LECTURE 8

A. MATERNAL CARE PROGRAM

Strategies
1. Provision of Regular & Quality Maternal Care Services
 Regular & quality prenatal care
- History-taking, utilization of HBMR (Home-Based Mother's Record) a guide in the
identification of risk factors
- PE: weight, ht, BP-taking
- Perform head to toe assessment, abdominal exam
TT immunization

- Micronutrient Supplementation
Vitamin A 10,000 IU 2x a week staring on the 4th
200, 000 IU month pregnancy
Postpartum: one dose
within 4 weeks
Iron 60mg/day 1st trimester
120mg/day 2nd and 3rd trimester
60 mg/day x 3mos Post-partum

- Laboratory exam: heat-acetic acid test, benedict's test

- Oral/dental exam

 Pre-Natal counselling
 Provision of safe, delivery care

- All birth attendants shall ensure clean & safe deliveries at home or at the facilities
(RHUs/hospitals)
- Qualifications for Home Care Delivery:
1. Full Term No history of previous infection
2. Gravida 1 to Gravida 4
3. No Premature Rupture of Membranes (PROM)
4. Cephalic Presentation
5. Adequate pelvis
6. No history of previous Cesarean Section
7. No history of prolonged labor
8. No history of previous Complications
9. Enlargement of abdomen is equal to age of gestation
- At-risk pregnancies and mothers must be immediately referred to the nearest institution
- Untrained traditional birth attendants who actively practice must be identified, trained &
supervised by a personnel of the nearest
• c c barangay health stations / RHU trained on maternal care.

2.Provision of Quality Postpartum Care:

Proper schedule of follow-up must be followed:
• 1st postpartum visit for home deliveries must be done within 24H after delivery
• 2nd, done at least 1 week after delivery
• 3rd, done 2-4 weeks thereafter

Attendants must be aware of the early signs & complications.

They should follow the 3 CLEANs:
1. CLEAN hands
2. CLEAN surface
3. CLEAN cord

Cardinal Signs of Post Partum Infection:

1. Board-like abdomen
2. Fever
3. Foul-smelling vaginal discharges

3. Improvement of the health personnel's capabilities on NB care, midwifery through

trainings.
1. Trainings for "hilots" must also be conducted
2. Improvement on the quality of care at the First

Referral Level
 Orientation, training should be done on the use of proper filling-up or HBMR card
 Proper referrals/endorsements must be done for future if-ups

3. Prevention of unwanted pregnancies through family planning services

4. Prevention & management of STDs
5. Promotion of appropriate health practices
6. Upgrade reporting services
7. Mobilize political commitment & community involvement to provide support to basic HC
delivery
MATERNAL, NEWBORN AND CHILD HEALTH AND NUTRITION - ensures, to
improve the health, well-being and survival of mothers and their child.

OBJECTIVES:
1. Every pregnancy to be wanted, planned and supported
2. Every pregnancy to be adequately managed throughout course
3. Every delivery to be facility-based and managed by skilled birth attendants/ skilled health
professionals
4. Every mother and newborn pair to secure proper postpartum and newborn care with smooth
transitions to the women's health care package for the mother and child survival package for the
newborn.

KEY STRATEGIES:
1. Ensuring universal access to and utilization of an MNCHN Core Package of services and
interventions
2. Establishment of a service delivery network at all levels of care to provide the package of
services and interventions
3. Organized use of instruments for health systems development to bring all localities to create
and sustain
4. Rapid build-up of institutional capacities of DOH and PhilHealth being the lead national
agencies that will provide support to local planning and development - to avoid delays that may
lead to maternal and newborn mortality.

3 TYPES OF DELAY:
1. Delay in identification of complication
2. Delay in referral
3. Delay in the management of complication

CHILDHEALTH PACKAGE:
1. Skilled birth attendances/skilled health professional-assisted delivery and facility-based
deliveries
2. Proper management of pregnancy and delivery complications and newborn
3. Access to Basic emergency Obstetric and Newborn Care or Comprehensive Emergency
Obstetric and Newborn Care Services

B. FAMILY PLANNING PROGRAM

Overall Goal: To provide universal access to family planning information and services
wherever and whenever these are needed.
Strategies:
1. Focus service delivery to the urban and rural poor
2. Reestablish the FP outreach program
3. Strengthen FP provision in regions with high unmet needs
4. Promote frontline participation of hospitals
5. Mainstream modern natural family planning
6. Promote and implement CSR strategy
Specific Goal: Maternal & Child Health Through:
a. Pregnant Timing Pregnancy: ideal age to be pregnant 20-30years old
b. Proper Interval of Pregnancy:
ideal spacing 3-5 years
Every 2 years - With risk
Every year - High risk

c. Proper # of Pregnancies:
Ideal 3x
4x - With risk
5x - High risk

3 Major Program Policies:

1. Improvement of family welfare with main focus on women's health, safe motherhood & child
survival
2. Freedom of choice
3. Promotion of family solidarity parenthood (except birth control)

Types of Family Planning Methods:

1. Female Sterilization - Perfect Use: 99.5%, Typical Use: 99.5%
Safe and simple surgical procedure which provides permanent contraception for women who do
not want more children. Also known as BTL that involves cutting or blocking the two fallopian
tubes.

2. Male Sterilization - Perfect Use: 99.9%, Typical Use: 99.8%

Permanent method wherein the vas deferens (passage of sperm) is tied and cut or block through a
small opening on the scrotal skin. It is also known as vasectomy.
3. Pill - Perfect Use: 99.7%, Typical Use:92.2%
Contains hormones estrogen and progesterone taken daily to prevent contraception.

4. Male Condom Pl Perfect Use: 98%, Typical Use: 85%

"Thin sheath of latex rubber made to fit on a man's erect penis to prevent the passage of sperm
cell and sexually transmitted disease organism into the vagina. It provide dua! protection from
STls including HIV preventing transmission of disease microorganism during intercourse.

5. Injectables - Perfect Use: 99.7%, Typical Use: 97.0%

Contain synthetic hormones, progestin which suppresses ovulation, thickens cervical mucus,
making it difficult for sperm to pass through and changes uterine lining.

6. Lactating Amenorrhea Method or LAM - Percent Use: 99.5%, Typical Use, 98%
~ Temporary introductory postpartum method of postponing pregnancy based on physiological
infertility experienced by Breast Feeding women.

7. Mucus/Billings/Ovulation - Perfect Use: 97%, Typical Use: 80%

Abstaining from sexual intercourse during fertile (wet) days prevents pregnancy

8. Basal Body Temperature - Perfect Use: 99%, Typical Use: 80%

BBT Methods is identifying the fertile period of a woman's cycle by daily taking and recording
of the rise in body temperature during and after ovulation.

9. Sympto-Thermal Method - Perfect Use: 9%, Typical Use: 80%

Method in identifying the fertile and infertile days of the menstrual cycle as determined through
a combination of observations made on the cervical mucus, basal body temp recording and other
sign of ovulation.
10. Two Day Method - Perfect Use: 96.5%, Typical Use: 86%-
vIs a simple fertility awareness-based method of FP that involve:
1. cervical secretions as an indicator of fertility
2. woman checking the presence of secretions everyday.

11. Standard Days Method - Perfect Use: 95%, Typical Use: 88%
VA new method of natural family planning in which all users with menstrual cycles between 26
and 32 days are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. -
The couples use color coded cycle beads to mark the fertile and infertile days of the menstrual
cycle.
C. PHILIPPINE REPRODUCTIVE HEALTH
Goal: To achieve "Better Quality Life among Filipinos"

RA 10354- Responsible Parenthood and Reproductive Health Act 2012

Local Framework Focuses on: Health needs of women, men, adolescents, children and
underserved groups.

3 Republic Acts:
RA 10028 - New Breastfeeding Act
RA 7600- Rooming Aid and Breastfeeding Acts
-Provide rooms in government and private hospitals.
EO51- Milk Code of the Philippines
Unang Yakap Program by DOH
Time Bound
1. Immediate and thorough drying.
2. Early skin-to-skin contact.
3. Properly-timed clamping.
4. non-separation of the newborn from the mother for early breastfeeding initiation and rooming
in.

Untimed Bound
1. Vitamin K
2. Uterine suctioning

POST-PARTUM PACKAGE:
1. post-partum visits
2. Micronutrient supplementation
3. Counseling on nutrition, child care, family planning and other available services

Storage Full-term Pre-term

Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
Main objectives:
1. To reduce maternal mortality rate.
2. To reduce child mortality.
3. To Halt and reverse spread of HIV/AIDS.
4. To increase access to reproductive health information and services.

10 Elements of Reproductive Health:

1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention and Management of Reproductive Tract Infections including STI's and HIV AIDS
5. Prevention and Management of Abortion and its Complication
6. Education and Counseling on Sexuality and Sexual Health
7. Prevention and Management of Breast and Reproductive Tract Cancers and other
Gynecological Conditions.
8. Men's Reproductive Health
9. Violence against Women and Children
10. Prevention and Management of Infertility and Sexual Dysfunctions

D. EXPANDED PROGRAM ON IMMUNIZATION (EPI)

Legal Basis: PD No. 996 - providing for compulsory basic immunization for infants and
children below 8 yrs. old. (September 16, 1976)
~ launched in July 1976
~ Free vaccines: BCG, DPT, OPV, Measles
DPT- Diphtheria, Pertussis, Tetanus-
Diphtheria- recommended for all babies, children, teens, and adults.
Pertussis -whooping cough
Tetanus- muscle spasm infection caused by Clostridium tetani bacteria.
OPV- Oral Poliovirus Vaccines

Goal of EPI:
• Reduction of morbidity & mortality of immunizable diseases
• Not al diseases are immunizable
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health service

Elements of EPI:
• Target setting: calculation of eligible population
• Formula: EP = total population x constant percentage

Constant percentage:
Infants = 3 % or .03
School Entrants = 3% or .0.3
Pregnant Mothers = 3.5% or .035

Cold Chain System

 A system used to maintain the potency of a vaccine from that of manufacturer to the time
it is given to child or pregnant woman.
Refrigerator: Freezer: (-15° to-25 ° C) - OPV, Measles
(Body: 2° to 8° C) - DPT, Hepa B, BCG, TT
2 most sensitive to heat vaccine: OPV & MEASLES
2 least sensitive to heat vaccine: BCG & TT

TARGET SETTING:
 Involves the calculation of the eligible population.
 "ELIGIBLE POPULATION" consists of any group of people targeted for specific
immunizations d/t susceptibility to one or several of the EPI diseases.

TYPES & SCHEDULE OF VACCINES

AT BIRTH 1 ½ MONTHS 2 ½ MONTHS 3 ½ MONTHS 9-12
1ST BCG DPT1 DPT2 DPT3 MEASLES
OPV1 OPV1 OPV3
HEP B 1 HEP B 2 HEP B 3

SIDE-EFFECTS OF BCG:
a. Koch's Phenomenon (Nisie)
 Inflammation of the site of injection after 2-4 days
 2 to 3 weeks abscess will ulcerate then heals leaving a scar
 Warm complex after vaccination
b. Deep abscess at site - even after 12 weeks.: Incision & drainage ~ Treatment: Powdered INH
c. Indolent ulceration- ulcer after 12 weeks. Treatment: Powdered INH
d. Glandular enlargement- abscess (2-3 weeks abscess will leave scar 12 weeks after)

SIDE-EFFECTS OF DPT:
a. Fever for a day (always bring antipyretic) - -Normal
b. Soreness at site within 3-4 days. Treatment: Warm compress-- Normal
c. Abscess after a week or more- incision & drainage- Not normal
d. Convulsions---Emergency: post-pone giving of next dose

SIDE-EFFECT OF MEASLES:
a. Fever 5-7 days after within 1-4 days-----Normal
b. Mild rashes---if it does not disappear--- -Roseola

REMEMBER THE PRINCIPLES:

1. Even if the interval exceeded that of the expected interval, continue to give the doses of the
vaccine.
2. Immunization can still be given until the child reaches 6 y/o
3. If there has been a reported epidemic of measles, measles vaccine can be given as early as six
months
4. BCG booster dose must be given to school entrants regardless of presence of BCG scar.
5. There is no contraindication to immunization, EXCEPT when the child had convulsions upon
giving the 1st dose of DPT.
6. MALNUTRITION is not a contraindication, but RATHER AN INDICATION for
immunization since common childhood disease are often severe to malnourished children.

Contraindication of Vaccine

 Malnourished
 Dehydrated
 Convulsion
 Chemo

CONTENT OF VACCINES:
• BCG: - live attenuated bacteria
• OPV and MEASLES: - live attenuated virus
• DIPTHERIA & TT: - weakened bacterial toxins
• PERTUSSIS: - killed bacteria
• HEPA B: - derived from plasma (plasma derivatives) RNA recombinants
PRINCIPLES OF VACCINATION
1. No BCG to a child born positive with HIV or AIDS.
2. DPT is not given to a child who has recurrent convulsions or active neurologic disease
3. DPT2 or DPT3 is not given to a child who has had convulsions or shock w/in 3 days the
previous dose but you can give DT.
4. Don't immunize children before referral
5. Moderate fever, " malnutrition, mild respiratory infection, cough, diarrhea & mild vomiting
aren't contraindication vaccination.
6. Safe to administer all EP| vaccines on the same day at different sites of the body.
7. No food 30 minutes after giving OPV
8. Assess the child for allergy to egg before giving measles vaccine.
9. Measles vaccine should be given as soon as the child is 9 months old regardless of whether
other vaccines will be given on that day.
10. Vaccination schedule should not be restarted from the beginning even if the interval between
doses exceeded.
11. It is safe and effective with mild side effects after vaccination.
12. Repeat BCG vaccination if the child does not develop a scar after the first injection.
13. Strictly follow the principle of never ever reconstitute the freeze-dried vaccines to any
diluents.
14. Use one syringe, one needle per child during vaccination.
15. During vaccination, clean the skin with cotton ball, moistened with water only (boiled H20).

BCG- protect the extra pulmonary TB

Fully Immunize after birthday
Complete Immunize before the birthday

Opened vaccines should be discarded after:

 BCG & Measles: 4-6 hours
 DPT, OPV, Hepa B & TT: 8 hours

Open OPV vials can be used for the next immunization if:
A. Expiry date has not passed
B. Vaccines stored at 0° C to 8° C
C. Not taken out at the health center for outreach activities

E.ORAL HEALTH PROGRAMS

Goal: To reduce the prevalence rate of dental caries and periodontal diseases from 92% in
1998 to 85% and from 78% in 1998 to 60% by the end of 2010 among general population.
Objectives:
1. To increase the proportion of orally fit Children under 6 years old to 80% by 2010.
2. To control oral health risks among the young people.
3. To improve the oral health conditions of pregnant women by 20% and older persons by 10%
every year until 2010.

Basic Package of Oral Health Care:

Classification of Oral interventions:
1. Preventive
✓ Oral Examination - Pit and Fissure Sealant Program
✓ Oral Hygiene - Fluoride Utilization Program
1. Curative
✓ Permanent filling - Temporary Filling
✓ Gum Treatment - Extraction
✓ Atraumatic Restorative Treatment
✓ Treatment of post extraction complication
✓ Drainage of localized oral abscess
2. Promotive - includes health educational activities directed to the priority groups thru
individual or group approach using accepted tools and media

E. UNDER FIVE CARE PROGRAM (UCFP)/ CONTROL OF DIARRHEAL DISEASES

UFC Program
- A package of child health-related services focused on the 0-59 months old children to
assure their wellness and survival.
A. GROWTH & HEALTH MONITORING (GMC)
A standard tool used in health centers to record vital information relative to child G & D, to
assess signs of malnutrition
✓ All newborns must be enrolled for UFCP
B. ORAL REHYDRATION THERAPY
Diarrhea:
(Unusual frequency of bowel movements more than 3x/day)
(Marked change in the amount of stool)
(Increase in stool liquidity)
3 Classifications of diarrhea:
Mild 5-10 unformed stool/24H Mild dehydration
Moderate 10-15 unformed stool/24H Moderated dehydrations
Severe >15 unformed stool/24H with Severe
associated signs and
symptoms

Measures on Diarrhea Prevention:

 Breastfeed infants
 Provide appropriate supplemental feeding
 Handwashing
 Utilize clean and potable water
 Clean toilet and observe proper feces disposal
 Immunize the child with measles
C. BREASTFEEDING
Unique characteristics of breast milk:

 Bonding
 Reduced allergic reaction
 Economical
 Always available
 Safe/ maintains the stool soft
 Temperature always right
 Fresh
 Emotional bonding
 Easily established
 Digestible
 Immunity
 Nutritious
 GIT disorders are decreased
 SPIR§TDRY TRACT

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ALTERNATIVE MEDICINE
Legal Basis: RA 8423 – promotes the use of herbal medicines

STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS

COMMUNICABLE DISEASE PREVENTION & CONTROL
1. NATIONAL TUBERCULOSIS CONTROL PROGRAMS (INTBCP)
"Tuberculosis is a highly infectious, chronic, respiratory disease caused by TB bacilli.
It is one of the 10 leading causes of morbidity & mortality in the Philippines
Which is also known as "Koch's Disease".

Objective of the Program:

 To control TB by reducing the annual risk of infection (prevalence & mortality rates)
Key Policies:
Prevention

 BCG vaccination under the EPI program

 • Annual identification of at least 45% of its prevalence
 Public health education re: PTB, mode of transmission, methods of control & importance
of early dx
 Provide outreach services for home supervision o patients in Multi-Drug Therapy & also
for preventive tx of contacts.

Case Finding:
* Direct sputum microscopy for identified TB symptomatic
* X-ray exam of TB symptomatic who are (-) after 2 or more sputum exam
* Establishment of passive & active collection points for sputum samples of all identified TB
symptomatic, as well as validation centers to ensure the standard & quality of sputum exam.
* case finding & treatment services shall be made available in the BHS/RHUs

Treatment:
* All TB cases must be treated for free, on ambulatory and domiciliary (home) basis, except
those with
Acute complications & emergencies.
* All sputum positive & cavitary cases shall be given priority for short course chemotherapy or
SCC for 6 mos.
* Standard Regimen or SR for a vear or intermittent SCC for 6 mos. shall be given to all
infiltrative but sputum negative.

• SR: IsonIazid and streptomcin sultate

• SCC: Combo pack, Multi drug therapy

• What is the purpose of SCC-MDT?

- Prevents developing resistance against the three drug combinations

- Shortens duration of treatment usually treatment lasts from 5-10 years. With SCC-MDT,
treatment can be reduced to a minimum of 6 months
- Eradicates & completely prevents the relapse of the disease

Direct Observation Treatment of Short -Course Chemotherapy (DOTS)

- "Tutok-Gamutan"

PB TREATMENT REGIMEN
DOTS (Direct Observed Treatment Short Course)
2. LEPROSY CONTROL PROGRAM:
Leprosy is a chronic disease of the skin & peripheral nerve caused by Mycobacterium Leprae

WHO CLASSIFICATION OF LEPROSY

1. Paucibacillary (tuberculoid & Indeterminate)- non- infectious
Duration of treatment: 6-9 months
2. Multibacillary (Lepromatous & Borderline) - infectious
Duration of treatment: 24- 30 months

Objectives of the Program:

 Provide MDT to all leprosy cases within 3 years & complete the treatment of 90% of all
cases out on MDT win the prescribed period.
 identify all correctable deformities & institution of appropriate intervention v Reduce the
stigma attached to the disease thru information, education and communication
 Formulate research proposals on topics associated leprosy.

Kev Policies:

 MDT as the core strategy for the National Lepros

 Control Program
 Procurement & supply of MDT Drugs, IC & training materials by CDC
 Health education
 Supervision & control of leprosy control activities

Strategies: Prevention:
* Health education
* BCG vaccination
* Case finding
* Validate old registered cases
* Early referral of suspected leprosy patients
* Epidemiologic investigation

Treatment:
* Ambulatory
* Domiciliary chemotherapy through the use of MDT as embodied RA 4073 which advocates
home treatment.

Signs & Symptoms

Early stage (CLUMP)
Change in skin color
Loss in sensation
Ulcers that do not heal
Muscle weakness
Painful nerves

Late Stage (GMISC)

Gynocomastia
Madarosis(loss of eyebrows)
Inability to close
eyelids (Lagopthalmos)
Sinking nosebridge
Clawing/contractures of fingers & nose

MDT TREATMENT REGIMEN

• Leprosy patients must be taught ways to prevent secondary injur caused by burns & rough
sharp objects
Emphasize importance of sustained therapy, correct dosage, effects of
drugs & the need for medical check-up from time to time
* Provide mental & emotional support to the families of leprosy patients
* Refer patients as needed.

Rehabilitation:
* Imbibe patient's participation in occupational activities
* Family & community health (PD 304)
* Non-segregation of leprosy patients
* Counseling & guidance
LOCALLY-ENDEMIC DISFASE PREVENTION & CONTROL
1. MALARIA CONTROL PROGRAM
Malaria is a vector-borne disease caused by female Anopheles mosquito causing such as fever,
sweating, intermittent chills, anemia & splenomegaly

2 Major Strategies of the Program

1: Vector Control
Chemically treated mosquito nets
Larva-eating fish
Environmental clean-up of stagnant
Anti-mosquitoosquito soap
Chemoprophylaxis- chloroquine 1-2 weeks ring an area then continues 4-6 weeks after leaving
the area

2: Detection & Early Treatment of Cases

 Early Recognition, Prevention & Control Malaria epidemics I

 dentification of a patient with malaria as soon as he is examined.

This may be done thru:

Clinical

 Signs & Symptoms-

 History of visit to & endemic area
Microscopic
-Mass blood smear exam

In the event that an imminent epidemic occurs, the following should be done:
* Mass blood smear collection
* Immediate confirmation & follow-up of cases
* Insecticide-treatment cf mosquito nets
1. SCHISTOSOMIASIS, H-FEVER, FILARIASIS CONTRE PROGRAM

 Snail eradication – use of moluscides

PREVENTION CONTROL & REHABILITATION OF NON-COMMUNICABLE

DISEASES
1. PHILIPPINE CANCER CONTROL PROGRAM
AO 89-A s. 1990
 Provided the Guidelines for the Philippine Cancer Contro
 Program specifying its program implementing guidelines & timetable policy,
components,
6 Pillars:
* Public Information & Health Education
* Cancer Prevention & Early Detection
* Cancer Epidemiology & Research
* Cancer Treatment
* Cancer Pain Relief
In cancer nursing, the aim of management is to relieve physical,
Vital Task of the nurse: To help the patient maintain his dignity 8 integrity
Cancer care is multidisciplinary.
Who are to be prioritized for health supervision?
• Newly diagnosed cases
 Post on cases/discharge
 Indigent cases needing continuity of hospital care
• Terminal case
9 Warning Signs:
C - change in blood, bowel/bladder habits
A - a sore throat that does not heal
U - unusual bleeding/discharge
T - thickening or lump in breast
I - indigestion or difficulty in swallowing
O - obvious change in wart or mole
N- nagging cough or hoarseness
U - unexplained anemia
S - sudden unexplained weight loss

LEVELS OF PREVENTION:
Primary Prevention: elimination of conditions causing cancer
Secondary Prevention: (Early detection; Needs Multidisciplinary approach)
Definitive Treatment and Management
a. Chemotherapy
b. Radiation
C. Surgery
Tertiary Prevention: Mutiarsciplinaryandioach) (Late detection:Needs

Supportive or Palliative Care

a. Physical

b. Psychological

C. Social

d. Spiritual

2. SMOKING CONTROL PROGRAM

Health hazard of smoking

- Lung cancer
- Cardiovascular diseases
- COPD
- Cancer of other body organs

Program Objectives: To decrease the prevalence of smoking-related diseases and subsequent premature
deaths

Programs components:

- Information and education on campaign and social mobilization

- Policy development and legislation
- Training of counselors in smoking cessation clinics for speciallyhospitals
 - Resource managements and monitoring

Strategies:

- National anti-smoking campaign

- World No Tabacco Day
- National No Smoking Day
- Yosi Kadiri Campaign

3. RENAL DISEASE

• Preventive Cardiology & Nephorology

• Enhance public awareness through health educatio, regarding healthy lifestyles
• Improve access to basic health services

"Buwan ng Buhay na Bato"

• Requires urinalysis of ALL children entering grade 1 so as to detect childhood kidney infections
which may lead to renal failure.
• Encourage adult Filipino to undergo urinalysis once a year.

4. CATARACT

National Focus: Cataracts Screening Week at DOH Centers

OPLAN: Sagip-Mata

- Eye surgery for cataract & squint operations for cross-eyed children

NUTRITION & ADEQUATE FOOD SUPPLY

Goal:

Reduce morbidity and mortality related to nutritional deficiencies

The improvement of nutritional status, productivity & quality of life of the population through adoption
of desirable dietary practices and healthy lifestyle.

To improve the quality life of Filipinos through better nutrition, increased productivity and improved
health.

Coverage: Protein Energy, Malnutrition, Vitamin A deficiency, iron deficiency anemia, iodine deficiency
disorder

3 Most Common Deficiencies:

1. Iron
2. Vitamin A

3. Iodine

Strategies:

1. Food-based intervention for sustained improvements in nutritional status.

2. Life-cycle approach with strategic attention to 0-3 years old children, adolescent females, and
pregnant/lactating women.

3. Effective complementation of nutrition interventions with other services.

 4. Geographical focus to needier areas.

10 NUTRITIONAL GUIDELINES FOR FILIPINOS

* Intended to give the message that no single foo provides all nutrients the body needs.

* Promoting exclusive breastfeeding from 0 to 4-6 months

* Giving advice on proper feeding of children. It also includes regular weighing to monitor the growth
of the children.

* Eating of fish, meat, poultry products and beans.

* Eating more vegetables.

* Eating food cooked in edible oil.

* Consuming milk and milk products.

* Using iodized salt to prevent iodine deficiency.

* Preventing food-borne diseases.

* Promoting healthy lifestyles.

Philippine Food & Nutrition Programs

* Directed to the provision of nutritio services to the DOH's identified priority vulnerable groups:

* Intants, pre-schoolers, schoolers, women of child bearing age also included are the pregnant &
lactating mothers) & the elderly

Objectives:

• To decrease the morbidity & mortality rates secondary to Avitaminosis & other nutritional
deficiencies among the population mostly composed of infants & children.

1. MALNUTRITION REHABILITATION PROGRAM

Tools utilized are Anthropometric measurements 'Stentit for Age: Measures degree & presence of we Height for Age: Measure
< 90% of standard• stunting or past chronic malnutrition
3. FOOD FORTIFICATION PROGRAM

Fortification is the addition of a micronutrient deficient in the diet to a commonly & widely consumed
food or seasoning. It involves:

* Incorporation of Monosodium Glutamate (MSG) with Vitamin A to reduce clinical signs of

Xerophthalmia

* The use of FIDEL salt in lieu with the National Salt lodization

Program Fortification for

Iodine

D efficiency

ELimination

4. NUTRITION SURVEILLANCE SYSTEM (Operation (Timbang)

- A system of keeping close watch on the state of nutrition & the causes of malnutrition within a locality,
which involves periodic collection of data & analvsis & dissemination of analyzed information.

TOOLS UTILIZED ARE ANTHROPOMETRIC MEASUREMENTS

Weight for Age: Measures degree and presence of stunting

Height for Age: Measures the presence of stunting <90% of standard stunting or past chronic
malnutrition

Weight for Height: Determines the presence of muscle wasting:

- Ideal body wt,: 135

Body mass index (BMI)=

wt in kgs / Ht in meters

If BMI is > 27.2 in men or 26.9 in women there is the need for wt, reduction
Skin Fold Measurement:

Indicates amount of body fat with the use of fat-caliper

Sites: triceps, biceps, subscapular, suprailiac

MUAC:

Estimates lean body mass or skeletal muscle reserves

A. PROTEIN ENERGY MALNUTRITION:

1. MARASMUS

- Child lacks food rich in CHON & energy

Usually the child is < 1 year old when malnutrition starts:

Very thin, no fat, muscle wasting v Prominent ribs v Very poor wt. gain

V Loose & wrinkled skin

Enlarged abdomen

~ Anxious, always hungry

- "Old Man's Face"

Treatment: Food high in protein & energy content

Frequency of feeding variety of food

2. KWASHIORKOR

- Disease of older children when the next baby is born

- Usually when the child is 1-3

y/o Very thin, fails to grow

v Swollen legs, feet, arms & hands v Light colored, weak hair v Doesn't want to eat v Moon-shaped v
Unhappy face v Dark spots on skin v Enlarged abdomen

v Skin sores & skin is peeling

Muscle wasting v Apathetic

Treatment for Both:

1. Food only

2. †CHON

3. Increase frequency of feeding

4. Increase variety of food preparation

B. IRON DEFIENCY ANEMIA

- Not enough hemoglobin in the RBC because of lack of Fe

Causes: Low intake of Fe-rich foods especiallymore absorbable iron from foods of animal origin
Sources: Liver, internal organs, meat (pork and chicken), blood, fish and shellfish, leafy vegetables
alugbati, kangkong, saluyot, petchay, kamote tops, mustarc (mustasa), dried beans, kadyos, mongo,
abitsuelas

Supplementation: FeS04 iron supplement- Drink fruit juice to enhance Fe absorption

C. VITAMIN A DEFICIENCY:

Consequences:

1. Night blindness

2. Nutritional blindness

Causes:

v Low intake of Vitamin A rich food v Low intake of protein v Illnesses like measles, diarrhea

Sources:

v Breast milk, animal sources, whole milk, eggs, liver,Meat

Yellow/orange fruits (papaya, mango)

Plant sources yellow/orange vegetables (carrots & squash)

v Green leafy vegetables (malunggay, kangkong),

Vitamin A capsule

D. IODINE DEFICIENCY DISORDER:

- Abnormalities d/t low iodine intake. Abnormalities ra from mild such as goiter, to serious as
stillb congenital abnormalities, growth & mental retardation8 physical and motor abnormalities

Consequences:

Fetus:

Abortion or miscarriages

Congenital abnormalities, stillbirths

Causes:

Goitrogens & other environmental factors

Low intake of iodine rich foods or low content of iodine in food.

SUPPLY & USE OF ESSENTIAL DRUGS

Essential drugs are medicinal preparations necessary to fill the basic health needs of the population.

National Drug Formulary contains the list of essential drugs

ENVIRONMENTAL SANITATION

Environmental Sanitation

Is defined as the study of all factors in man's physical environment, which may exercise a deleterious
effect on his health, well-being and survival.

Goal:

To eradicate & control environmental factors in de transmission through the provision of basic services
& facilities to all households.

1. WATER SUPPLY SANITATION PROGRAM

3 TYPES OF APPRIOVED WATER SUPPLY FACILITIES
 2. Proper Excreta & Sewage Disposal System

Types of Approved Toilet Facilities

5. Hospital Waste Management

Goal:

• To prevent the risk of contraction contract nosocomial infection from type disposal of
infectious, pathological & other wastes from hospital
6. Programs related to health-risk minimization secondary to environmental pollution

These include the following:

- Anti-smoke Belching campaign and Air Pollution Campaign

- Zero Solid Waste Management
- Toxic, chemical and Hazardous Waste Management
- Red tide Control and Monitoring
- Integrated Pest Management and Sustainable Agriculture
- Pasig River Rehabilitation Management

7. Education of prevailing health problems

Accepted activity at all levels of public health used means of improving the health of the people through
techniques which may influence people's thought motivation, judgment & action.

3 Aspects of Health Education:

* Information- provision of knowledge

* Communication- exchange of information

* Education- change in knowledge, attitudes & skills

Sequence of Steps in Health Education

Creating awareness

Creating motivation

Decision making action

HIV/ STI PREVENTION & CONTROL

Operational Strategies:

- Promotion of health/ health education

- Disease detection
- Treatment program
- Contact tracing
- Clinical services

Program Components:

- Case-finding
- Case management
- Training
- Monitoring
- Reporting system
- Operations research

MENTAL HEALTH

- - A state of well-being where a person can realize h her own abilities, to cope with the
normal stresses of life & work productively
- - The emotional adjustment the person achieve in which he can live with reasonable comfort,
functioning, acceptably in the community where he/she lives
- - Involves the promotion of a healthy state of mind among the whole population through
 - - Developing positive outlook in life
- - Strengthening coping mechanisms

Vulnerable group to the development of Mental Illness

- Women
- Street children
- Victims of torture or violence
- Internal refugees
- Victims of armed conflicts
- Victims of natural & man-made disasters

Components of Mental Health Program:

* Stress

* Drugs and Alcohol Abuse Rehabilitation

* Treatment and Rehabilitation of Mentally-ill Patients

* Special Project for Vulnerable Groups

Stresses in the environment of children such as times of disasters & natural calamities, disintegration of
the values, structure & functions of the family & urbanization, migration drugs & physical & sexual
abúse & poverty have direct effects on physical & mental health.