Expanded Program for Immunization

(EPI)
Principles of EPI Freeze dried
1. Epidemiological situation  BCG (Bacillus  Live Infant-
2. Mass approach Calmette attenuated 0.05mlPreschool-
3. Basic Health Service Guerin) bacteria 0.1ml
The 7 immunizable diseases DT-
1. Tuberculosis  DPT weakened
2. Diptheria (Diphtheria toxin
3. Pertussis Pertussis P-killed
4. Measles Tetanus) bacteria  liquid-0.5ml
5. Poliomyelitis
 OPV (Oral  weakened
6. Tetanus
Polio Vaccine) virus  liquid-2drops
7. Hepatitis B
Target Setting  Plasma
 Infants 0-12 months  Hepatitis B derivative  Liquid-0.5ml
 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years
 Weakened  Freeze dried-
 Measles virus 0.5ml
old
Objectives of EPI Schedule of Vaccines
 To reduce morbidity and mortality
rates among infants and children  Age at 1st  Interval between
from six childhood immunizable  Vaccine dose dose  Pr
disease
Elements of EPI  BC
 Target Setting pro
 Cold chain Logistic Management- BCG  At birth from
Vaccine distribution through cold
chain is designed to ensure that the  An
vaccines were maintained under  DPT  6 weeks  4 weeks of s
proper environmental condition until
 Th
the time of administration.
 OPV  6weeks  4weeks inc
 Information, Education and
Communication (IEC)  An
 Assessment and evaluation of Over-  @birth,6th the
all performance of the program  Hepa B  @ birth week,14th week car
 Surveillance and research studies
 9m0s.-  At
Administration of Vaccines  Measles 11m0s. imm
 Vaccine  Content  Form & Dosage
  6 months – earliest dose of measles
given in case of outbreak
 9months-11months- regular schedule
of measles vaccine
 15 months- latest dose of measles
given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less
than 12 months old child with
complete immunizations of DPT,
OPV, BCG, Anti Hepatitis, Anti
measles.
  Not more than 5days- Health
Tetanus Toxoid Immunization
Schedule for Women
  Vaccine  Minimum age interval
 TT1  As early as possible
 TT2  4 weeks later
 TT3  6 months later
 TT4  1year later/during next pregnancy
 TT5  1 year later/third pregnancy
 There is no contraindication to
immunization except when the child
is immunosuppressed or is very, very
ill (but not slight fever or cold). Or if
the child experienced convulsions
after a DPT or measles vaccine,
report such to the doctor
immediately.
 Malnutrition is not a contraindication
for immunizing children rather; it is
an indication for immunization since
common childhood diseases are
often severe to malnourished
children.
Cold Chain under EPI
 Cold Chain is a system used to
maintain potency of a vaccine from
that of manufacture to the time it is
given to child or pregnant woman.
 The allowable timeframes for the
storage of vaccines at different levels
are:
 6months- Regional Level
 3months- Provincial
Level/District Level
 1month-main health centers-
with ref.
centers using transport boxes.
 Most sensitive to heat: Freezer (-15
to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and
freezing (body of ref. +2 to +8
degrees Celsius)
 BCG
 DPT
 Hepa B
 TT
 Use those that will expire first, mark
“X”/ exposure, 3rd- discard,
 Transport-use cold bags let it stand
in room temperature for a while
before storing DPT.
 Half life packs: 4hours-BCG, DPT,
Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”)
– vaccine is practiced to assure that
all vaccines are utilized before the
expiry date. Proper arrangement of
vaccines and/or labeling of vaccines
expiry date are done to identify those
near to expire vaccines.

II. NEWBORN SCREENING
- NBS Act of 2004
- Approved on April 7, 2004
Newborn screening program in the
Philippines currently includes screening of
six disorders:
1. Congenital hypothyroidism (CH)
2. Congenital adrenal hyperplasia
(CAH)
3. Phenylketonuria (PKU)
4. Glucose-6- phosphate
dehydrogenase (G6PD) deficiency
5. Galactosemia (GAL)
6. Maple syrup urine disease
(MSUD)
The expanded screening will include
22 more disorders such as
hemoglobinopathies and additional
metabolic disorders, namely, organic
acid, fatty acid oxidation, and amino
acid disorders. The latter are
included in the standard care across
the globe.
Performance of Newborn Screening
 NBS shall be performed after
twenty-four (24) hours of life
but not later than three (3)
days from complete n.
 A NB that must be placed in
intensive care in order to
ensure survival may be
exempted from the 3-day
requirement BUT must be
tested by seven (7) days of
age
The expanded NBS will be offered as
optional to parents in all participating
facilities. First option is the screening of six
disorders at ₱550, which is included in the
newborn care package for Philhealth
members and the second option is the full
complement of disorder at ₱1500. At
present, there is on-going discussion with
Philhealth to increase subsidy for expanded
newborn screening.
The formal recommendation to expand the
coverage of the NBS program was prompted
by the results of the study Enhancing case
detection of selected inherited disorders
through expanded newborn screening in the
Philippines by Dr. Carmencita Padilla and
Dr. Tomas Aguirre of University of the
Philippines Manila. The data of Filipino
newborns screened through the California
newborn screening program (CNSP) from
2005 to 2009 revealed that serious disorders
were detected from CNSP which are not
included in the existing program of the
country.
III. PHILIPPINE HEALTH CARE
LAWS
REPUBLIC ACT – an act passed by the
Congress of the Philippines, while the form
of government is Republican government.
 Republic Act 349 – Legalizes the use
of human organs for surgical,
medical and scientific purposes.
 Republic Act 1054 – Requires the
owner, lessee or operator of any
commercial, industrial or agricultural
establishment to furnish free
emergency, medical and dental
 assistance to his employees and created the Commission on
laborers. population
 Republic Act 1080 – Civil Service  Republic Act 6425 – Dangerous
Eligibility Drug Act of 1992
 Republic Act 1082 – Rural Health  Republic Act 6511 – Act to
Unit Act standardize the examination and
 Republic Act 1136 – Act recognizing registration fees charged by the
the Division of Tuberculosis in the National Boards, and for other
DOH purposes.
 Republic Act 1612 – Privilege  Republic Act 6675 – Generics Act of
Tax/Professional tax/omnibus tax 1988
should be paid January 31 of each  Republic Act 6713 – Code of
year Conduct and Ethical Standards for
 Republic Act 1891 – Act Public Officials and Employees
strengthening Health and Dental  Republic Act 6725 – Act
services in the rural areas strengthening the prohibition on
 Republic Act 2382 – Philippine discrimination against women with
Medical Act which regulates the respect to terms and condition of
practice of medicines in the employment
Philippines  Republic Act 6727 – Wage
 Republic Act 2644 – Philippine Rationalization Act
Midwifery Act  Republic Act 6758 – Standardized
 Republic Act 3573 – Law on the salaries
reporting of Communicable Diseases  Republic Act 6809 – Majority age is
 Republic Act 4073 – Liberalized 18 years old
treatment of Leprosy  Republic Act 6972 – Day care center
 Republic Act 4226 – Hospital in every Barangay
Licensure Act requires all hospital to  Republic Act 7160 – Local
be licensed before it can operative Government Code
 Republic Act 5181 – Act prescribing  Republic Act 7164 – Philippine
permanent residence and reciprocity Nursing Act of 1991
as qualifications for any examination  Republic Act 7170 – Law that
or registration for the practice of any govern organ donation
profession in the Philippines  Republic Act 7192 – Women in
 Republic Act 5821 – The Pharmacy development nation building
Act  Republic Act 7277 – Magna Carta of
 Republic Act 5901 – 40 hours work Disabled Persons
for hospital workers  Republic Act 7305 – The Magna
 Republic Act 6111 – Medicare Act Carta of public Health Workers
 Republic Act 6365 – Established a  Republic Act 7392 – Philippine
National Policy on Population and Midwifery Act of 1992
 Republic Act 7432 – Senior Citizen
Act
 Republic Act 7600 – Rooming In
and Breastfeeding Act of 1992
 Republic Act 7610 – Special
protection of children against abuse,
exploitation and discrimination act
 Republic Act 7624 – Drug Education
Law
 Republic Act 7641 – New
Retirement Law
 Republic Act 7658 – An act
prohibiting the employment of
children below 15 years of age
 Republic Act 7719 – National Blood
Service Act of 1994
 Republic Act 7875 – National Health
Insurance Act of 1995
 Republic Act 7876 – Senior Citizen
Center of every Barangay
 Republic Act 7877 – Anti-sexual
harassment Act of 1995
 Republic Act 7883 – Barangay
Health workers Benefits and
Incentives Act of 1992
 Republic Act 8042 – Migrant
Workers and Overseas Filipino Act
of 1995
 Republic Act 8172 – Asin Law
 Republic Act 8187 – Paternity Leave
Act of 1995
 Republic Act 8203 – Special Law on
Counterfeit Drugs
 Republic Act 8282 – Social Security
Law of 1997 (amended RA 1161)
 Republic Act 8291 – Government
Service Insurance System Act of
1997 (amended PD 1146)
 Republic Act 8344 – Hospital
Doctors to treat emergency cases
referred for treatment
 Republic Act 8423 – Philippine
Institute of Traditional and
Alternative Medicine
 Republic Act 8424 – Personal tax
Exemption
 Republic Act 8749 – The Philippine
Clean Air Act of 1999
 Republic Act 8981 – PRC
Modernization Act of 2000
 Republic Act 9165 – Comprehensive
Dangerous Drugs Act 2002
 Republic Act 9173 – Philippine
Nursing Act of 2002
 Republic Act 9288 – Newborn
Screening Act
PRESIDENTIAL DECREE – An order of
the President. This power of the President
which allows him/her to act as legislators
was exercised during the Marshall Law
period.
 Presidential Decree 46 – An act
making it punishable for any public
officials or employee, whether of the
national or local government, to
receive directly or indirectly any
gifts or valuable things
 Presidential Decree 48 – Limits
benefits of paid maternity leave
privileges to four children
 Presidential Decree 69 – Limits the
number of children to four (4) tax
exemption purposes
 Presidential Decree 79 – Population
Commission
 Presidential Decree 147 – Declares
April and May as National
Immunization Day
 Presidential Decree 148 – Regulation
on Woman and Child Labor Law
 Presidential Decree 166
– Strengthened Family Planning
 program by promoting participation
of private sector in the formulation
and implementation of program
planning policies.
 Presidential Decree 169 – Requiring
Attending Physician and/or persons
treating injuries resulting from any
form of violence.
 Presidential Decree 223
– Professional Regulation
Commission
 Presidential Decree 442 – Labor
Code Promotes and protects
employees self-organization and
collective bargaining rights.
Provision for a 10% right differential
pay for hospital workers.
 Presidential Decree 491 – Nutrition
Program
 Presidential Decree 539 – Declaring
last week of October every as
Nurse’s Week. October 17, 1958
 Presidential Decree 541 – Allowing
former Filipino professionals to
practice their respective professions
in the Philippines so they can
provide the latent and expertise
urgently needed by the homeland
 Presidential Decree 568 – Role of
Public Health midwives has been
expanded after the implementation of
the Restructed Health Care Delivery
System (RHCDS)
 Presidential Decree 603 – Child and
Youth Welfare Act / Provision on
Child Adoption
 Presidential Decree 626 – Employee
Compensation and State Insurance
Fund. Provide benefits to person
covered by SSS and GSIS for
immediate injury, illness and
disability.
 Presidential Decree 651 – All births
and deaths must be registered 30
days after delivery.
 Presidential Decree 825 – Providing
penalty for improper disposal
garbage and other forms of
uncleanliness and for other purposes.
 Presidential Decree 851 – 13th Month
pay
 Presidential Decree 856 – Code of
Sanitation
 Presidential Decree 965 – Requiring
applicants for Marriage License to
receive instruction on family
planning and responsible parenthood.
 Presidential Decree 996 – Provides
for compulsory basic immunization
for children and infants below 8
years of age.
 Presidential Decree 1083 – Muslim
Holidays
 Presidential Decree 1359 – A law
allowing applicants for Philippine
citizenship to take Board
Examination pending their
naturalization.
 Presidential Decree 1519 – Gives
medicare benefits to all government
employees regardless of status of
appointment.
 Presidential Decree 1636 – requires
compulsory membership in the SSS
and self-employed
 Presidential Decree 4226 – Hospital
Licensure Act
PROCLAMATION – an official
declaration by the Chief Executive / Office
of the President of the Philippines on certain
programs / projects / situation
  Proclamation No.6 – UN’s goal of
Universal Child Immunization;
involved NGO’s in the immunization
program
 Proclamation No. 118 – Professional
regulation Week is June 16 to 22
 Proclamation No. 499 – National
AIDS Awareness Day
 Proclamation No. 539 – Nurse’s
Week – Every third week of October
 Proclamation No. 1275 – Declaring
the third week of October every year
as “Midwifery Week”
LETTER OF INSTRUCTION – An order
issued by the President to serve as a guide to
his/her previous decree or order.
 LOI 47 – Directs all school of
medicine, nursing, midwifery and
allied medical professions and social
work to prepare, plan and implement
integration of family planning in
their curriculum to require their
graduate to take the licensing
examination.
 LOI 949 – Act on health and health
related activities must be integrated
with other activities of the overall
national development program.
Primary Health Care (10-19-79)
 LOI 1000 – Government agencies
should be given preference to
members of the accredited
professional organization when
hiring
EXECUTIVE ORDER – an order issued
by the executive branch of the government
in order to implement a constructional
mandate or a statutory provision.
 Executive Order 51 – The Milk
Code
 Executive Order 174 – National
Drug Policy on Availability,
Affordability, Safe, Effective and
Good Quality drugs to all
 Executive Order 180 – Government
Workers Collective Bargaining
Rights Guidelines on the right to
Organize of government employee.
 Executive Order 203 – List of
regular holidays and special holidays
 Executive Order 209 – The Family
Code (amended by RA 6809)
 Executive Order 226 – Command
responsibility
 Executive Order 503 – Provides for
the rules and regulations
implementing the transfer of
personnel, assets, liabilities and
records of national agencies whose
functions are to be devoted to the
local government units.
 Executive Order 857 – Compulsory
Dollar Remittance Law
Other Important Information
 Administrative Order 114
– Revised/updated the roles and
functions of the Municipal Health
Officers, Public Health Nurses and
Rural Midwives
 ILO Convention 149 – Provides the
improvement of life and work
conditions of nursing personnel.
INTEGRATED MANAGEMENT ON
CHILDHOOD ILLNESSES
The Integrated Management of
Childhood Illness strategy has been introduced
in an increasing number of countries in the • To contribute to the healthy growth &
region since 1995. IMCI is a major strategy for development of children
child survival, healthy growth and development
and is based on the combined delivery of IMCI Components of Strategy
essential interventions at community, health • Improving case management skills of health
facility and health systems levels. IMCI includes workers
elements of prevention as well as curative and • Improving the health systems to deliver IMCI
addresses the most common conditions that • Improving family and community practice
affect young children. The strategy was **For many sick children a single diagnosis may
developed by the World Health Organization not be apparent or appropriate
(WHO) and United Nations Children’s Fund Presenting complaint:
(UNICEF). • Cough and/or fast breathing
In the Philippines, IMCI was started on • Lethargy/Unconsciousness
a pilot basis in 1996, thereafter more health • Measles rash
workers and hospital staff were capacitated to • “Very sick” young infant
implement the strategy at the frontline level. Possible course/ associated condition:
• Pneumonia, Severe anemia, P. falciparum
DEFINITION malaria
• IMCI is an integrated approach to child health • Cerebral malaria, meningitis, severe
that focuses on the well-being of the whole dehydration
child. • Pneumonia, Diarrhea, Ear infection
• IMCI strategy is the main intervention • Pneumonia, Meningitis, Sepsis
proposed to achieve a significant reduction in
the number of deaths from communicable Disease Focus of IMCI:
diseases in children under five • Acute Respiratory Infection
• Diarrhea
GOAL • Fever
• By 2010, to reduce the infant and under five • Malaria
mortality rate at least one third, in pursuit of the • Measles
goal of reducing it by two thirds by 2015. • Dengue Fever
• Ear Infection
AIM • Malnutrition
• To reduce death, illness and disability, and to
promote improved growth and development The IMCI Case Management Process
among children under 5 years of age. • Assess and classify
• IMCI includes both preventive and curative • Identify appropriate treatment
elements that are implemented by families and • Treat/refer
communities as well as by health facilities. • Counsel
• Follow-up
IMCI Objectives
• To reduce significantly global mortality and The Integrated Case Management Process
morbidity associated with the major causes of Check for General Danger Signs:
disease in children • A general danger sign is present if:
o The child is not able to drink or breastfeed
o The child vomits everything
o The child has had convulsions
o The child is lethargic or unconscious

Assess Main Symptoms

• Cough/DOB
• Diarrhea
• Fever
• Ear problems
Assess and Classify Cough of Difficulty of
Breathing
• Respiratory infections can occur in any part of
the respiratory tract such as the nose, throat,
larynx, trachea, air passages or lungs.
Assess and classify PNEUMONIA
• Cough or difficult breathing
• An infection of the lungs
• Both bacteria and viruses can cause pneumonia
• Children with bacterial pneumonia may die
from hypoxia (too little oxygen) or sepsis
(generalized infection).
** A child with cough or difficult breathing is
assessed for:
• How long the child has had cough or difficult
breathing
• Fast breathing
• Chest indrawing
• Stridor in a calm child.
Remember:
** If the child is 2 months up to 12 months the
child has fast breathing if you count 50 breaths
per minute or more
** If the child is 12 months up to 5 years the
child has fast breathing if you count 40 breaths
per minute or more.
COLOR CODING
PINK (URGENT REFERRAL) YELLOW (Treatment at GREEN (Home management
outpatient health facility

OUTPATIENT HEALTH OUTPATIENT HEALTH HOME

FACILITY FACILITY
• Caretaker is counseled on:
• Pre-referral treatments • Treat local infection
• Home treatment/s
• Advise parents • Give oral drugs
• Feeding and fluids
• Refer child • Advise and teach caretaker
• When to return immediately
• Follow-up
• Follow-up

REFERRAL FACILITY SEVERE PNEUMONIA OR • Give first dose of an

VERY SEVERE DISEAS appropriate antibiotic
• Emergency Triage and
Treatment ( ETAT) • Give Vitamin A

• Diagnosis, Treatment • Treat the child to prevent low

blood sugar
• Monitoring, follow-up
• Refer urgently to the hospital •
Give paracetamol for fever >
38.5oC

• Any general danger sign or PNEUMONIA • Give an appropriate antibiotic

for 5 days
• Chest indrawing or
• Soothe the throat and relieve
• Stridor in calm child cough with a safe remedy

• Advise mother when to return

immediately

• Follow up in 2 days

• Give Paracetamol for fever >

38.5oC

• Fast breathing NO PNEUMONIA : COUGH • If coughing more than more

OR COLD than 30 days, refer for
assessment

• Soothe the throat and relieve

the cough with a safe remedy

• Advise mother when to return

immediately

• Follow up in 5 days if not

improving
 • No signs of pneumonia or very
severe disease

Assess and classify DIARRHEA

A child with diarrhea is assessed for:
• How long the child has had diarrhea
• Blood in the stool to determine if the child has dysentery
• Signs of dehydration.
Classify DYSENTERY
• Child with diarrhea and blood in the stool

Two of the following signs? SEVERE • If child has no other severe

classification:
• Abnormally sleepy or difficult DEHYDRATION
o Give fluid for severe
to awaken dehydration (
• Sunken eyes Plan C ) OR
• Not able to drink or drinking

poorly • If child has another severe

classification:
• Skin pinch goes back very
o Refer URGENTLY to hospital
slowly
with

mother giving frequent sips of

ORS

on the way

o Advise the mother to continue

breastfeeding

• If child is 2 years or older and

there is

cholera in your area, give

antibiotic for

cholera

Two of the following signs :
• Restless, irritable
• Sunken eyes
• Drinks eagerly, thirsty
• Skin pinch goes back slowly
SOME • Give fluid and food for some
dehydration (Plan B )
DEHYDRATION
• If child also has a severe
classification:
o Refer URGENTLY to
hospital with mother giving
frequent sips of ORS on the way

o Advise mother when

to return immediately
 • Follow up in 5 days if not
improving

• Not enough signs to classify as NO DEHYDRATION • Home Care

some or severe dehydration
• Give fluid and food to treat
diarrhea at home (Plan A)

• Advise mother when to return

immediately

• Follow up in 5 days if not

improving

• Dehydration present SEVERE PERSISTENT • Treat dehydration before

DIARRHEA referral unless the child has
another severe classification •
Give Vitamin a • Refer to
hospital

• No dehydration PERSISTENT DIARRHEA • Advise the mother on feeding a

child who has persistent diarrhea

• Give Vitamin A

• Follow up in 5 days

• Blood in the stool DYSENTERY • Treat for 5 days with an oral

antibiotic recommended for
Shigella in your area

• Follow up in 2 days

• Give also referral treatment

Does the child have fever?

**Decide:
• Malaria Risk
• No Malaria Risk
• Measles
• Dengue

Malaria Risk
• Any general danger sign or VERY SEVERE FEBRILE • Give first dose of quinine
DISEASE / MALARIA ( under medical supervision or if
• Stiff neck a hospital is not accessible
within 4hrs )

• Give first dose of an

appropriate antibiotic

• Treat the child to prevent low

blood sugar

• Give one dose of paracetamol

in health center for high fever
(38.5oC) or above
 • Send a blood smear with the
patient

• Refer URGENTLY to hospital

• Blood smear ( + ) MALARIA • Treat the child with an oral

antimalarial
If blood smear not done:
• Give one dose of paracetamol
• NO runny nose, and in health center for high fever
(38.5oC) or above
• NO measles, and
•Advise mother when to return
• NO other causes of fever
immediately

• Follow up in 2 days if fever

persists

• If fever is present everyday for

more than 7 days, refer for
assessment

• Blood smear ( – ), or • Give one dose of paracetamol

in health center for high fever
• Runny nose, or FEVER : MALARIA (38.5oC) or above
UNLIKELY
• Measles, or Other causes of • Advise mother when to return
fever immediately

• Follow up in 2 days if fever

persists

• If fever is present everyday for

more than 7 days, refer for
assessment

No Malaria Risk
 Any general danger sign VERY SEVERE FEBRILE • Give first dose of an
or DISEASE appropriate antibiotic
 Stiff neck
• Treat the child to prevent low
blood sugar

• Give one dose of paracetamol

in health center for high fever
(38.5oC) or above

• Refer URGENTLY to hospital

 No signs of very severe FEVER : NO MALARIA • Give one dose of paracetamol

febrile disease in health center for high fever
(38.5oC) or above

• Advise mother when to return

immediately

• Follow up in 2 days if fever


Measles
• Clouding of cornea or
• Deep or extensive mouth
ulcers
• Pus draining from the eye or
• Mouth ulcers
• Measles now or within the last
3 months
Dengue Fever
• Bleeding from nose or gums or
• Bleeding in stools or vomitus
or
• Black stools or vomitus or
• Skin petechiae or Cold
clammy extremities or
• Capillary refill more than 3
seconds or
• Abdominal pain or
• Vomiting
• Tourniquet test ( + )
• No signs of severe dengue
hemorrhagic fever
persists
• If fever is present everyday for
more than 7 days, refer for
assessment
SEVERE COMPLICATED • Give Vitamin A
MEASLES
• Give first dose of an
appropriate antibiotic
• If clouding of the cornea or
pus draining from the eye, apply
tetracycline eye ointment
• Refer URGENTLY to hospital
MEASLES WITH EYE OR • Give Vitamin A
MOUTH COMPLICATIONS
• If pus draining from the eye,
apply tetracycline eye ointment •
If mouth ulcers, teach the
mother to treat with gentian
violet
MEASLES • Give Vitamin A
SEVERE DENGUE If skin petechiae or Tourniquet
HEMORRHAGIC FEVER test,are the only positive signs
give ORS
• If any other signs are positive,
give fluids rapidly as in Plan C
• Treat the child to prevent low
blood sugar
• DO NOT GIVE ASPIRIN
• Refer all children Urgently to
hospital
FEVER: DENGUE • DO NOT GIVE ASPIRIN
HEMORRHAGIC UNLIKELY
• Give one dose of paracetamol
in health center for high fever
(38.5oC) or above
• Follow up in 2 days if fever
 persists or child shows signs of
bleeding

• Advise mother when to return

immediately

Does the child have an Ear problem?

MASTOIDITIS • Give first dose of appropriate

 Tender swelling behind
the ear
• Pus seen draining from the ear
and discharge is reported for
less than 14 days or
antibiotic • Give paracetamol for
pain • Refer URGENTLY
ACUTE EAR INFECTION • Give antibiotic for 5 days
• Give paracetamol for pain

• Ear pain • Dry the ear by wicking

• Follow up in 5 days

• Pus seen draining from the ear CHRONIC EAR INFECTION • Dry the ear by wicking
and discharge is reported for
less than 14 days • Follow up in 5 days

• No ear pain and no pus seen NO EAR INFECTION • No additional treatment

draining from the ear

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very Severe disease

COTRIMOXAZOLE BID FOR AMOXYCILLIN BID FOR 5

5 DAYS DAYS

Age or Weight Adult tablet Syrup Tablet Syrup

2 months up to 12 months ( 4 – ½ 5 ml 1/2 5 ml

< 9 kg )

12 months up to 5 years ( 10 – 1 7.5 ml 1 10 ml

19kg )

B. For Dysentery

COTRIMOXAZOLE BID FOR AMOXYCILLIN BID FOR 5

5 DAYS DAYS

AGE OR WEIGHT TABLET SYRUP SYRUP 250MG/5ML

2 – 4 months ( 4 – < 6kg ) 1/2 5 ml 1.25 ml (1/4 tsp)

4 – 12 months ( 6 – < 10 kg ) 1/2 5 ml 2.25 ml (1/4 tsp)

 1 – 5 years old ( 10 – 19 kg ) 1 7.5 ml 1 tsp

C. For Cholera

TETRACYCLINE QID FOR 3 COTRIMOXAZOLE

DAYS BID FOR 3 DAYS

AGE OR WEIGHT Capsule 250mg Tablet Syrup

2 – 4 months ( 4 – < 6kg ) ¼ ½ 5ml

4 – 12 months ( 6 – < 10 kg ) ½ ½ 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5 ml

Give an Oral Antimalarial

CHOLOROQUINE Primaquine Give Primaquine Sulfadoxine +

Give for 3 days single dose in Give single dose Pyrimethamine
health center for in health center Give single dose
P. Falciparum for P.
Falciparum

AGE TABLET ( 150MG ) TABLET TABLET TABLET

( 15MG) ( 15MG) ( 15MG)

DAY1 DAY2 DAY3

2months – ½ ½ ½ 1/4
5months

5 months – 12 ½ ½ ½ ½
months

12 months – 3 1 1 ½ ½ 1/4 3/4

years old

3 years old – 5 1 1/2 1 1/2 1 3/4 1/2 1

years old

GIVE VITAMIN A

AGE VITAMIN A CAPSULES 200,000 IU

6 months – 12 months 1/2

12 months – 5 years old 1

GIVE IRON
 AGE or WEIGHT Iron/Folate Tablet FeSo4 200mg Iron Syrup FeSo4 150 mg/5ml
+ 250mcg Folate (60mg (6mg elemental iron per ml )
elemental iron)

2months-4months (4 –<6kg) 2.5 ml

4months – 12months (6 –<10kg) 4 ml

12months – 3 years (10 –<14 ½ 5 ml

kg)

3years – 5 years ( 14 – 19kg ) 1/2 7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG ) SYRUP (120MG/ 5ML)

2 months – 3 years ( 4 –<14kg) 1/4 5 ml

3 years up to 5 years (14 – 19 kg 1/2 10 ml

)

GIVE MEBENDAZOLE

• Give 500mg Mebendazole as a single dose in health center if:

o hookworm / whipworm is a problem in children in your area, and

o the child is 2 years of age or older, and
o the child has not had a dose in the previous 6 month

Non Sustainabct

CORE VALUES

1. CARING

2. DIVERSITY

3. EXCELLENCE

4. INTEGRITY

5. HUMAN DIGNITY

6. AUTONOMY

7. ALTRUISM

8. SOCIAL JUSTICE

CARING
 A culture of caring, as a fundamental part
of the nursing profession, characterizes our
concern and consideration for the whole person,
our commitment to the common good, and our
outreach to those who are vulnerable.

All organizational activities are managed

in a participative and person-centered way,
demonstrating an ability to understand the needs
of others and a commitment to act always in the best interests of all stakeholders.

DIVERSITY

A culture of inclusive excellence

encompasses many identities, influenced by the
intersections of race, ethnicity, gender, sexual
orientation, socio-economic status, age, physical
abilities, religious and political beliefs, or other
ideologies. It also addresses behaviors across
academic and health enterprises. Differences affect
innovation so we must work to understand both
ourselves and one another.

EXCELLENCE

A culture of excellence reflects a commitment to

continuous growth, improvement, and understanding. It is a
culture where transformation is embraced, and the status quo
and mediocrity are not tolerated.

INTEGRITY

A culture of integrity is evident when organizational principles of open

communication, ethical decision-making, and humility are encouraged, expected,
and demonstrated consistently. Not only is doing the right thing simply how we do
business, but our actions reveal our commitment to truth telling and to how we
always see ourselves from the perspective of others in a larger community.
HUMAN DIGNITY

can be thought of as an individual's sense of self-worth and self-respect. It can

encompass many things, including the right to fill basic needs, like food, shelter, and
personal safety. In the healthcare environment, human dignity is more focused on
aspects of privacy, respect, and autonomy

AUTONOMY

Professional autonomy means having the authority to make decisions and the
freedom to act in accordance with one's professional knowledge base. Relevance to
clinical practice: To gain autonomous practice, nurses must be competent and have
the courage to take charge in situations where they are responsible.

ALTRUISM

is concern for the welfare and well-being of others. In professional practice, altruism
is reflected by the nurse's concern and advocacy for the welfare of patients, other
nurses, BHWs, and healthcare providers

SOCIAL JUSTICE

Social justice ideology requires nursing students to uphold moral, legal, and
humanistic principles related to health. Social justice is a core nursing value and the
foundation of public health nursing. Social justice implies that there is a fair and
equitable distribution of benefits and burdens in a society.