis B
w/ those b/w 4 & 18 months of age especially vulnerable. o Administration of the hepatitis B vaccine @ birth ↓reduces the chance of the child becoming a carrier
5. Influenza
“Haemophilus influenzae type b”
 Vaccine Contents Form

Important considerations r/t the schedule & manner of administering infant immunizations: BCG Freeze-dried, reconstituted w/ a
Live, attenuated bacteria
1. Use only 1 sterile syringe & needle per client. (Bacillus Calmette-Guerin) special diluent
2. There is ✗need to restart a vaccination regardless of the time that has elapsed b/w doses. RNA-recombinant, using Hepatitis B surface antigen Cloudy, liquid, in an auto-
3. All the EPI antigens are safe & effective when administered simultaneously, that is, Hepatitis B Vaccine (HBs Ag) disable injection syringe if
during the same immunization session but @ different sites. available
It is ✗t recommended, however, Diphtheria toxoid, inactivated pertussis bacteria, tetanus
to mix diff vaccines in 1 syringe b4 injection,/ to use a fluid vaccine for reconstitution of a freeze-dried vaccine. DPT-Hep B-Hib toxoid recombinant DNA surface antigen, & synthetic Liquid, in an auto-disable injection
(Pentavalent vaccine) conjugate of Haemophilus influenzae B bacilli syringe
When a vaccine is administered to an infant @ the same time w/ another injectable vaccine,
the vaccines should be administered on diff sites.
Oral Polio Vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
However, if more than 1 injection has to be given on the same limb,
the injection sites should be 2.5-5 cm apart to prevent overlapping of Local rxs. Freeze-dried, reconstituted w/ a
Anti-measles vaccine
Live, attenuated virus special diluent
(AMV1)
4. The recommended sequence of the co administration of vaccines = OPV 1st → followed by Rotavirus vaccine,
then other appropriate vaccines. Measles-mumps-rubella Freeze-dried, reconstituted w/ a
5. OPV - administered by putting drops of vaccine straight from the dropper onto the child’s tongue. Live, attenuated virus
vaccine (AMV2) special diluent
Do ✗t let the dropper touch the tongue.
Clear, colorless liquid, in a
6. Only monovalent hepatitis B vaccine must be used for the birth dose. Rotavirus vaccine Live, attenuated virus
container w/ an oral applicator
Pentavalent vaccine must ✗t be used for the birth dose bc DPT & Hib vaccine should ✗t be given @ birth.
Tetanus Toxoid Weakened Toxin Clear, colorless liquid,.Sometimes
Monovalent vaccine - 1 that contains an ANTIGEN against a SINGLE disease.
slightly turbid in appearance
Pentavalent vaccine contains antigens against 5 diseases:
diphtheria, pertussis, tetanus, hepatitis & Haemophilus influenzae B (Hib).
Vaccine Side Effects Management
7. Children who have ✗t received AMV1as scheduled & whose parents/ caretakers do ✗t know whether they have
received AMV1 shall be given AMV1 a.s.a.p, then AMV2 [1 month after the AMV1 dose.] - 1. Koch’s phenomenon ✓1. NO management
- acute inflammatory reaction w/in 2-4 days after vaccination; is needed
8. All children entering day care centers/preschool & grade 1 shall be screened for Measles immunization. - usually indicates previous exposure to TB ✓2. Refer to the physician
Those w/o the immunization shall be referred to the nearest health facility for immunization. - 2. Deep abscess @ vaccination site; almost invariably for incision & drainage
BCG
due to SQ/ deeper injection
(Bacillus Calmette-Guerin)
9. The 1st dose of rotavirus vaccine is administered only to infants aged 6 - 15 wks. - Indolent Ulceration ✓3. Treat w/ INH powder
The 2nd dose - given only to infants aged 10 wks up - a ↑maximum 32 wks. - ulcer w/c persists after 12 weeks from vaccination date ✓4. If suppuration occurs, treat
- Glandular enlargement as deep abscess.
10. Administer the entire dose of the rotavirus vaccine slowly on 1 side of the mouth (b/w cheek & gum) w/ the tip of the
- enlargement of Lymph glands draining the injection site Refer to physician for I&D.
applicator directed toward the back of the infant’s mouth.
To prevent spitting/ failed swallowing, stimulate the rooting & sucking reflex of the young infant. Hepatitis B Vaccine - LOCAL soreness @ the injection site ✓ NO Tx is necessary
For infants aged 5 months/↑ older, lightly stroke the throat in a [ downward motion ] to stimulate swallowing. - 1. Fever that usually lasts for only 1 day. ✓1. Advise parent
Fever beyond 24 hours is to give antipyretic
✗t due to the vaccine but to other causes ✓2. Reassure parent that
I. Vaccines: CONTENTS & FORM
1st table - 2. LOCAL soreness @ the injection site soreness will disappear
- 3. Abscess after a week/ ↑ usually indicates that the injection after 3-4 days
DPT-Hep B-Hib
II. Side Effects of vaccination & their management (Pentavalent vaccine) was ✗t deep enough/ the needle was ✗t sterile. ✓3. I&D may be necessary
2nd table ✓4. Proper management of
- 4. Convulsions: although very rare, may occur in children convulsions;
↑older than 3 months; caused by the pertussis vaccine pertussis vaccine
should ✗t be given anymore
 Oral Polio Vaccine - None
1.5. EPI vaccines & the special diluents have the ff cold chain requirements:
- Fever 5-7 days after vaccination in some children; ✓Reassure parent instruct them to
Anti-measles vaccine
sometimes there is a mild rash give antipyretic.
(AMV1) - OPV: -15 to –25°C. OPV has to be stored in the freezer.
In the vaccine bag, OPV is placed in contact w/ cold packs.
Measles-mumps-rubella - LOCAL soreness, fever, irritability & malaise in some ✓Reassure parent instruct them to - ALL other vaccines (including measles vaccine, MMR & Rotavirus vaccine) have to be stored in the
vaccine (AMV2) children give antipyretic. refrigerator @ a temp of +2 to +8°C.
These vaccines should be stocked neatly on the shelves of the refrigerator.
- Some children develop mild vomiting & diarrhea, fever & ✓ Reassure parent & instruct them
Do ✗t stock vaccines @ the refrigerator door shelves.
Rotavirus vaccine irritability to give antipyretic & Oresol to the
child - Hepatitis B vaccine, Pentavalent vaccine, Rotavirus vaccine & TT - damaged by freezing
✓Apply cold compress at the site. - should ✗t be stored in the freezer.
Tetanus Toxoid NO other Tx is needed. - Wrap the containers of these vaccines w/ paper b4 placing them in the vaccine bag w/ cold packs
- LOCAL soreness @ the injection site
- Keep diluents cold by storing them in the refrigerator in the lower/ door shelves.
2. Observe the 1st expiry-first out (FEFO) policy
3. Comply w/ recommended duration of storage & transport.
◑BCG (Normal Course) - @ the health center/RHU w/ a refrigerator, the duration of storage should ✗t exceed 1 month.
1. Wheal formation that disappears after 30 minutes. Using transport boxes, vaccines can be kept only up to a maximum of 5days.
2. A small red tender swelling at the injection site [ after 2 weeks ]. This develops into a small abscess, w/c ulcerates - Take NOTE! if the vaccine container has a vaccine vial monitor (VVM)
3. The ulcer heals by itself & leaves a scar. ! VVM = round disc of heat-sensitive material placed on a vaccine vial to register cumulative heat exposure.
4. The course from the vaccination to the formation of the scar takes about [ 12 weeks ] DIRECT relationship exists b/w rate of color change & temp: ↑temp. ↑color change

4. Abide by the open-vial policy of the DOH.

III. MAINTAINING THE POTENCY of the EPI vaccines Multi-dose vial may be opened for 1 or 2 clients if the health worker feels that a client can✗t come back for the scheduled
`Vaccines confer immunity only when they are potent, & to retain their potency, immunization session.
vaccines must be properly stored, handled & transported. Multidose liquid vaccines, like → OPV, Pentavalent vaccine, hepatitis B vaccine & TT from w/c 1/ ↑ doses have been taken
1. Maintain the COLD CHAIN, the ff standard sterile procedures, may be used in the next immunization sessions for up to a maximum of 4 weeks,
system for ensuring the potency of a vaccine from the time of manufacture to the time it is given to an eligible client. provided that ALL the ff conditions are met:
1.1. STORAGE of vaccines should ✗t exceed: - The expiry date has ✗t passed
▪ 6 months @ regional lvl - The vaccine has ✗t been contaminated
▪ 3 months @ provincial/district lvl
▪ 1 month @ the main health centers/RHU (w/ refrigerators)
- The vials have been stored under appropriate cold chain conditions
▪ ✗t more than 5 days @ health centers - The VVM septum has ✗t been submerged in H2O
- The VVM on the vial, if attached, has ✗ reached the discard point
1.2. TRANSPORT of vaccines – use transport boxes/ vaccine carriers 5. Reconstitute freeze-dried vaccines such as→ BCG, AMV & MMR only w/ the diluents supplied w/ them
1.3. HANDLING of vaccines – once opened/ reconstituted, 6. Discard reconstituted freeze-dried vaccines 6 hrs after reconstitution/ @ the end of the immunization session, w/cever
vaccines must be placed in a special cold pack during immunization sessions comes sooner.
1.4. Discard: 7. Protect BCG from sunlight & rotavirus from light.
○BCG vaccines after 4 hours
○DPT, Polio, Measles & Tetanus Toxoid vaccines after 8 hours/ @ the end of a working day IV. Contraindications to Immunization
*The Public Health N. (PHN) = the Cold Chain Officer In general, there are NO contraindications to immunization of a sick child if the child is well enough to go home.
- In-charge of maintaining the cold chain equipment & supplies, like → the freezer/refrigerator, Sending children away & telling mothers to bring them back for immunization when they are well enough is ✗t a good
transport box, vaccine bags/carriers, cold chain monitors, thermometers & cold packs practice bc it delays immunization.
- Implements an emergency plan in the event of an electrical breakdown/ power failure Bringing the child back to the RHU/Health Center for immunization at another time may ✗t be easy for the mother.
 This also leaves the child @ risk of getting sick of an immunizable disease. - Of these 12 programs,
8 = nutrition-specific, 1 = nutrition-sensitive &
There are a few ABSOLUTE CONTRAINDICATIONS to the EPI vaccines. Do ✗t give: 3 = enables support programs
1. Pentavalent vaccine/DPT to children over 5 yrs of age.
2. Pentavalent vaccine/DPT to a child w/ recurrent convulsions or another active neurological disease of the CNS. - Program for local gov’t mobilization
3. Pentavalent vaccine 2 or 3/DPT 2 or 3 to a child = among the 3 enabling programs to ensure their wider
who has had convulsions/ shock w/in 3 days of the most recent dose participation in delivering nutritional outcomes.
4. Rotavirus vaccine when the child has a history of hypersensitivity to a previous dose of the vaccine, - The PPAN 2017-2022 comes w/ a budget estimate
intussuceptions/ intestinal malformation/ acute gastroenteritis. for the entire period of [ 6 years ]
5. BCG to a child who has Ss/Sxs of AIDS/ other immune-deficiency conditions/ who are immuno-supressed - The plan has a monitoring & evaluation framework
showing the plan for progress monitoring & evaluation
Some conditions that are considered FALSE CONTRAINDICATIONS, in w/c case the health worker may continue thru the 6-year period.
w/ the scheduled/ appropriate immunizations include:
i. Malnutrition
ii. Low-grade fever Nutrition problems to be addressed
iii. Mild respiratory infxn 1. H↑GH lvls of stunting & wasting among children under-5 years of age, w/ lvls that have remained UNchanged over
iv. Diarrhea – children w/ diarrhea who are due for OPV should receive a dose of OPV [ during the visit ] the yrs.
This dose, however, is ✗t counted. The child should return when the next dose of OPV is due. Also stunting = relatively ↓low among infants 0-11 months old, but is significantly h↑gher among 1y/olds.
The prevalence of stunting remains h↑gh for the older children.
PNEUMOCOCCAL VACCINE 23 [earlier nasa p. 3] 2. Deficiencies in vit A, iron, & iodine particularly among grps for w/c the problem is of public health significance.
✰ School-based immunization program 3. Hunger & food insecurity with 68.3% of Filipino households ✗t meeting their caloric requirements.
1. HUMAN PAPILLOMAVIRUS (TYPES 6, 11, 16, 18) RECOMBINANT VACCINE While this lvl is lower than that recorded in1989 (74.1%) it is higher than the level reported in 1998 (57%) & 2008 (67%).
2. MEASLES RUBELLA & TETANUS DIPHTHERIA VACCINE 4. @ the same time, overWt. & obesity among various population grps should be addressed, especially among adults.
Provision of Logistics
5. Maternal nutrition should also be addressed as survey results have shown that the prevalence of nutritionally-at-
risk women has ✗ improved over the yrs, w/ a prevalence rate b/w 24-26% since 2008. Furthermore, adolescent
🍏PH Plan of Action for Nutrition 2017-2022 pregnant women, those of poor educational attainment, coming from the poorest wealth quintile, & are employed
- Integral part of the Philippine Development Plan 2017-2022 have relatively higher lvls of undernutrition. Maternal nutrition could also affect the nutrition of the growing fetus.
6. Poor infant & young child feeding in the first 2 yrs of life coupled
- It is consistent w/ the Duterte Administration 10-point Economic Agenda, the Health for All Agenda of the
w/ bouts of infxn can explain the H↑GH lvls of stunting.
DOH, the dev’t pillars of malasakit (protective concern), pagbabago (change or transformation), & kaunlaran (dev’t)
& the vision of Ambisyon 2040 7. Exclusive breastfeeding (EBF) in the first 6 months of life continues to be a challenge.
EBF ↑d from 48.9% in 2011 to 52.3% in 2013 but went back to 48.8% in 2015.
- It fxs in & considers country commitments to the global community as embodied in the 2030 Sustainable Dev’t Goals,
However, a look at EBF rates by single age group w/in the 0-5 months-old band would show declining EBF w/ the
the 2025 Global Targets for Maternal, Infant & Young Child Nutrition, the 2014 International Conference on Nutrition
↓lowest rate among the 5-month olds.
- It consists of 12 programs & 46 projects serving as a framework for actions that ↓low rate of EBF together w/ the rate of never breastfed represent sub-optimal breastfeeding practice.
could be undertaken by member agencies: These low rates deprive the infant of needed nutrients for optimum growth @ the time when his growth is most rapid
○ National Nutrition Council (NNC), 8. By the 6th month of life, the infant should receive nourishment from solid & semi- solid food,
○ other national government agencies, in addition to breastmilk. However, only 15.5% of infants 6-23 months old receive the minimum acceptable diet
○ local government units, 9. The age grp 6-11 months old are the worst off for this indicator. Furthermore, while the highest wealth quintile has
○ non-government organizations, higher proportion of children 6-23 months old w/ minimum acceptable diet, the level is still ↓low @ less than (<)20%.
○ academic institutions, &
Thus, the problem for achieving optimum complementary feeding is ✗ simply rooted on income.
○ development partners.
■ For better accountability, a member agency of the NNC Governing Board
has been designated as lead for 1/ ↑ of these programs
Causality of malnutrition
1. A framework for the causality of child & maternal undernutrition. The framework ✗es undernutrition to arise from the
immediate causes of inadequate dietary intake & disease. These immediate causes are, in turn, linked with underlying
causes that include food insecurity, poor caring & feeding practices, & poor home environmental conditions &
inadequate health services. However, these immediate & underlying causes are further linked to basic causes at the
society level that covers among others, low access & control of resources.
2. While the framework is a globally accepted, & used framework, a framework that integrates under- & overnutrition in
one framework has been developed for use in the ASEAN region.
3. Thus, addressing both under- & overnutrition should involve actions to eliminate or reduce the negative impact of the
identified causal factors.
Focus on the first 1000 days of life. The first 1000 days of life refer to the period of pregnancy up to the first two years of the
child. This is the period during which key health, nutrition, early education & related services should be delivered to ensure
the optimum physical & mental development of the child. This is also the period during which poor nutrition can have
irreversible effects on the physical & mental development of the child, consequences of which are felt way into adulthood.
Complementation of nutrition-specific & nutrition-sensitive programs. This strategic thrust recognizes that malnutrition has
immediate, underlying, & basic causes, which should be addressed to achieve targeted nutritional outcomes. Thus, there is a
need to implement & deliver nutrition-specific interventions. These interventions “address the immediate determinants of fetal
& child nutrition & development, i.e. adequate food intake & nutrient intake, caregiving & parenting practices, & low burden
of infectious diseases.

Goal To improve the nutrition situation of the country as a contribution to:
i. The achievement of Ambisyon 2040 by improving the quality of the human resource base of the country
ii. ↓Reducing inequality in human dev’t outcomes
iii. ↓Reducing child & maternal mortality
Objectives
- PPAN 2017-2022 has two layers of outcome objectives, the outcome targets & the sub-outcome/ intermediate targets.
- The former refers to final outcomes against which plan success will be measured.
- The latter refers to outcomes that will contribute to the achievement of the final outcomes.
Intensified mobilization of local government units. To ensure that PPAN 2017- 2022 delivers the planned outcomes,
38 areas with greater magnitude of the stunting & wasting will be prioritized for mobilization of local government units.
Mobilization will aim to transform low-intensity nutrition programs to those that will deliver targeted outcomes. It will
involve capacity building & mentoring of LGUs on nutrition program management to transform them to self-propelling LGUs able
to plan, implement, coordinate, & monitor & evaluate effective nutrition programs. This strategy is also expected to compliment
the interventions in the First 1000 Days.
Reaching geographically isolated & disadvantaged areas (GIDAs) & communities of indigenous peoples. Efforts to
ensure that PPAN 2017-2022 programs are designed & implemented to reach out to GIDAs & communities of indigenous
peoples will be pursued. The community of NGOs & development partners’ resources will be engaged for this purpose.

Outcome targets NUTRITION-SENSITIVE PROGRAMS [pp12-14]

- To ↓reduce lvls of child stunting & wasting
- To ↓reduce micronutrient deficiencies to lvls below public health significance
- NO ↑ in overWt. among children
- To ↓reduce overweight among adolescents (from 8.3% to <5%) & adults (from 31.1% to 28%)

Sub-outcome/ intermediate outcome targets

- To ↓reduce the proportion of nutritionally-at-risk pregnant women from 24.8% to 20% by 2022
- To ↓reduce the prevalence of low birthweight from 21.4% in 2013 to 16.6% by 2022
- To ↑ the prevalence of exclusive breastfeeding among infants 5 months old from 24.7% in 2015 to 33.3 by 2022
- To ↑ the %age of children 6-23 months old meeting the minimum acceptable diet from 18.6% in 2015 to 22.5% by
2022
- To ↑ the proportion of households with diets that meet the energy requirements from 31.7% in 2013 to 37.1 by 2022

Strategic Thrusts
- Focus on the 1st 1000 days of life.
- Complementation of nutrition-specific & nutrition-sensitive programs.
- Intensified mobilization of local government units.
- Reaching geographically isolated & disadvantaged areas (GIDAs) & communities of indigenous peoples.
- Complementation of actions of national & local governments
Enabling Programs
- Mobilization of local government units for nutrition outcomes
- Policy development for food & nutrition
- Strengthened management support to the PPAN 2017-2022

🍏◑INFANT & YOUNG CHILD FEEDING

- IYCF was issued jointly by the World Health Organization (WHO) & the United Nations Children’s Fund (UNICEF) in
2002, to reverse the disturbing trends in infant & young child feeding practices.
- It aimed to improve the nutritional status & health of children especially the under-3 & consequently reduce infant &
under-5 mortality.
GOAL:
↓Reduction of child mortality & morbidity through optimal feeding of infants & young children

MAIN OBJECTIVE:
To ensure & accelerate the promotion, protection & support of good IYCF practice

🖸Executive Order No. 51

Aim of the Code is to contribute to the provision of safe & adequate nutrition for infants by the protection & promotion of breast
feeding & by ensuring the proper use of breastmilk substitutes & breastmilk supplements when these are necessary, on the
basis of adequate information & through appropriate marketing & distribution

◑ Garantisadong Pambata
Objectives:
- Contribute to the reduction of infant & child morbidity & mortality towards the attainment of MDG 1 & 4.
- Ensure that all Filipino children, especially the disadvantaged group (GIDA), have equitable access to affordable health, nutrition
& environment care.

Expanded Garantisadong Pambata Administrative Order 36 (2010)

o Feeding Program
o Community-based Deworming & Vit. A supplementation
o School-based Deworming & Vit. A supplementation
o Dose? Calendar schedule?

◑ Food Fortification Program

🖸Republic Act 8976, “An Act Establishing the Philippine Food Fortification Program & for other purposes”
- mandating fortification of flour, oil & sugar with Vitamin A & flour & rice with iron by Nov 7, 2004 & promoting voluntary fortification
thru the SPSP, Signed into law on November 7, 2000

Objectives:
o To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition
Problem
o To discuss various types of food fortification strategies
o To provide an update on the current situation of food fortification in the Philippines
Status & Recommendations for the Sangkap Pinoy Seal Program Adverse effects & intervention:
o There are 139 processed food products with SangkapPinoySeal with 83% with vitamin A, 29% with iron & 14% with o Allergy/local sensitivity – give antihistamine
iodine (2008) o Mild abdominal pain – give anti-spasmodic
o 37% of the products are snack foods o Diarrhea – give oral rehydrating solution
o Most of the products FDA analyzed are within the standard o Erratic worm migration – pull out worms from mouth/nose/ from other body orifices
o
Deworming is ✗t advised if the child has:
o Serious illness which requires referral to the hospital
o Abdominal pain
o Diarrhea
o History of sensitivity to drugs
o Severe malnutrition

◑ MICRONUTRIENT SUPPLEMENTATION PROGRAM ◑NUTRITIONAL ASSESSMENT

o short-term intervention for correcting high levels of micronutrient deficiencies until more sustainable food-based Anthropometry – the measurement of physical dimensions & gross composition of the body in determining the nutritional status.
approaches can be used effectively. Such measurements include:
o VAD, IDA & IDD persist in the Philippines, which is why this program is recommended for 0-59 month old children, in
addition to pregnant & lactating women & other women of reproductive age,/ those w/in the ages of 15-49 y/o. Weight-for-age – body weight relative to the child’s age. This measurement is frequently used because of ease of use.

Length/height-for-age - reflects attained growth in length or height in relation to child’s age at a given time. This can help identify
children who are short or stunted due to prolonged undernutrition or repeated illness. However, heredity must be considered
when using this measurement

Mid-upper arm circumference – used for rapid screening for malnutrition to identify children who need referral for further
assessment or treatment. MUAC below 115 mm is an accurate indicator of severe malnutrition in children aged 6-59 months
(WHO 2009).

*The MUAC is always taken on the [L] arm

*To measure MUAC, find the midpoint b/w the top of the shoulder & the tip of the elbow while the child’s [L] arm is
bent.
*Wrap the measuring tape around the upper arm at the level of the midpoint. *Read the MUAC while the arm is
hanging down the side of the body & relaxed (UNICEF 2011)

Clinical examination – recognition of signs of malnutrition from physical examination such as eye examination for lesions in
VAD or history taking, such as the mother's description of her child’s night blindness. This is useful in detecting micronutrient
deficiencies & severe forms of malnutrition like kwashiorkor & marasmus.

Biochemical examination – assessment of specific components of blood or urine samples in order to measure specific aspects
of one’s metabolism. In 2008, the National Nutrition Survey was conducted & included among the tests were serum retinol
◑DEWORMING
determination (to detect & determine severity of VAD), hemoglobin determination for iron-deficiency anemia (IDA) detection &
o Children 1-12 years old should be dewormed every 6 months. urine examination for detection of iodine deficiency.
o Children aged 12-24 months are given albendazole 200 mg/ half tablet of mebendazole 500 mg
o Children older than 2 years old are given albendazole 400 mg or mebendazole 500 mg.
o Both medications require intake on a full stomach.
🍏HERBAL MEDICINES 6. SAMBONG
- In recognition of the deep-seated practice of traditional medicine as an alternative modality for treating & preventing diseases a. Blumea Balsamifera
in the Philippines, the Department of Health (DOH) through its former Secretary Juan M. Flavier launched the b. INDICATIONS: treat kidney stones, wounds & cuts, rheumatism, anti-diarrhea, anti spasms, colds &
Traditional Medicine Program in 1992. = program aims to promote an effective & safe use of traditional medicine. coughs & hypertension, anti-edema, diuretic, anti-urolithiasis

- Then President Fidel V. Ramos appreciated the importance of the traditional medicine program & signed into law 7. ALKAPULKO
🖸Republic Act 8423 (R.A. 8423), Traditional & Alternative Medicine Act (TAMA) of 1997. a. Cassia Alata L. "ringworm bush/ schrub"
b. INDICATIONS: Antifungal
- This gave rise to the creation of Philippine Institute of Traditional & Alternative Health Care (PITAHC), w/c is tasked to promote c. tinea infxns, insect bites, ringworms, eczema, scabies & itchiness.
& advocate the use of traditional & alternative H. C. modalities thru scientific research & product development. d. Consideration: Fresh, matured leaves are pounded. Apply as soap to the affected part 1-2 times a day.

1. LAGUNDI 8. NIYUG-NIYUGAN
a. Vitex Negundo, "5-leaved chaste tree" a. QUISQUALIS INDICA L. "Chinese honey suckle”
b. INDICATIONS: cough, colds & fever. b. INDICATION: Anti-helminthic, ASCARIASIS
c. It is also used as a relief for asthma & pharyngitis, rheumatism, dyspepsia, boils, & diarrhea. c. Consideration: ✗t to be given to children below 4 years old.

2. ULASIMANG BATO 9. TSAANG GUBAT

a. Pepperonia Pellucida a. Carmona Retusa/ "Wild tea"
b. INDICATION: ↓uric acid b. INDICATIONS:
c. effectivity in treating arthritis & gout. taken as tea to treat skin allergies including eczema, scabies & itchiness wounds in childbirth
c. Stomache
3. BAWANG d. Diarrhea
a. Allium Sativum 10. AMPALAYA
b. INDICATIONS: ↓cholesterol, BaWHAT a. Mamordica charantia "bitter melon"
c. (hypertension & toothache) b. INDICATION: DM
d. treat infection w/ antibacterial, anti-inflammatory, anti-cancer & anti-hypertensive properties. hemorrhoids, coughs, burns & scalds, & being studied for anti-cancer properties.
It is widely used to ↓cholesterol level in blood.
e. CAUTION: Take on a full stomach REMINDERS in the USE of HERBAL MEDICINES
1. Avoid the use of insecticides as these may leave poison on plants.
4. BAYABAS 2. In the preparation of herbal medicine, use a clay pot & remove cover while boiling at low heat.
a. Psidium Guava L.
3. Use only part of the plant being advocated.
b. INDICATIONS: Wounds, toothache, diarrhea
c. antiseptic, anti-inflammatory, anti-spasmodic, antioxidant hepatoprotective, anti-allergy, antimicrobial, 4. Follow accurate dose of suggested preparation.
anti-plasmodial, anti-cough, antidiabetic, & antige✗oxic in folkloric medicine. 5. Use only 1 kind of herbal plant for each type of Sxs/ sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
5. YERBA BUENA
7. If Ss/Sxs are ✗t relieved after 2 or 3 doses of herbal medication, consult a doctor.
a. (Clinopodium douglasii) - Peppermint,
b. INDICATIONS: analgesic to relieve body aches & pain due to rheumatism & gout.
It is also used to treat coughs, colds & insect bites
c. Swollen gums, Pain, Insect Bites, Toothache, Menstrual/Gas Pain, Arthritis, Rheumatism ,
Nausea, Diarrhea, Cough & Cold