NCM 104 Lec: Community Health Nursing
MODULE 6 - DOH Programs Related to Family Health
EXPANDED PROGRAM ON IMMUNIZATION
Objective: reduce morbidity and mortality among infants
and children
PD 996 - compulsory immunization of children less than
8 yrs old.
RA 10152 - mandatory infants and children up to 5 yrs
old immunization act of 2011
Hep B vaccine - 1st vaccine to be given
7 + 2 vaccines
COLD CHAIN MANAGEMENT
- used to maintain potency of the vaccine.
General Policies on Cold Chain
1. Stock vaccine neatly on the shelves not on the door
2. Keep diluent in lower shelves or in the door
3. Clearly separate different types of vaccine
4. FEFO – first to expire, first to open
5. Store measles and OPV with frozen ice pack in the
transport boxes
6. Discard BCG vaccines after 4 hours of reconstitution
7. Discard DPT, Polio, Measles, and TT after 8 hours of
reconstitution.
Time frame for Storage of Vaccine
1. 6 months at the regional level
2. 3 months at the provincial level/ district level
3. 1 month at the main health centers
refrigerators)
4. Not more than 5 days at health center/ BHU
Tetanus Toxoid Immunization Schedule for Women
- When given to women of childbearing age, vaccines
that contain tetanus toxoid (TT) not only protect
women against tetanus, but also prevent neonatal
tetanus in their newborn infants.
INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESS
- An approach established to strengthen the provision
of comprehensive and essential health package to
the children.
The strategy was developed by the:
● World Health Organization (WHO) and United
Nations Children’s Fund(UNICEF)
● In the Philippines, IMCI was started on a pilot basis
in 1996
● Aims to reduce childhood mortality and improve the
quality of carefor major childhood illness, especially
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at first level health facilities.
INCI PROCESS
Ask, Look, Listen and Feel for:
● Signs of severe illness
ASSESS
● Main symptoms and common
healht issues
Based on severity of classification:
● RED: severe, urgent referral
CLASSIFY &
required (very serious)
IDENTIFY
● YELLOW: treat in clinic (serious)
TREATMENT
● GREEN: home treatment and
advice (less serious)
Integrated treatment for all
TREAT
classifications
The carataker on home treatment &
COUNSEL
follow-up
FOLLOW-UP On care and re-assess
The three color-coded classifications also tell you where
to give these treatments. (RED, YELLOW & GREEN)
ESSENTIAL INTRAPARTUM AND NEWBORN CARE
(EINC)
- Aims to increase th quality of care around the time of
birth and during the first few weeks of life to
eliminate preventable causes of newborn death.
(with
EINC practices during the intrapartum period
● continuous maternal support by having a companion
of choice during labor and delivery
● freedom of movement during labor
● monitoring progress of labor using the partograph
● non-drug pain relief before offering labor anesthesia
● position of choice during labor and delivery
● spontaneous pushing in a semi-upright position
● non-routine episiotomy
● and active management of the third stage of labor
(AMTSL)
Early Essential Newborn Care
- Emphasize are sequence of 4 actions that are
performed step by step
- is organized so that essential time bound
interventions are not interrupted;
- fills a gap for a package of bundled interventions in a
guideline format.
1. Immediate and thorough drying
a. For 30 sec to 1 min
b. Warms the newborn and stimulate breathing
● Within 1st 30 secs
○ Call out the time of birth
○ Dry the newborn thoroughly for at least 30
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NCM 104 Lec: Community Health Nursing
MODULE 6 - DOH Programs Related to Family Health
seconds
○ Remove wet cloth
○ Do a quick check of breathing while d
Notes:
● During the 1st seconds:
● Do not ventilate unless the baby is floppy/limp and
not breathing
● Do not suction unless the mouth/ nose are blocked
with secretions or other material
● Within 0 – 3 minutesrying
Notes:
● Do not wipe off vernix
● Do not bathe the newborn
● Do not do foot printing
● No slapping
● No hanging upsidedown
● No squeezing of chest
2. Early skin to skin contact
a. Skin to skin contact between mother and
newborn
b. Delayed washing for at least 6 hours prevent
hypotermia, infection, andhypoglycemia
● After 30 seconds drying
○ If newborn is breathing or crying:
○ Position the newborn prone on the mother’s
abdomen or chest
○ Cover the newborn’s back with a dry
blanket
○ Cover the newborn’s head with a bonnet
Notes:
● Avoid manipulation (suctioning) that may cause
trauma or infection
● Place identification band on the ankle (not wrist)
● Skin to skin contact is doable even for CS newborns
3. Properly timed cored clumping and cutting
a. Prevents anemia, protects against death due to
hemorrhage in prematurenewborn
b. Properly timed cord clumping and cutting
means waiting for the cord pulsation to stop
(1-3 minutes)
● 1 – 3 minutes
○ Remove the first set of gloves
○ After the umbilical pulsations have stopped,
clamp the cord using a sterileplastic clamp
or tie at 2 cm from the umbilical base
○ Clamp again at 5 cm from the base
○ Cut the cord close to the plastic clamp
Notes:
● Do not milk the cord towards the baby
● Cut the cord close to the plastic clamp so that there
is no need for a 2nd “trim”
● Do not apply any substance onto the cord
4. Non-separation of the mother and newborn for
early initiation of breastfeeding
a. Provides colostrum – a substance equivalent to
the babies first immunizationfor its protective
properties
● Within 90 minutes
○ Leave the newborn in skin to skin contact
○ Observe for feeding cues, including
tonguing, licking, rooting
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○ Point these out to the mother and
encourage her to nudge the
newborntowards the breast
● Counsel on positioning
○ Newborn’s neck is not flexed nor twisted
○ Newborn is facing the breast
○ Newborn’s body is close to mother’s body
○ Newborn’s whole body is supported
● Counsel on attachment and sucking
○ Mouth wide open
○ Lower lip turned outwards
○ Baby’s chin touching the breast
○ Sucking is slow, deep with some pauses
Notes:
● Minimize handling by health workers
● Do not give sugar water, formula or other
● Do not give bottles or pacifiers
● Do not throw away colostrum
● Weighing, bathing, eye care, examinations,
injections (hepatitis B, VitaminK) should be done
after the first full breastfeed is completed
● Postpone washing until at least 6 hours
NEWBORN SCREENING
Republic Act No. 9288 or the Newborn Screening Act
of 2004
- To reduce preventable deaths of all Filipino
newborns due to more common and rare congenital
disorders through timely screening and proper
management
- Introduce in 1996 adopted in 2004 by the DOH
- A simple procedure to find out if a baby has a
congenital metabolic disorder.
Why is it important?
- Because most babies with metabolic disorders look
normal at birth. Onemayonly know it once signs and
symptoms are already severe and irreversible. These
disorders may lead to mental retardation and even
death, if untreated.
When is it done?
- It is ideally done on the 48th hour or at least 24
hours after birth. Becausesome disorders are not
detected if the test is done earlier than 24 hours.
Andthe baby must be screened again after 2 weeks
to obtain more accurateresults.
How is it done
- A few drops of blood are taken from the baby's heel,
blotted on a special absorbent filter card and then
sent to Newborn Screening Center (NSC). –paying
for an amount, 500 – 600 pesos.
Who will collect?
● Physician
● Nurse
● Midwife
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MODULE 6 - DOH Programs Related to Family Health

● Medical Technologist ● Treatment of neonatal sepsis / infection

● Oxygen support
Where is it available? ● Management of low birth weight or
● preterm newborn
- All practicing health institutions:
● Other specialized newborn services
● Hospitals
● Lying-in Clinics
● Health Centers
● Rural Health Units
NUTRITION PROGRAM
Expanded newborn package from 6 – 28 , expanded is
28 disorders whichinclude: Objectives
- hemoglobinopathies and additional metabolic
- To decrease the morbidity and mortality rates
disorders. Cost 1500 or 1800
secondary to Avitaminoses andother nutritional
When are the results available? deficiencies among the population mostly composed
of infants and children.
- Within 3 weeks after the laboratory receives and
tests the samples Goal

- The improvement of nutritional status, productivity

A negative screen means…
and quality of life of thepopulation through the
- The results are normal and the baby is not
adoption of desirable dietary practices and healthy
suffering from any of the disorders being
lifestyle
screened.
- Philippine Food and Nutrition Programs - directed
towards the provision of nutrition services to the
In case of a positive screen…
DOH’s identified priority vulnerable groups: infants,
- The Newborn Screening Nurse Coordinator will
preschoolers, schoolers, women of childbearing age
immediately informthecoordinator of the
(also included are the pregnant and lactating
institution. The parents are recalled for
mothers) and theelderly
confirmatory testing
Coverage

● Protein-energy malnutrition (PEM)

● Vitamin A Deficiency (VAD)
BASIC EMERGENCY OBSTETRICS AND NEWBORN
● Iron Deficiency Anemia (IDA)
CARE AND COMPREHENSIVE EMERGENCY
● Iodine Deficiency Disorders ( IDD)
OBSTETRICS AND NEWBORN CARE
1. MALNUTRITION REHABILITATION PROGRAM
BEmONC
Basic Emergency Obstetrics and Newborn Care

● Oxytocic drugs IV / IM 2. MICRONUTRIENT SUPPLEMENTATION PROGRAM

● Antibiotics IV / IM
● Anticonvulsants IV / IM - Interventions to address the health and nutritional
● Manual removal of placenta needs of infants and children
● Manual vacuum aspiration of retained products of - Garantisadong Pambata
conception 1. Vitamin A Supplementation twice a year
● Vacuum extraction 2. Araw ng Sangkap Pinoy
● Newborn resuscitation
● Treatment of neonatal sepsis / infection
DOSE/
● Oxygen support TARGET PREPARATION
DURATION
CEmONC
Infant 100, 000 IU 1 dose only
Comprehensive Emergency Obstetrics and Newborn
Care
1 cap every 6
Children 200, 000 IU
months
● Oxytocic drugs IV / IM
● Antibiotics IV / IM
1 cap/tab twice
● Anticonvulsants IV / IM
Pregnant a week start at
● Manual removal of placenta 10, 000 IU
Women 4 months until
● Manual vacuum aspiration of retained products of
delivery
conception
● Vacuum extraction 1 cap/1 dose
● Surgery (cesarean section) Post-partum
200, 000 IU w/in 4 weeks
● Blood transfusion Women
after delivery
● Newborn resuscitation

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NCM 104 Lec: Community Health Nursing 11/09/22
MODULE 6 - DOH Programs Related to Family Health

- Position of choice during labot and

3. FOOD FORTIFICATION PROGRAM
- FORTIFICATION is the addition of a micronutrient
deficient in the diet toacommonly and widely
consumed food or seasoning.
- Food fortification or enrichment is the process of
adding micronutrients (essential trace elements and
vitamins) to food.
RA 8976 – Food Fortification Law
1. Rice – iron
2. Flour – iron and Vit. A
3. Cooking oil – Vit. A
4. Sugar – Vit. A
4. NUTRITION SURVEILLANCE SYSTEM
- The Nutrition Surveillance system involves keeping
a close watchonthestate of nutrition and the causes
of malnutrition within a locality. Thiswhich involves
periodic collection of data and analysis and
LEGAL MILESTONES
A. PD 491 – Nutrition Act of the Philippines
● declares nutrition as a priority of the government
● creates the National Nutrition Council
● designated July as the Nutrition Month
B. RA 832- rice Enrichment Law
● All milled rice will have to be enriched with
pre-mixed Rice
C. RA 8172- FIXED Salt
delivery
- Freedom of movement during labor
5. When given to women of childbearing age, vaccines
that contain tetanus to toxoid (TT) protection covers
which of the following? - Protect not only women
against tetanus, but also prevent neonatal tatenus
in their newborn infants.
6. Which of the following is the objectives of
NUTRITION PROGRAM - To decrease the morbidity
and mortality rates secondary to Avitaminoses and
other nutritional deficiencies among the
population mostly composed of infants and
children.
7. An approach established to strengthen the provision
of comprehensive and essential health package to
the children. - Integrated Management of
Childhood Illness
8. The objective of this program is to reduce the
morbidity and mortality among infants and children -
Expanded Program on Immunization
9. Who are the children covered by the IMCI protocol?
- sick children up to 2 months (Sick young
- infant2 months up to 5 years (sick child)
10. 4 early essential newborn care:
- Immediate and thorough drying
- Early skin to skin contact
- Properly timed cored clumping and cutting
- Non-separation of the mother and newborn
for early initiation of breastfeeding.
11. To reduce preventable deaths of all filipino
newborns due to more common and rare congenital
disorders through timely screening an proper
management - Newborn screening
12. Cold chain time management frame for storage
of vaccine in health center/BHU - Not more than 5
days
13. Use to maintain potency of the vaccine - Cold
chain management

D. Policy on Vitamin A Supplementation Program

MODULE 6 QUIZ

1. Decree that requires compulsory immunization of

children less than 8 years old. - RA 10152
2. Place the 5 IMCI Process in order.
- Assess
- Classify and Identify treatment
- Treat
- Counsel
- Follow-up
3. AIms to increase the quality of care around the time
of birth and during the first few weeks of life to
eliminate preventable causes of newborn death. -
Essential Intrapartum and Newborn Care (EINC)
4. EINC practices during the intrapartum period are
which of the following?
- Continuous maternal support by haing
a companion of choice during labor and
delivery

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