• Immunization is the process whereby a person is made
immune or to an infectious disease, typically by the
DOH Programs Related to Family Health
Expanded Program of Immunization (EPI)
• was established in 1976 to ensure that infants/children
and mothers have access to routinely recommended
infant/childhood vaccines. Six vaccine preventable
diseases were initially included in the EPI: tuberculosis,
poliomyelitis, diphtheria, tetanus, pertussis and measles. In
the Philippines it began in July 1979; every Wednesday is
designated as immunization day
• PD 996, is 1976 Providing for compulsory basic
immunization for infants and children below eight years of
age
• RA 10152- known as Mandatory Infants and Children
Health Immunization Act of 2011 requires all children
under 5 years old to be given basic immunization against
vaccine preventable diseases.
• RA 7846 provides for compulsory immunization against
Hepatitis B for infants and children below 8 years old . It
also provided for Hep B immunization within 24 hours of
birth
• COMPLETELY IMMUNIZED CHILDREN ( CIC) –refers
to children who completed their immunization schedule at
the age of 12-23 mos.
• CHILD PROTECTED AT BIRTH (CPAB) -a term used to
describe a child whose mother has received: •2 doses of
TT during this pregnancy provided that the second dose
was given at least a month prior to delivery • At least 3
doses of TT anytime any time prior to pregnancy with
this child
• FULLY IMMUNIZED CHILD ( FIC ) are those who were
given BCG, 3 doses of OPV, 3 doses of DPT and Hepa B
vaccine or 3 doses of Pentavalent and 1 dose of measles
vaccines before the child reaches 12 months of age.
IMMUNIZATION: CONCEPTS
administration of a vaccine.
• Vaccines stimulate the body’s own immune system to
protect the person against subsequent infection or disease
• Six vaccine-preventable diseases were initially included
in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus,
pertussis and measles.
• Vaccinations promote health and protect children from
disease – causing agents.
• Infants and newborns need to be vaccinated at an early
age since they belong to vulnerable age group. They are
susceptible to childhood disease.
• Maintain a master list of eligible children for
immunization.
ADMINISTER IMMUNIZATION FOLLOWING
THE PROTOCOLS
• right administration of vaccines
• right dose
• right route
• right schedule
• right interval
• proper utilization of cold chain
• Infuse proper aseptic technique and infection control •
one syringe: one child
• proper disposal of syringes
• Provide health teachings regarding EPI scheduled
immunization activity to enhance the awareness of
community and motivate them to adhere with the
campaigns.
• Conduct visits in the community to assess their needs
and to identify cases of EPI diseases.
• Have an updated record of children who had received
immunization and the like and report cases if there is.
PRINCIPLES IN HANDLING, TRANSPORTING
& STORING VACCINES
COLD CHAIN AND LOGISTICS
• Cold Chain Manager = Public Health Nurse
• Temperature monitoring of vaccines is done in all levels
of health facilities to monitor vaccine temperature
• Temperature checking is done twice a day in the morning
and in the afternoon before going home
• Temperature is plotted every day in monitoring chart to
monitor break in cold chain

TYPE OF STORAGE HOURS OF

VACCINE TEMPERAT LIFE
URE AFTER
OPENING

Most OPV, -15 to -25 C 8 hours

Sensitive Measles At the
to Heat freezer

Most Hep B, 2 to 8 C 8 hours

Sensitive DPT, Tetox Body of the
to Cold refrigerator

Sensitive BCG 2 to 8 C 4 hours

to sunlight Body of the
and refrigerator
Fluorescen
t light
SYMBOL EXPLANATION STAGE
Equipment:
The inner square I
• Cold room is lighter than the
• Freezer / Refrigerator outer circle. If the
expiry date has
• Transport box not passed, USE
• Vaccine carrier the vaccine.

• Thermometer As time passes II

the inner square
• Cool dog
is still lighter than
• Temperature monitoring the outer circle. If
the expiry date
• VVM (vaccine vial monitor)
has not passed,
• FIRST EXPIRY FIRST OUT USE the vaccine.

Discard point: III

the color of the
inner square
matches that of
the outer inner
circle. DO NOT
USE the vaccine.

Beyond the IV
discard point:
inner square is
darker than the
outer circle. DO
NOT USE the
vaccine.

OTHER CONSIDERATION TO MAINTAIN

POTENCY

1. Multidose liquid vaccine ( Penta, TT, Hep B ) may

be used to a maximum of 4 weeks
2. Reconstituted freeze dried vaccine (BCG, AMV,
MMR )will be discarded within 6 hours
 3. Use designated diluents for reconstitution
BCG At 0.05ml ID Right
4. Protect BCG from sunlight and Rotavirus from light (Bacillus birth Deltoid
Calmette Region
Guerin)
IMPORTANT CONSIDERATIONS RELATED
HEP. B At 0.5ml IM Anterolate
TO THE SCHEDULE AND MANNER OF birth ral thigh
muscle
ADMINISTERING INFANT IMMUNIZATION
DPT-Hep B- 6 0.5ml IM Anterolate
Hib( PENTA wks, ral thigh
1. There is no need to restart a vaccination VALENT) 10 muscle
wks,
regardless of the time that has elapsed between
14
doses. wks
2. All the EPI antigens are safe and effective when
Oral Polio 6 2 drops Oral Mouth
administered simultaneously Vaccine wks,
10
3. It is not recommended to mix different vaccines in
wks,
one syringe 14
wks
4. Vaccine should be administered in different sites
5. If more than one vaccine has to be given on the Pneumococc 6 0.5ml IM Anterolate
al wks, ral left
same limb injection site must be 2.5-5cm apart to
conjugated 10 thigh
prevent overlapping of local reactions vaccine wks, muscle
(PCV) 14
6. OPV first followed by Rotavirus
wks
7. First dose of Rotavirus is administered only to
IPV 14 0.5ml IM Anterolate
infants aged 6-15 weeks 2nd dose is given to aged wks ral left
10 weeks -32 weeks only thigh
muscle

CONTRAINDICATIONS Anti Measles 9-11 0.5ml SQ Outer part

Vaccine mos of the
AMV 1 upper arm

1. Anaphylaxis or severe hypersensitivity reaction to Measles- 12-15 0.5ml SQ Outer part

a previous dose Mumps- mos of the
Rubella AMV upper arm
2. Person with a known allergy to a vaccine 2
component SHOULD NOT be vaccinated
Rotavirus 6wks, 1.5ml Oral Mouth
3. Pentavalent vaccine/DPT to a child with recurrent 10
convulsions or another active neurological disease wks

4. Pentavalent 2 or 3 to a child who has had

convulsions within 3 days of the most recent dose
(WHO, 2005)
5. Rotavirus vaccine when the child has a history of
previous previous dose of the vaccine ,
intussusception or intestinal malformation or AGE
(DOH, 2012)
6. Do not give live vaccines like BCG to an
immunosuppressed client
7. A child with s/sx of severe dehydration 8. Fever of
38.5C and above

SCHEDULE AND MANNER OF

ADMINISTRATION OF INFANT
IMMUNIZATION

VACCINE AGE DOSE ROUTE SITE

 ● Note OPV 3 AND IPV vaccine must be
administered together If cannot be given together
with OPV don’t give IPV IPV and PCV 3 2.5CM
OR 2 FINGERS (DISTANCE OF THE INJECTION
SITE)
● IPV OR inactivated polio vaccine will boost
immunity against poliovirus types 1 and 3 in
children who have previously received OPV

Side effects of vaccination and their

management

VACCINE SIDE EFFECTS MANAGEMENT

BCG Koch’s No management

phenomenon: an is needed
acute
inflammatory
reaction 2-4 days
after vaccination ,
usually indicates
previous
exposure to
tuberculosis

Deep abscess at Refer to physician

vaccination site; for incision and
almost invariably drainage
due to
subcutaneous or
deeper injection

Indolent treat with INH

ulceration: an Powder
ulcer which
persist after 12
wks from
vaccination

Glandular If suppuration
enlargement: occurs , treat as
enlargement of deep abscess
the lymph glands
draining the
injection site

Hepatitis B Local soreness at No treatment is

Vaccine the injection site needed

Pentavalent Fever that last for Advise parent to

 1 day but fever give antipyretic
beyond 24 hours FAMILY COPING INDEX
is not due to the
vaccine but to
other causes
Purpose: To provide a basis for estimating the
Local soreness of Reassure parents
nursing needs of a particular family
the injection site that soreness will
disappear after 3- Health care need: A family health care need is
4 days
present when:
Convulsions : Proper
● The family has a health problem with which they
although very management of
rare may occur in convulsions ; are unable to cope.
children older pertussis vaccine
than 3 months should not be ● There is a reasonable likelihood that nursing will
caused by given anymore make a difference in the family’s ability to cope.
pertussis vaccine
Relation to coping nursing need: COPING may be
OPV None
defined as dealing with problems associated with
AMV Fever 5-7 days Reassure parent
health care with reasonable success. When the family
after vaccination and instruct to
in some children; give antipyretic to is unable to cope with one or another aspect of health
sometimes there the child
is a mild rash care, it may be said to have a coping deficit.

MMR Local soreness, Reassure parent DIRECTION OF SCALING

fever , irritability , and instruct to
and malaise in give antipyretic
some children Two parts of Coping Index:
1. A point on the scale
Rotavirus Some children Reassure parents
Tetanus toxoid develop mild and instruct them 2. A justification statement
vomiting and to give antipyretic
diarrhea , fever and oresol to the The scale enables you to place the family in relation
and irritability child Apply cold to their ability to cope with the nine areas of family
Local soreness at compress at the
the injection site site no other nursing at the time observed and as you would
treatment
expect it to be in 3 months or at the time of discharge
if nursing care were provided. Coping capacity is
rated from 1 (totally unable to manage this aspect
of family care) to 5 (Able to handle this aspect of
care without the help from community sources).
TETANUS TOXOID The justification consists of brief statements or
phrases that explain why you have rated the family as

VACCINE MINIMUM PERCENT DURATION you have.

INTERVAL PROTECTE OF
D PROTECTI GENERAL CONSIDERATIONS
ON

TeTox 1 As early as
1. It is the coping capacity of and not the underlying
possible problem that is being rated.
during
pregnancy 2. It is the family and not the individual being rated.

TeTox 2 4 weeks 80% 3 years

3. Rating should be done after 2-3 home visits
after TeTox (Mother) when the nurse is more acquainted with the
1
family.
TeTox 3 6 months 95% 5 years
4. Justification - a brief statement that explains
after TeTox (Mother)
2 why you have rated the family as you have.
TeTox 4 1 year after 99% 10 years These statements should be expressed in terms
TeTox 3 (Mother)
of behavior of observable facts.
TeTox 5 1 year after 99% Lifetime 5. Terminal rating is done at the end of the given
TeTox 4 (Mother)
period of time. This enables the nurse to see
 progress the family has made in their stresses and problems of life and to plan for
competence; whether the prognosis was happy and fruitful living.
reasonable; and whether the family needs further ● Family Living: This category is concerned
nursing service and where emphasis should be largely with the interpersonal or group aspects of
placed. family life.

SCALING CUES ● Physical Environment: This is concerned with

the home, the community and the work
The following descriptive statements are “cues” to environment as it affects family health.
help you as you rate family coping. They are limited ● Use of Community Facilities: Generally keeps
to three points – appointments. Follow through referrals. Tells
1 or no competence others about Health Departments services.
2 for moderate competence
3 for complete competence IMPLEMENTING FAMILY CARE PLAN

AREA SCORE JUSTIFY

CATEGORIES OF INTERVENTION
1
1. Promotive - Enabling people to increase control
3
over and improve their health. It involves the
5
population as a whole in the context of their
everyday lives, rather than focusing on people at
AREAS TO BE ASSESSED risk for specific diseases, and is directed toward
action on the determinants or causes of health.
● Physical independence: This category is
“Broad/General – prevent illness but not specific
concerned with the ability to move about to get
illnesses”
out of bed, to take care of daily grooming,
walking and other things which involve daily
activities. Four core service elements related to
health promotion:
● Therapeutic Competence: This category
includes all the procedures or treatment ■ Prevention of disease, injury and illness
prescribed for the care of ill, such as giving ■ Health education, anticipatory guidance and
medication, dressings, exercise and relaxation, parenting skill development
special diets. ■ Support that builds confidence and is
● Knowledge of Health Condition: This system is reassuring for mothers, fathers and carers
concerned with the particular health condition ■ Community capacity building
that is the occasion of care.
● Application of the Principles of General 2. Preventive - Dealt with the prevention of illness

Hygiene: This is concerned with the family action to decrease the burden of disease and

in relation to maintaining family nutrition, associated risk factors. Focuses on preventing

securing adequate rest and relaxation for family disease and illness and promoting overall

members, carrying out accepted preventive general health and wellbeing. Nurses work to

measures, such as immunization. prevent risk factors for disease through patient

● Health Attitudes: This category is concerned education. They provide instruction on healthy

with the way the family feels about health care in diets. Immunizations and exercise. “For specific

general. illnesses”

● Emotional Competence: This category has to 3. Curative - Is to cure a disease or promote

do with the maturity and integrity with which the recovery from an illness, injury or condition;

members of the family are able to meet the usual involves treatment intended to alleviate the
 symptoms or cure a current medical condition. It and travel time if the family is motivated and
strives to reduce pain, improve function, and help independent.
improve quality of lids for the patient’s
impairment. “There are signs and symptoms” INTERPROFESSIONAL CARE IN THE
4. Rehabilitative - Nurses assist patients with COMMUNITY:
temporary and long-term disabilities or chronic
illnesses. They assist in adapting to their ● Interprofessional Practice (IPP) - Is a
conditions, meeting their highest potential, and collaborative practice which occurs when health
living more independent lives. care provides work with people from within their
own profession, with people outside their
TOOLS OF PUBLIC HEALTH NURSE profession and with patients and their families
1. Public Health Bag (PHN) - Essential and ○ Rural Health Unit Personnel
indispensable equipment of the public health ○ Local Government Units
nurse which he/she has to carry along when ○ Government Organizations
he/she goes out home visiting. It contains basic ● Government Organizations
medications and articles which are necessary for ■ DSWD - The Department of Social Welfare
giving care. and Development is the primary government
agency mandated to develop, implement
HOME VISIT and coordinate social protection and
poverty-reduction solutions for and with the
- Is a family-nurse contact which allows the health
poor, vulnerable and disadvantaged.
worker to assess the home and family situations
The following agencies are attached to DSWD:
in order to provide the necessary nursing care
○ Council for the Welfare of Children
and health related activities. In performing home
○ Inter-Country Adoption Board
visits, it is essential to prepare a plan of visit to
○ National Youth Commission
meet the needs of the client and achieve the best
○ National Council on Disability Affairs
results of desired outcome.
■ Nutritional Council - National Nutrition
Council Core Functions:
GROUP CONFERENCE
○
Formulate national food and nutrition
policies and strategies and serve as
- Often involves the entire family and can be done the policy, coordinating and advisory
body of food, nutrition and health
at home, clinic, school, or work place. It is useful
concerns
in a situation where the family has a chronic ○ Coordinate planning, monitoring, and
evaluation of the national nutrition
problem that is having a negative effect on the
program
entire family. ○ Coordinate the hunger mitigation and
malnutrition prevention program to
achieve Millennium Development
TELEPHONE CALLS
Goals
○ Strengthen competencies and
- May be effective, efficient and appropriate if the capabilities of stakeholders through
objectives and outcomes of care require public education, capacity building and
immediate access to data, given problems on skills development
○ Coordinate the release of funds, loans,
distance or travel time.
and grants from government
organizations (GO's) and non
WRITTEN COMMUNICATION government organizations (NGO'S);
and
- Is another less time consuming option for the ○ Call on any department, bureau, office, agency,
and other instrumentalities of the government
nurse when there are a large number of families
for assistance in the form of personnel, facilities
needing to follow-up on top problems of distance and resources as the need arises
 ■ The Commission on Population (POPCOM)
- Is a government agency mandated as the
overall coordinating monitoring and policy
making body of the population programs. It is
the lead agency promoting activities.
● Non-government organizations:
■ Socio-civic organizations - A nonprofit
organization or corporation that is operated
exclusively for the promotion of social welfare.
■ Religious organizations
■ Schools
BASIC EMERGENCY OBSTETRIC AND
NEWBORN CARE (BEMONC)
PROVIDER FACILITIES
● Barangay Health Station (BHS)
● Rural Health Unit (RHU)
● District
● Community Hospitals
SERVICES PROVIDED BY THE PROVIDER
FACILITIES
1. Pre-pregnancy package of services include the
following provisions:
❖ Micronutrient supplementation consisting of important
minerals and vitamins such as zinc, iodine, calcium,
vitamin A capsules and
iron tablets
● Iron folate 60 mg tablets 1 tablet daily
● Vitamin A at least 5000 IU every week (a daily
multivitamin supplement maybe taken as
option when the required vitamin A is not
available)
● Promotion of use of iodized salt
❖ Tetanus toxoid immunization following the
recommended schedule
❖ Family Planning
● IEC and FP counseling with focus on modern
methods and fertility awareness and
observing the principles of informed choice,
birth spacing,
responsible parenthood and respect for life; and
contraceptive provision as appropriate
❖ Provision of oral health services
❖ Counselling on STI/HIV/AIDS, nutrition, personal
hygiene, and the consequences of abortion
❖ STI screening using syndromic approach
❖ Adolescent and youth health services including peer and
professional counseling and RH education
❖ Promotion of healthy lifestyle including advice relative
to smoking cessation, healthy diet, regular exercise and
moderate
alcohol intake.
❖ Management of lifestyle-related diseases like diabetes,
cardiovascular disease (CVD), etc.
❖ Prevention and Management of other diseases including
tuberculosis, malaria (e.g. provision of insecticide treated
bed nets
for malaria-infested areas), schistosomiasis, and
anemia
2. Complete Prenatal Package
❖ Provision of eight essential antenatal care services
● Monitoring of height and weight
● Taking the blood pressure
● Screening and blood testing including
Complete Blood Count, blood Typing,
urinalysis, VDRL or RPR, HbSAg, blood
sugar screening, pregnancy test, cervical cancer
screening using acetic acid wash and papanicolaou
smear.
● Micronutrient supplementation (iron, folate
andVitaminA supplementation) Malaria
prophylaxis where appropriate
● Deworming
● Birth planning
❖ Promotion of exclusive breastfeeding, newborn
screening, BCG and Hepatitis B birth dose immunization.
❖ Counseling on:
1. Use of modern FP methods especially
lactation amenorrhea (LAM), with focus on
health caring
and health seeking behaviors; and
2. Contraception including surgical procedures
where appropriate: bilateral tubal ligation
(BTL), no scalpel vasectomy (NSV) and
 management of complications resulting from ❖ Postpartum nursing care
contraception. ● Perineal washing
❖ Laboratory screening and medical management of STI- ● Changing of hospital gown
HIV cases and their complications. ● Checking vital signs
❖ Counseling on Healthy Lifestyle with focus on smoking ● Rooming-in
cessation, healthy diet and nutrition, regular exercise, STI
control HIV prevention and oral health . For the Newborn:
❖ Prevention and management of early bleeding in ❖ Drying to keep the baby warm
pregnancy. ❖ Provision of appropriate thermal care through mother
❖ Administration of antenatal loading dose of steroids for and newborn skin-to-skin contact, maintaining a delivery
threatened premature delivery. room temperature of 25-28 degrees centigrade and
❖ Early detection and management of signs of wrapping the newborn with clean, dry cloth.
complications of pregnancy. ❖ Immediate latching on and initiation of breastfeeding
❖ Measurement of fundic height against the age of within the first hour after birth.
gestation, fetal heartbeat and fetal movement count ❖ Non-immediate cord clamping (1-3 minutes or until
to assess the adequacy of cord pulsation stops)
fetal growth and well being.
❖ Prevention and management of other conditions as Should complications occur, a BEmONC provider
indicated: facility must be able to administer the following
● Hypertension emergency care
● Anemia services:
● Diabetes ❖ Parenteral administration of oxytocin in the third stage
● Tuberculosis of labor.
● Malaria ❖ Parenteral administration of loading doses of anti-
● Schistosomiasis convulsant.
● STI/HIV/AIDS ❖ Parenteral administration of initial dose of antibiotics.
❖ Provision of other support services: ❖ Assisted vaginal delivery during imminent breech
● Antenatal registration through active tracking delivery.
by the WHTs ❖ Manual removal of placenta
● Birth Planning ❖ Removal of retained placental products.
● Home visits and follow up ❖ Administration of loading dose of steroids for premature
● Safe blood supply labor.
● Transportation and communication support ❖ Administration of intravenous fluid, blood volume
services expander and/or blood transfusion.
❖ Newborn resuscitation
3. Complete Childbirth Package ❖ Treatment of neonatal sepsis as necessary.
For the mother : ❖ Oxygen support for newborns
❖ Monitoring vital signs and the progress of labor using
the partograph. 4. Complete Post-Partum and Post-Natal Package
❖ Identification of early signs and symptoms and For the Mother:
administration of appropriate management of prolonged ❖ Postpartum check up including identification of early
labor, signs and symptoms of postpartum complications like
hypertension, abnormal presentation, bleeding. hemorrhage,
❖ Active management of the third stage of labor. infection and hypertension
❖ Provision of immediate postpartum nursing care (prior ❖ Micronutrient supplementation, including iron and
to discharge from the delivery room) folate.
❖ Counseling on: ❖ Micronutrient supplementation consisting of important
● Proper Nutrition. minerals and vitamins such as zinc, iodine, calcium,
● Benefits of exclusive breastfeeding up to six vitamin A capsules and iron tablets
months. ✓ Iron folate 60 mg tablets 1 tablet daily for 3-6 months.
● Benefits of skin to skin contact especially ✓ Vitamin A at least 5000 IU every week (a daily
among preterm babies multivitamin supplement maybe taken as option when the
● Essential neonatal care required vitamin A is not available).
❖ Laboratory screening and medical management of STI- ✓ Promotion of use of iodized salt
HIV cases and their complications ❖ Tetanus toxoid immunization following the
❖ Provision of FP services and contraception including recommended schedule
surgical procedures where appropriate: bilateral tubal ❖ Family Planning
ligation (BTL), ✓ IEC and FP counseling with focus on modern methods
no-scalpel vasectomy (NSV) and management of and fertility awareness and observing the principles of
complications resulting from contraception. informed choice, birth spacing, responsible parenthood and
❖ Prevention and management of other diseases as respect for life; and
indicated: ✓ Contraceptive provision as appropriate
● Hypertension ❖ Provision of oral health services
● Diabetes ❖ Counselling on STI/HIV/AIDS, nutrition, personal
● Anemia hygiene, and the consequences of abortion
● Tuberculosis ❖ Laboratory screening for STIs
● Malaria ❖ Adolescent and youth health services including peer and
● Schistosomiasis professional counseling and RH education
● STI/HIV/AIDS ❖ Promotion of healthy lifestyle including advice relative
For the Baby: to smoking cessation, healthy diet, regular exercise and
● Postnatal care required within 24 hours after moderate alcohol intake.
birth includes ❖ Management of lifestyle-related diseases like diabetes,
✓ Cord care CVD, etc
✓ Breastfeeding ❖ Prevention and Management of Other Diseases
✓ Vitamin K injection including tuberculosis, malaria (e.g. provision of
✓ Eye prophylaxis insecticide treated bed nets for malaria-infested areas),
✓ Delayed bathing until 6 hours of life schistosomiasis, and anemia
✓ BCG and first dose of Hepatitis B Immunization
✓ Newborn screening Prenatal care package
● Counseling on post-partum/post-natal check- The following antenatal services provided at the
up, home care and immunization BEmONC provider facilities shall likewise be provided
in a CEmONC facility:
5. Provision of other support services ❖ Provision of eight essential antenatal care services 1.
❖ Birth registration Monitoring of height and weight
❖ Safe blood 2. Taking the blood pressure
❖ Transportation and communication 3. Screening and blood testing including Complete
Blood Count, blood Typing, urinalysis, VDRL or RPR,
COMPREHENSIVE EMERGENCY OBSTETRIC HbSAg, blood sugar screening, pregnancy test,
AND NEWBORN CARE (CEMONC) cervical cancer screening using papanicolaou smear
4. Micronutrient supplementation (iron, folate and

Pre-pregnancy Vitamin A supplementation)

5. Tetanus toxoid immunization
6. Malaria prophylaxis where appropriate ● Perineal washing
7. Deworming 20 ● Change hospital gown
8. Birth planning ● Check vital signs
● Rooming-in in the case of non-problematic
❖ Promotion of exclusive breastfeeding, newborn cases.
screening, BCG and Hepatitis B birth dose immunization. ● Return to ward if baby is preterm and needs to
❖ Counseling on: be confined at the Newborn Intensive Care
✓ use of modern FP methods especially lactation Unit (NICU). Advice should be given relative to
amenorrhea (LAM), with focus on health caring and health breastfeeding schedules at the NICU.
seeking behaviours; and
✓ contraception including surgical procedures where For the newborn:
appropriate: bilateral tubal ligation (BTL), noscalpel ❖ Drying to keep the baby warm
vasectomy (NSV) and management of complications ❖ Non-immediate cord clamping
resulting from contraception ❖ Provision of warmth through skin-to-skin contact with
❖ Counselling on Healthy Lifestyle with focus on smoking mother, immediate latching on and initiate breastfeeding
cessation, healthy diet and nutrition, regular exercise, STI within first hour after birth.
control HIV prevention and oral health ❖ Prevention and
Management of early bleeding in pregnancy and its
complications.
❖ Administration of antenatal loading dose of steroids for BASIC EMERGENCY OBSTETRIC AND
threatened premature delivery. NEWBORN CARE
❖ Early detection and management of danger signs and
complications of pregnancy. ● Parenteral administration of oxytocin in the
❖ Measurement of fundic height against the age of third stage of labor.
gestation, fetal heart beat and fetal movement count to ● Parenteral administration of initial dose of
assess the adequacy of fetal growth and wellbeing. antibiotics.
❖ Prevention and management of other diseases as ● Assisted vaginal delivery during imminent
indicated: breech delivery.
● Hypertension ● Manual removal of placenta.
● Anemia ● Removal of retained placental products.
● Diabetes ● Administration of loading dose of steroids for
● Tuberculosis premature labor.
● Malaria ● Intravenous fluid administration, blood volume
● Schistosomiasis expander and/or blood transfusion.
● STI/HIV/AIDS ● Newborn resuscitation.
● Treatment of neonatal sepsis
COMPLETE CHILDBIRTH PACKAGE For the ● Oxygen support for the newborn.
mother:
❖ Monitoring vital signs and the progress of labor using COMPREHENSIVE EMERGENCY OBSTETRIC
the partograph. AND NEWBORN CARE
❖ Identification of early signs and symptoms and
administration of appropriate management of prolonged ● Caesarian section
labor, hypertension, abnormal presentation, bleeding. ● Blood transfusion
❖ Active management of the third stage of labor. ● Management of newborn complications
❖ Provision of immediate post-partum nursing care (prior
to discharge from the delivery room) POSTPARTUM/POSTNATAL CARE
 ● In addition, the CEmONC provider facilities
Postpartum care package shall provide comprehensive emergency
● Post-partum check up including identification postnatal care that include life support
of early signs and symptoms of postpartum management for -
complications such as hemorrhage, infection ✓ low birth weight newborns
and hypertension. ✓ premature newborns
● Micronutrient supplementation, including iron ✓ sick newborns
and folate ● sepsis
● Counselling on: ● fetal alcohol syndrome
✓ Nutrition ● asphyxia
✓ Exclusive breastfeeding up to six months ● severe birth trauma
✓ Essential neonatal care ● severe jaundice others
✓ Special neonatal care for preterm and
“problematic” babies
✓ Laboratory screening and medical management
of STI-HIV cases and their complications
✓ Provision of FP services including
contraception: bilateral tubal ligation (BTL), no- NUTRITION
scalpel vasectomy (NSV) and management of
complications resulting from contraception Micronutrient Program
✓ Prevention and management of other diseases as Goal of Micronutrient:
indicated ➢ Achievement of better health outcomes, sustained health
● Hypertension financing and responsive health system by ensuring that all
● Diabetes Filipinos especially the disadvantaged group (lowest 2
● Anemia income quantiles)have equitable access to affordable health
● Tuberculosis care.
● Malaria
● Schistosomiasis Objectives:
● STI/HIV/AIDS 1. Contribute to the reduction of disparities related to
✓ Counseling on post-partum/post-natal check-up, nutrition through a focus on population groups and
home care and immunization areas highly affected or at risk to malnutrition
2. To provide vitamin A capsules, iron and iodine
● Immediate postnatal care package supplements to treat or prevent specific micronutrient
(required within 24 hours after birth) deficiencies
✓ Cord care 3. Go to scale with key interventions on micronutrient
✓ Initiation of Breastfeeding within the supplementation, food fortification, salt iodization and
first hour of life nutrient education.
✓ Vitamin K injection 4. Revive, identify, document and adopt good
✓ Eye prophylaxis practices and models for nutrition improvement.
✓ Delayed bathing to 6 hours of life 5. Build Nutrition human resource in relevant
✓ BCG and first dose of Hepatitis B departments/ agencies.
Immunization
✓ Newborn screening Interventions/Strategies Employed or
✓ Other services implemented
● Birth registration
1. Micronutrient Supplementation- is the provision implementers in providing good quality
of pharmaceutically prepared vitamins & minerals for micronutrient supplementation services to
treatment or prevention of specific micronutrient targeted populations nationwide
deficiency.
2. Food Fortification- the addition of essential MENTAL HEALTH GAP ACTION
micronutrients to widely consumed food product at PROGRAMME
levels above its normal state.
3. Improving diet/ dietary diversification- the mhGAP
adoption of proper food and nutrition practices thru ✓ is WHO’s action plan to scale up services for mental,
nutrition education food production & consumption. neurological and substance use disorders for countries
4. Growth monitoring and promotion- is an especially with low and lower middle incomes.
educational strategy for promoting child health, ✓ The priority conditions addressed by mhGAP are:
human development and quality of life through depression, schizophrenia and other psychotic disorders,
sequential measurement of physical growth and suicide, epilepsy, dementia, disorders due to use of alcohol,
development of individuals in the community. disorders due to use of illicit drugs, and mental disorders in
children.
✓ The mhGAP package consists of interventions for
prevention and management for each of these priority
The following policies were formulated and conditions.
implemented:
● AO No. 2010-0010: revised Policy on
Micronutrient Supplementation to support
Essential Intrapartal
achievement of 2015 MDG Targets to reduce
under-five and maternal deaths and
micronutrient needs of other population Is a package of evidence-based practices
groups recommended as the standard care in all births by
● AO No. 2007-0045: Zinc Supplementation skilled attendants in all government and private
and reformulated Oral rehydration salt in the settings by:
Management of diarrhea among children ● Department of Health (DOH)
● ASIN Law- R.A. 8172, “An act promoting salt ● Philippine Health Insurance Corporation
iodization nationwide and for other purposes”, (Philhealth ), and
signed into law on Dec. 20, 1995 ● World Health Organization (WHO).
● Food fortification law, R.A. 8976, “An act Basic component of DOH’s Maternal Newborn and
establishing the Philippine Food Fortification Child Health and Nutrition (MNCHN) strategy.
Program and for other purposes” mandating ● EINC practices at birth:
fortification of flour, oil and sugar with Vit A ○ Bound chronologically –ordered
and flour and rice with iron by November 7, ○ Standard procedures
2004 and promoting voluntary fortification
4 TIME BOUNDED INTERVENTIONS
through the SPSP, signed into law on
November 7, 2000 1. Immediate Drying

● Department Memorandum No. 2011-0303 2. Early skin to skin contact

“Micronutrient powder supplementation for 3. Proper cord clamping and cutting

children 6-23 months” 4. Non separation of baby from mother and

● Micronutrient supplementation manual of breastfeeding initiation

operations was developed to guide local,

regional and national managers and Purpose
 ● Immediate drying and early skin to skin
Purposes of Newborn Screening
contact – prevents hypothermia
● Properly timed cord clamping and cutting of
● Ensures early detection and management of
umbilical cord – prevents anemia
several congenital metabolic disorders
● Breastfeeding initiation within the first hour of
● Early diagnosis and initiation of treatment with
life prevents neonatal deaths
long-term care
CHANGES IN PRACTICES IN THE DELIVERY ● Ensures normal growth and development
ROOM

VISION
Dont’s:
The National Comprehensive Newborn Screening
● Manipulation of routine secretions if the baby
System envisions all Filipino children will be born
is crying and breathing normally
healthy and well, with an inherent right to life,
● Putting the newborn on a cold or wet surface
endowed with human dignity; and Reaching their full
● Wiping off vernix caseosa if present
potential with the right opportunities and accessible
● Foot printing
resources.
● Bathing earlier than 6 hours of life
● Unnecessary separation of the newborn
○ Weighing MISSION
○ Anthropometric measurements
○ Vit K administration To ensure that all Filipino children will have access to
○ Hepatitis B vaccine and avail of total quality care for the optimal growth
○ BCG and development of their full potential.
● Transferring of newborn to nursery/NICU
without indication GOAL

To reduce preventable deaths of all Filipino newborns

NEWBORN SCREENING due to more common and rare congenital disorders
through timely screening and proper management.

Newborn Screening (NBS) Program Why is the NBS Protocol Needed?

NBS - Integrated as part of the country’s public health ● Proper sequencing or order of newborn care
delivery system with the enactment of the Republic services need to be standardized based on
Act no. 9288 (Newborn Screening Act of 2004). current evidence that show reduction in neonatal
Department of Health (DOH) mortality and morbidity.
● Lead agency in the implementation of the law ● Achieving United Nations Millennium
and collaborates with other National Development Goal 4 of Reducing Under 5 Child
Government Agencies (NGA) and key Mortality (through reduction of neonatal deaths).
stakeholders
● It is also a service that has been available in IMCI (INTEGRATED MANAGEMENT OF
the Philippines since 1996
CHILDHOOD ILLNESS)
● Under the DOH, NBS is part of the Child
Development and Disability Prevention
◦ is an integrated approach to child health that
Program at the Disease Prevention and
focuses on the well-being of the whole child.
Control Bureau.
◦ IMCI aims to reduce death, illness and disability,
and to promote improved growth and development Who are the children covered by the IMCI protocol
among children under five years of age. ?
◦ IMCI includes both preventive and curative elements 1. Sick children birth up to 2 months (Sick Young
that are implemented by families and communities as Infant)
well as by health facilities. 2. Sick children 2 months up to 5 years old (Sick
child)
1995 IMCI was developed WHO- UNICEF to all
developing countries WHAT ARE THE STEPS IN THE IMCI CASE
1997 IMCI was brought to the Philippines thru the MANAGEMENT PROCESS?
DOH
2001 integration of IMCI to Nursing and Midwifery 1. Assess the child ‘s illness.
Curriculum ( attended by the academe from different 2. Classify the illness based on signs
Nursing & Midwifery school 3. Identify the treatment
4. Treat the child.
5. Counsel the mother
Reasons for Developing IMCI 6. Follow -up

◦ Curative care
General Danger Signs
◦ Aspect of Nutrition
◦ Not able to drink or breastfeed
◦ Immunization
◦ Vomits everything
◦ Disease prevention
◦ Convulsions
◦ Health promotion
◦ Lethargic or unconscious
◦ Convulsing now

Main Symptoms
◦ Cough or difficult breathing
◦ Fever
◦ Diarrhea
◦ Ear Problems

NATIONAL TB PROGRAM (NTP)

Important Elements for Improving Child

Health
◦ Improve case management of sick children
◦ Improve nutrition
◦ Ensure immunization
◦ Prevent injuries
◦ Prevent other diseases VISION: A country where TB is no longer a public
◦ Improve psychosocial support and stimulation health problem
GOAL: Cure at least 85% of the new sputum smear ● The only contraindication for DSSM is
positive TB cases discovered hemoptysis
Detect at least 70% of the estimated new ● Pulmonary TB symptomatics can only
sputum smear positive cases undergo other diagnostic tests (such as
cxr/culture) if necessary only after they have
OBJECTIVES: undergone DSSM with 3 sputum specimens
● Improvement of access to and quality of ● No TB diagnosis shall be made based on the
services results of chest X ray examination alone. PPD
● Enhancement of patient’s health seeking results should not also be used as bases for
behavior TB diagnosis.
● Sustainability of support for TB control
activities
● Strengthening management of TB control
services at all levels
CASEFINDING
● Is a method of identifying and diagnosing TB
cases among individuals suspected signs and
symptoms of TB.
● Fundamental to case finding is the detection
of infectious cases through DSSM
______________ - is the principal diagnostic method
IDENTIFYING TB SYMPTOMATICS
accepted by the NTP
● Provides a definitive diagnosis of active TB
● Identify TB symptomatics consulting at the
● The procedure is simple
DOTS facility
● It is economical, and
Signs and symptoms:
● A microscopy center can be put up even in
6. Other symptoms:
remote areas
● Motivate TB symptomatics to undergo DSSM
DSSM result serve as bases for categorizing TB
● Record details of each specimen submission
symptomatics according to standard case definition
(name of pt., date of submission, and result)
DSSM is used to:
● Encourage household members of identified
● Monitor progress of patients with sputum
TB cases, who are also TB symptomatics to
smear positive TB while they are receiving
undergo DSSM
anti TB treatment, and
● Confirm cure at the end of treatment\
COLLECTION AND TRANSPORT OF SPUTUM
ACTIVE CASE FINDING - a health worker’s
SPECIMEN
purposive effort to find TB cases
● Submit three sputum specimen within 2 days.
PASSIVE CASE FINDING - finding cases among TB
If quality sputum is not collected within 2 days
symptomatic who present themselves in a DOTS
the patient is given 1 week to complete the
facility
three specimen. If the patient fails to complete
POLICIES
the three specimen collection within one week,
● DSSM shall be the primary diagnostic tool in
another three set of three should be collected.
NTP case finding
○ First spot specimen on the spot - is
● All TB symptomatics identifies shall be asked
collected at the time of consultation or
to undergo DSSM for diagnosis before start of
soon as the TB symptomatics is
the treatment
identified
 ○ Early Morning Specimen - first
sputum produced early in the morning
immediately after waking up. It is
collected by the patient according to
instructions given by the DOTS facility
staff.
○ Third specimen or second spot
specimen - is collected when the TB
symptomatics comes back to the
DOTS facility to submit the second
specimen
INSTRUCTIONS ON HOW TO PRODUCE QUALITY
SPUTUM
● Rinse mouth with water
● Breathe deeply, hold breath, then exhale
slowly. Repeat the entire sequence twice,
● Cough strongly at the height of deep
inspiration after inhaling deeply for the third
time and spilt the sputum in the container
INTERPRETATION OF SPUTUM RESULTS /
LABORATORY DIAGNOSIS
● SMEAR POSITIVE - at least 2 positive
sputum smear results
● DOUBTFUL - only 1 positive out of 3 sputum
specimens.
○ ACTION TO TAKE: Request for
another set of 3 sputum specimens
RESULT:
1. If at least 1 specimen from the second set
specimens is positive = diagnosis is positive
2. If all 3 specimens from the second set of
specimens are negative = diagnosis is
negative
NOTE: The specimen out of the smear (+) results
with highest number is the final AFB
quantification
● SMEAR NEGATIVE - all three sputum smear
result are negative
Decision on Patient’s Diagnosis Based on Lab
Results
1. If POSITIVE - refer to physician for
assessment and initiation of treatment
2. If DOUBTFUL - ask patient to submit another
3 sputum specimens within one week
3. If NEGATIVE - re-assess smear negative w/
persistent symptoms, refer patient for CXR, if
CXR findings are suggestive of TB, refer to
TBDC.
CASE HOLDING
● Is the procedure w/c ensure that patients
complete their treatment
● The shortest duration of treatment is 6 mos.
● The treatment compliance is necessary to
cure TB and avoid development of drug
resistance.
Objective: effective and complete treatment of TB
cases, especially pulmonary sputum smear positive
cases
DIRECTLY OBSERVED TREATMENT - is a strategy
developed to ensure treatment compliance providing
constant and motivational supervision to TB patients.
● DOT works by having a responsible person
referred to as TREATMENT PARTNER,
watch the TB pt. Take medicines everyday
during the whole course of treatment
● QUALIFIED TREATMENT PARTNERS
a. DOTS facility staff (midwife or nurse)
b. Trained community member (BHW, Local
gov’t official, or former TB pt)
c. Family member
CLASSIFICATION OF TB
● Pulmonary TB
● Extra Pulmonary TB
Types of TB cases
1. NEW - has never had treatment for TB or who
has taken anti TB drugs for less than one
month
2. RELAPSE - previously treated for TB,
declared cured or treatment completed, and is
diagnosed with bacteriologically positive
(smear or culture) TB
3. TREATMENT FAILURE - a pt who, while on
treatment, is sputum smear positive at five 1. RIFAMPICIN - GI intolerance, orange colored
months or later during the course of treatment urine, flu like symptoms, mild skin reaction
2. ISONIAZID - peripheral neuropathy, GI
intolerance, mild skin reactions
3. PYRAZINAMIDE - hyperuricemia and mild
skin reactions
4. ETHAMBUTOL - optic neuritis
5. STREPTOMYCIN - ototoxicity, pain on the
injection site
4. RETURN AFTER DEFAULT (RAD) - returns
to treatment w/ positive bacteriology following TREATMENT OUTCOME
interruption of treatment for 2 month or more
5. TRANSFER IN - transferred to another facility 1. Cured
adopting NTP policies with proper referral slip 2. Complete treatment
to continue treatment 3. Died
4. Fail
TWO FORMULATIONS OF ANTI TB DRUGS 5. Default
6. Transferred out
● Fixed Dose COmbination (FDC’s) - 2 or
more first line anti TB drugs are combined in COMMUNICABLE &
one tablet NON-COMMUNICABLE DISEASES
● Single Drug Formulation (SDF) - each drug
is prepared individually LEPROSY CONTROL PROGRAM

LEPROSY
● Causative Agent: Mycobacterium Leprae/
Hansens bacillus
● Mode of Transmission: prolonged skin
contact, droplet infection
● Incubation Period: 5 ½ months – 5 years
● Laboratory/Diagnostic Test: Skin Slit test

● Early signs:
- Reddish or white change in skin color,
- Loss of sensation on the skin lesion,
ANTI TB DRUGS AND ITS MINOR ADVERSE - Decrease/loss of sweating and hair growth
REACTIONS over the lesion,
- Thickened and or painful nerves,
 - Muscle weakness,
- Pain or redness of the eye, DENGUE CONTROL PROGRAM
- Nasal obstruction/bleeding,
- Ulcers that do not heal

● Late signs:
- Loss of eyebrow (madarosis)
- Inability to close eyelids (lagopthalmos)
- Clawing of fingers and toes
- Contractures ● Dengue - a viral infection characterized by

- Sinking of the nose bridge sudden onset of fever which would last for

- Enlargement of the breast in males 2 - 7 days.

(gynecomastia) ● Types of dengue:

- Chronic ulcers 1. dengue fever

2. dengue hemorrhagic fever

● Prevention: 3. undifferentiated fever

- BCG vaccination
- Avoidance of prolonged skin to skin contact ● Carriers:

with active untreated case 1.) Aedes Aegypti - primary vector of the disease;

- Good Personal Hygiene prefers to breed indoor in artificial container.

- Adequate Nutrition 2.) Aedes Albopictus - most common in rural

- Health Education areas; secondary vector of dengue

● Patient Classification of Leprosy ● Causative Agent: Dengue virus 1, 2, 3, 4, and

1. Paucibacillary (PB): Chikungunya virus

(-) Skin Slit test or 5 lesions or less ● Vector: aedes aegypti, aedes albopictus
● Mode of Transmission: Bite of mosquito

2. Multibacillary (MB): (vector)

(+) Skin Slit test & more than 5 lesions ● Incubation Period: 3-15 days

● Treatment & Management of Leprosy ● Laboratory/Diagnostic Exam :

Multi-Drug Therapy - Rumpel Lead’s Test/Tourniquet Test-

- use of two (2) or more drugs such as Presumptive test

Rifampicin, Clofazimine, and Dapsone - Platelet Count – confirmatory test

- Viral isolate antigen

● Benefits of Early Treatment:

1. Cured within a shorter period ● Classification:

2. Will not be able to infect other susceptible - Grade I: Flu-like symptoms

members of the household rash

3. Prevent the progress of skin lesions in the (+) Tourniquet test

body.
4. Prevent nerve damage leading to deformities. - Grade II: Manifestations of Grade I plus

5. Prevent relapse & resistance to drugs. spontaneous bleeding (Toxic Stage)

TROPICAL DISEASE - Grade III: Manifestations of Grade II plus

beginning signs of circulatory failure
CONTROL PROGRAM
 - Grade IV: Grade III plus shock 3. Rapid Diagnostic Test (RDT)

● New classification of Dengue ● Activities/Strategies:

- Dengue with warning sign - PROMOTIVE
- Dengue without warning sign 1. community health education
- Severe dengue
- PREVENTIVE
● 4s in Dengue Prevention 1. treated mosquito nets
- Search and Destroy breeding places of 2. indoor residual spraying
mosquito 3. seeding of streams
- Seek immediate treatment 4. clearing of streams
- Say no to indiscriminate fogging 5. other personal protection measures
- Self protection
● CURATIVE
SCHISTOSOMIASIS CONTROL PROGRAM 1. Early diagnosis & prompt treatment

● Causative Agent: Schistosoma japonicum, ● SUPPORT MECHANISMS

S. mansoni, S. Haematobium 1. Surveillance
2. Epidemiological Investigation
● Vector: Oncomelania quadrasi (snail)
● Incubation Period: 2 months ● Treatment
● Mode of Transmission: Vehicle (water), - ORAL
Indirect (skin pores) 1. Chloroquine phosphate 25O mg - All species
● Laboratory/Diagnostic Test: Direct Stool exam except P. malariae
1. COPT (Cercum Ova Precipetin Test) 2. Sulfadoxine 50 mg - For resistant P.
2. Kato Katz Technique falciparum
● Prevention & Control: 3. Primaquine- For relapse P. vivax & ovale
- Treatment of cases 4. Pyrimethamine 25 mg/tab
- Environmental Sanitation 5. Quinine Sulfate 300 mg/tab
- Snail Control 6. Tetracycline HCl 250 mg/cap
- Health Education 7. Quinidine Sulfate 200 mg

MALARIA CONTROL PROGRAM - PARENTERAL

1. Quinine hydrochloride 300 mg/ml, 2ml

(marsh fever,periodic fever,King of tropical dse) 2. Quinidine glucolate 80 mg (50 mg) 1 vial

● Causative Agent: Protozoa genus

Plasmodium: Malaria Prevention and Control
● Symptoms: Recurrent fever preceded by chills
and profuse sweating (triad signs), Malaise, 1. Mosquito control
Anemia 2. Chemical methods
● Mode of transmission: bite of female 3. Biological methods
anopheles mosquito 4. Zooprophylaxis
● Laboratory/Diagnostic Examination: 5. Environmental methods
1. History of having been in a malaria-endemic 6. Screening of houses
area: Palawan & Mindoro 7. Educational methods
2. Blood smear 8. Mechanical methods –
9. Universal Precaution
10. Screening of blood donors

FILARIASIS CONTROL PROGRAM

● endemic in the Philippines (DOH, 2010).

● The WHO classification for endemicity is
based on the elimination level of a microfilaria
rate (MFR) of less than one percent, and an
antigen rate of less than one percent per
Implementing Unit (IU). ELEPHANTIASIS
● Out of 80 endemic provinces, 43 provinces
have not reached the target level due to lack
of awareness and understanding about the
disease and its elimination.
● Causative Agent:
Wuchereria brancrofti, Burgia malayi
● Mode of Transmission: Bite of mosquito
● Vector: Aedes poicillus, Culex quiquefasciatus
● Goal:
● Strategies:
- The goal of National Filariasis Elimination
1. Use of mosquito nets
Program (NFEP) is to:
2. Residual spraying
- Eliminate filariasis as a public health problem
3. Screening of houses
by 2015 with a prevalence rate of
4. Use of protective clothing among plantation
microfilaremia of less than 1 percent.
workers.
5. Elimination of mosquito breeding places.
Filariasis
6. Mass Treatment
● Signs and Symptoms:
- chills,
- fever,
- myalgia,
- lymphangitis with gradual thickening of the
skin (commonly affecting limbs, scrotum)
resulting in elephantiasis and hydrocele.
● Laboratory/Diagnostic Examination:
- Circulating Filarial Antigen (CFA) – finger prick
how and when is this best done?
● Treatment:
- Diethylcarbamazine citrate (Hetrazan)
● Prevention: Eradication of vectors