COMMUNITY HEALTH NURSING (PART 1)
 Citizens and communities have a right
PRIMARY HEALTH CARE
ALMA ATA DECLARATION
 September 6-12, 1978
 First International Conference on PHC
 PHC goal: HEALTH FOR ALL BY THE YEAR
2000
 ALMA-ATA, Kazakhstan, RUSSIA (USSR)
 Sponsored by WHO and UNICEF
ASTANA DECLARATION
 October 25-26, 2018
 Marks by 40 years since the first Global
Conference on PHC
 Declaration of Astana took place in Astana,
Kazakhstan
 Hosted by WHO, UNICEF and the Government
of Kazakhstan
LETTER OF INSTRUCTION (LOI) 949
 Philippines First Asian country to have
adopted PHC as a national strategy
 The legal basis of PHC was signed by Pres.
Ferdinand Marcos
 Signed by October 19, 1979
 HEALTH FOR ALL FILIPINOS (by the year
2000) AND HEALTH IN THE HANDS OF THE
PEOPLE (by the year 2020)
 END GOAL of PHC approach is for people to
be SELF-RELIANT
PRINCIPLES OF PHC: 4 A’s of PHC
1) ACCESSIBILITY
 Essential and appropriate health services
are available to citizens within a
reasonable geographical distance by an
appropriate provider and within a time
frame that is appropriate (Not more than
5 km away and 30 minutes to travel)
2) AVAILABILITY
 Care can be obtained whenever people
need it (24/7)
3) AFFORDABILITY
 The cost should be within the means and
resources of the individual and the
country (not totally free SERVICES)
4) ACCEPTABILITY
 Health services offered area to be in
accordance to the prevailing beliefs
and practices of the intended clients of
care.
COMMUNITY PARTICIPATION
and responsibility to be active partners in
making decisions about their own health
and the health of their communities.
 Heart and Soul of PHC
 The ideal word for COMMUNITY
PARTICIPATION is “The nurse is working
WITH THE PEOPLE”
HEALTH PROMOTION
 Focus or enabling citizens to increase
control over and improve their health and
well-being
 BASIC PRINCIPLE: PREVENTION IS BETTER
THAN CURE
APPROPIRATE TECHNOLOGY
 The people, procedures, equipment, drugs,
and resources used are EFFECTIVE and
CULTURALLY ACCEPTABLE to individuals
and the community
 Use of cheaper, scientifically valid tools
and methods that are all suitable and
acceptable to the families and communities
 E.g. use of herbal medicines, acupuncture,
acupressure
INTERSECTORAL COLLABORATION
 Partnership between community and health
agencies
 E.g.
a) Referral system among the RHU
b) NGOs
c) Local social welfare and Development
Office
SOCIAL MOBILIZATION
 Enhancing people participation
 Process of BRINGING TOGETHER ALL
SOCIETAL AD PERSONAL INFLUENCES TO
RAISE AWARENESS of and demand for
healthcare, assist in the delivery of resource
and services, and cultivate sustainable
individual and community involvement.
DECENTRALIZATION
 Transfer of authority, functions and/or
resources from the center to the periphery
within a specific sector
 The Philippines decentralized government
health services in 1992 through devolution
with the Implementation of the Local
Government Code (RA 7160)
4 MAJOR PILLARS OF PHC (CORNERSTONES) 2) INTERMEDIATE LEVEL
1) INTERSECTORAL LINKAGES (Multisectoral)  First source of professional health
2) USE OF APPROPRIATE TECHNOLOGY care
3) SUPPORT MECHANISM MADE AVAILABLE  Attends health problems beyond the
4) ACTIVE COMMUNITY PARTICIPATION competence of grassroots workers
(sustained by social mobilization) a) Rural Sanitary Inspectors
b) Medical Practitioners and
COMPONENTS OF PHC: “MAD ELEMENTS” OF PHC their Assistants
1) Mental Health c) Registered Midwives
2) Access to Sentrong Sigla d) Nurse in Public Health (PHN)
3) Dental Health 3) FIRST LINE HOSPITAL PERSONNEL
4) Education In Concerning Prevailing Health  Provide backup health services for
Problems cases that needs hospitalization
5) Locally Endemic Disease Preventions And a) Doctors with Specialties:
Control 1. OB
6) Expanded Program Of Immunization Against 2. Pediatrician
Major Infectious Diseases (RA 10152) 3. Cardiologist
7) Maternal And Child Healthcare Including 4. Dentist
Family Planning b) Other Healthcare
8) Essential Drugs Arrangement Professionals
9) Nutritional Food Supplement, And Adequate c) Nurse Specialist
Supply Of Safe And Basic Nutrition d) Anesthesiologist and Surgeon
10) Treatment Of Communicable And Non-
Communicable Diseases And Promotion Of LEVELS OF HEALTHCARE DELIVERY SYSTEM
Mental Health 1) PRIMARY
11) Safe Water And Sanitation  Basic health procedures
 25-75 beds capacity
DOH STANDARD RATIO OF HEALTHCARE WORKERS  Puericulture centers/Birthing in or
Lying in
BARANGAY HEALTH 1:20 HOUSEHOLDS  Rural Health Unit (RHU) (RA 1082)
WORKERS  Community Health Centers Or
MIDWIFE 1:5,000 Barangay Health Station (BHS)
NURSE 1:20,000 2) SECONDARY
MD/PHYSICIAN 1:20,000  Referral system of primary level
SANITARY INSPECTOR 1:20,000  Minor operations and laboratory
DENTIST 1:50,000 examinations
CONTACT TRACERS 1:800  100-200 beds capacity
 Outpatient Department Hospitals
LEVELS OF PHC WORKERS  Provincial Hospitals
1) GRASSROOTS/VILLAGERS  District Hospitals/Emergency District
 First contact of the community Hospital
 Initial link to healthcare 3) TERTIARY
 Renders simple curative/preventive  Referral system of secondary level
health measures  Highly specialized staff and technical
 Serves as the foundation of healthcare equipment
 Trained local individuals in the  Complex medical and surgical
community provides interventions
 BATA:  Major operations and invasive
a) BHWs procedures
b) Auxiliary Volunteers  Medical Centers & National Hospitals
c) Traditional Birth Attendants/  Regional Hospitals
TBA (Trained hilots)  Training and Teaching Hospitals
d) Albularyos
3 LEVELS OF PREVENTION 3. Swab Test for COVID-
1) PRIMARY LEVEL 19
 Target: HEALTHY individuals b) Blood tests
 GOAL: To prevent/delay the actual 1. CBC for blood
occurrence of disease disorders
 INTERVENTION: Health Promotion (Pancytopenia)
and Disease Prevention 2. ELISA (Confirmatory
 HEALTH EDUCATION for Dengue)
 Basic health service that aims 3. Western Blot for HIV
to modify harmful practices of (Confirmatory)
people and their unscientific 4. CD4 T cell Count
knowledge and attitude (Confirmatory for
 ACTIVITIES: AIDS)
a) Health Education c) Contact tracing
1. Family Planning d) Quarantine (separation of
2. Genetic Counseling contact to well individuals)
b) Healthy Lifestyle Habits e) Disease surveillance
1. Health Diet f) Diagnostic Tests
2. Rest 1. Ultrasound
3. Exercise 2. CXR
4. Not Smoking 3. MRI
c) Hygiene (HANDWASHING) 4. CT Scan
d) Immunization/Inoculation 5. Mammography
e) Isolation of the diagnosed sick g) Treatment/Cure of disease
child to pregnant mother h) Examination of breast (BSE)
f) Intake or use of Prophylactic i) Examination of Testes (TSE)
drugs j) OPLAN Timbang
1. Antiretroviral drugs k) Screening Test & Selective
2. Chloroquine tablets Examinations
(Prophylaxis of malaria) 1. Newborn Screening
3. Doxycycline (Prophylaxis 2. Screening for
of leptospirosis) hypertension
4. Crede’s Prophylaxis l) Trauma & CRISIS
(prevent PREVENTION (stress
gonorrheal/chlamydial eye debriefing)
infection) 3) TERTIARY LEVEL
g) Vector Control  Target: Individuals with diagnosed
1. Destroy breeding sites (for illness and advance disease
Dengue, Zika prevention)  GOAL: Reduce impact/limit disability,
2. Clear hanging trees in the prevent sequelae and prevent death
riverbanks (for Malaria  INTERVENTION: Rehabilitation
prevention)  ACTIVITIES:
2) SECONDARY LEVEL a) Therapies
 Target: Sick or at risk individuals 1. Physical therapy
 GOAL: SCREENS clients for early 2. Occupation therapy
detection and prompt treatment of (Prostheses use)
the disease b) Health care and treatment for
 INTERVENTION: Early diagnosis and those infected by COVID-19
treatment c) Use of assistive devices
 ACTIVITIES: d) Maintenance drugs among
a) Case finding tools patient with hypertension
1. Skin Slit Smears for e) Blood pressure and Blood
leprosy sugar monitoring
2. Sputum smear for TB f) Self-Management Education
for patient with diabetes
 g) Use of chemotherapeutic
drugs and radiation for cancer
h) Provide family therapy for
abusive families; remove
children from home
DEPARTMENT OF HEALTH
 Dr. Francisco Duque III (DOH Secretary)
 VISION: Filipinos are among the healthiest
people in Southeast Asia by 2022, and Asia by
2040
 MISSION: To lead country in the development
of a productive, resilient, equitable and
people centered health system
ROLES AND FUNCTIONS OF DOH
3 BASIC FUNCTIONS “LEA”
1) LEADERSHIP IN HEALTH
 Serve as the national policy and
regulatory institution
 Provide leadership in formulation,
monitoring and evaluation of national
health policies
 Serve as advocate in the adoption of
health policies, plans and programs to
address national and sectoral concerns
 FORMULATE
 Creates the policies, protocols, rules
and regulations of health in the
Philippines.
 ADVOCATE
 Protect the right of the people
 REGULATE
 All hospitals must have certification of
cooperation from DOH
 Make sure affordable and safe health
services in the country
2) ENABLER & CAPACITY BUILDER “IME”
 INNOVATE
 Update of health practices in the
country.
 MONITOR
 All hospitals in the country have
license from DOH
 All hospitals in the country are
checked by the DOH
 ENSURE
 Must have safe and quality health
services
3) Administrator of specific services
 EMERGENCY SERVICES “EMA”
 In case of emergencies, the DOH must
ensure safe and quality healthcare
services
 MANAGE SELECTED HOSPITAL
 Specific hospitals are funded are from
DOH
 E.g. Philippine General Hospital
 Specialized Hospitals = Specific cases
(e.g. National Kidney Institute,
Philippine Heart Centre)
 ADMINISTER BASIC SERVICES
 To provide basic health services
UNIVERSAL HEALTH CARE (RA 11223)
 KALUSUGAN PANGKALAHATAN (KP)
 Highest possible quality of healthcare for
EVERY Filipino
 Care that is accessible, efficient, equitably
distributed, adequately funded, fairly
financed, and appropriately used by an
informed and empowered public
UHC’S 3 THRUSTS
 KEY PLAYERS IN UHC: DOH, LGU & PhilHealth
1) FINANCIAL RISK PROTECTION
 Through expansion in enrollment and
benefit delivery of the National Health
Insurance Program (NHIP) or PhilHealth
2) IMPORVED ACCESS TO QUALITY HOSPITALS
AND HEALTHCARE FACILITIES
 Upgrading government-owned and
operated hospitals and health facilities
 Rehabilitation and Construction of Critical
Health Facilities
 Treatment Packs for HTN and DM
 Obtained and distributed to RHUs
3) ATTAINMENT OF HEALTH-REALTED MDGs
 MDG signed: September 2000
 Target: 2015
 Goals: 8 MDGs
 To reduce maternal and child mortality
 TO reduce morbidity and mortality from
TB, Malaria and incidence of HIV/AIDS
 8 MDGs
1) Eliminate Extreme Poverty And Hunger
2) Achieve Global Primary Education
3) Promote Gender Equality And Empower
Women
4) Reduce Child Mortality (reduce the under-
five mortally rate by 2/3 in year 2015)
 Pneumonia = single largest
infectious cause of death in
children worldwide (under-five)
 Diarrhea =
 Asphyxia = Common cause of
newborn deaths
 5) Improve Maternal Health (reduce
maternal mortality by 3 quarters (3/4) in
2015)
 Direct Maternal Deaths (HOUSE)
a) Hemorrhage
b) Obstructed Labor
c) Unsafe Abortion
d) Sepsis
e) Eclampsia
6) Combat Malaria, HIV/AIDS, And Other
Diseases (Including neglected tropical
diseases)
7) Ensure Environmental Sustainability
8) Develop A Universal/Global Partnership
For Development
SUSTAINABLE DEVELOPMENT GOALS
1) No Poverty
2) 0 (Zero) Hunger
3) Good Health & Well-Being
4) Education (Quality)
5) Equality (Gender)
6) Clean Water And Sanitation
7) Affordable And Clean Energy
8) Decent Work And Economic Growth
9) Industry, Integration And Infrastructure
10) Reduced Inequalities
11) Cities And Communities (Sustainable)
12) Consumption And Production
13) Climate Change Action
14) Life Below Water
15) Life On Land
16) Peace, Justice & Strong Institution
17) Partnership For Goals
IMPORTANT NOTES:
a) MDGs 4 & 5 is the priority of the DOH
b) Reduce Child Mortality And Improve
Maternal Health are 2 goals which are VERY
specific to Maternal Child Health (MCH)
 Infant Mortality Rate = most sensitive
indicator for mortality and morbidity
c) Reduction of maternal mortality of 75% by
year 2015
d) NATIONAL PRIORITY: MDG 1 (Eradicate
Extreme Poverty)
FILED HEALTH SERVICE INFORMATION SYSTEM
(FHSIS)
 Provides a summary of data on health service
delivery and selected programs from the
barangay level up to the national level
 FHSIS Importance:
a) Facilitates information for monitoring
and evaluating health program
implementation
b) Help local government determine public
health priorities
c) Service delivery monitoring
d) It monitors health status of the
community
e) Source of data to detect any unusual
occurrence of a disease
COMPONENTS OF FHSIS
1) INDIVIDUAL TREATMENT RECORD (ITR)
 Use to record patient address, full
name, age, symptoms and diagnosis
(piece of paper/patient consultation
record)
 Individual treatment record or
FAMILY TREATMENT RECORD is the
fundamental block or foundation of
FHSIS
2) TARGET CLIENT LIST (TCL)
 Primary Advantage: Lets nurses and
midwives save time and effort in
monitoring treatment and services to
beneficiaries
 TCL will be transmitted to the next
facility in the form form of
REPORTING FORMS
 TCLS TO BE MAINTAINED ARE:
a) TCL for Prenatal
b) TCL for Postpartum Care
c) TCL for Family Planning
d) TCL for Under One year old
children
e) TCL for Sick Children
f) NTP TB Register (National
Leprosy Control Program)
3) TALLY/REPORTING FORMS
 Reporting forms is the ONLY
mechanism through which date are
routinely transmitted from one
facility to another
 Reports are submitted directly to the
PROVINCIAL HEALTH OFFICE (PHO)
 E-2 is the Maternal Death Form
 Reporting forms from BHU Facility to
the PHO
 Output Reports are solely produced
by the PHO
 Data submitted to the PHO is
processed using MICROCOMPUTER
 The recommended frequency in
tallying activities and services using
tally sheets is DAILY
  Counting of the tally sheet is done at c) Uric Acid lowering Agent
the END OF THE MONTH d) Tophi prevention
e) YES you can boil it or eat like a salad
RA 7160 (Devolution Code or Local Government  PREPARATION:
Code) a) ½ cup of leaves boiled in a
 Aims to transform local government units glasses for water
into self-reliant communities and active b) Divide into 3 parts and drink one
partners part 3x a day
3) BAWANG (Allium Sativum)
LOCAL HEALTH BOARD (LHB) a) Hypertension
1) PROVINCIAL HEALTH BOARD b) Toothache
a) Chairman: GOVERNOR c) Neutralize free radicals & lowers
b) Vice Chairman: Provincial Health Officer cholesterol level
c) MEMBERS:  PREPARATION:
1. Chairman, Committee on Health a) Fried, roasted soaked in vinegar
of Sangguniang Panlalawigan for 30 minutes
2. DOH Representative (PHN) b) Blanched in boiled water for 15
3. NGO Representative (Private minutes
Sector) c) Take 2 pieces 3x a day AFTER
2) CITY & MUNICIPAL HEALTH BOARD MEALS
a) Chairman: MAYOR 4) BAYABAS (Psidium Guajava)
b) Vice Chairman: Municipal Health Officer a) Stomach Flu/Diarrhea
c) MEMBERS: b) Use for Wound Washing
1. Chairman, Committee on Health c) Gets rid of fungi, amoeba, and bacteria
of Sangguniang Panlungsod d) Antiseptic activity
2. DOH Representative (PHN) e) Toothache
3. NGO Representative (Private  PREPARATION:
Sector) a) Young leaves can be boiled taken
 TAKE NOTE: 3-4x a day for diarrhea
a) MIDWIFE is NOT a member of the b) Warm decoction for gargle in
Health Board toothache
b) Midwives are the FRONTLINE 5) YERBA BUENA (Mentha Cordifolia)
WORKERS in COMMUNITY and RHU a) ANALGESIC
c) Midwives links the community to RHU b) Pruritus or itchiness
c) Arthritis/Rheumatism
RA 8423 – TRADITIONAL AND ALTERNATIVE d) Insect bites and swollen gums
MEDICINAL ACT (TAMA) of 1997 e) Nausea & Vomiting
 By Juan Flavier f) Flatulence or Gas pain
1) LAGUNDI (Vitex Negundo) g) Loss of consciousness temporarily
a) Sprain and Skin Diseases (syncope) – alternative of spirit of
b) Headache & Fever ammonia
c) Rheumatism h) Menstrual pain
d) Eczema  PREPARATION:
e) Dysentery a) For PAIN: boil leaves in 2 glasses
 PREPARATION: for 15 minutes
a) Decoction: Boil ½ cup of chopped b) Divide
fresh or dried leaves in 2 cups of c) Decoction in 2 parts and drink
water for 10-15 minutes one
b) Drink half cup 3 times a day 6) SAMBONG (Blumea Balsamifera)
c) Pounded leaves for headache and a) Antiurolithiasis
rheumatism b) Diuretic
2) ULASIMANG BATO/PANSIT-PANSITAN c) Anti-edema
(Peperonia Pellucida) d) NOT used for kidney infections
a) Gouty arthritis (Great Toe pain)
b) Others: Boils and abscesses
  PREPARATION: 4) Use only part of the plant being advocated
a) Decoction of leaves – boil 5) Symptoms persist after 2-3 doses – CONSULT
chopped leaves in a glass of physician
water
b) Divide into 3 parts BOTIKA NG BARANGAY/BOTIKA NG BAYAN (BnB)
c) Drink one part every 3 hours  Botika ng Barangay (BnB), a government-
7) AKAPULKO (Cassia Alata L.) initiated poverty alleviation program to
a) Antifungal parasites herb increase access of community people to
b) Ringworm (Fungal) affordable medicines
c) Athlete’s Foot  VENDOR: At least 2 BHW
d) Tinea flava  MANAGED BY: legitimate community
e) Scabies (Parasite) organization. NGOs and/or LGUs
 PREPARATION:
a) Pounded fresh matured leaves DRUGS SOLD IN BnB
b) Can be made into a soap, cream 1) RIPES (TB drugs)
or paste applied to affected area 2) NIFEDIPINE
1-2x a day 3) AMOXICILLIN (1st line antibiotic of
c) Apply cream all over the body for pneumonia)
scabies 4) ALBENDAZOLE
8) NIYOG NIYOGAN (Quisqualis Indica) 5) PARACETAMOL
a) Anti-helminthic 6) COTRIMOXAZOLE (2nd line antibiotic of
b) Expel worms or parasite like pneumonia)
roundworms, tapeworms, hookworms. 7) ORS (Oresol)
 PREPARATION: 8) QUININE
a) Take seeds 2 hours AFTER  ASPIRIN is NOT BEING SOLD in BnB
dinner
b) CHILDREN: at least 4-7 seeds IMMUNIZATION PROGRAM
c) ADULTS: at least 8-10 seeds  VACCINE HISTORY:
d) CONTRAINDICATED to less than 1) EDWARD JENNER
4 years old  Founder of Vaccinology in the West
9) TSAANG GUBAT (Carmona Retusa)= Wild Tea (1796)
a) Antispasmodic (Cramps)  After he inoculated a 13 y/o boy with
b) Body cleanser/wash vaccinia virus (cowpox) which
c) Diarrhea demonstrated immunity to smallpox
d) Oral Hygiene or canker sores  In 1798, the FIRST smallpox vaccine
e) Mouth wash used in “SAGIPIN: UNANG was developed
NGIPIN” (fluoridation of teeth)  Smallpox vaccine was the FIRST
f) Eczema SUCCESSFUL VACCINE to be
g) Natural remedy for biliary colic developed
10) AMPALAYA (Momordica Charantia)  WHO declares GLOBAL eradication
a) DM Type 2 of Smallpox (May 1980)
 PREPARATION:  LAST WILD CASE of small pox –
a) Chopped leaves Somalia (1977)
b) Boil in a glass of water for 15
minutes EXPANDED PROGRAM ON IMMUNZATION
c) Take 1/3 cup 3x a day AFTER (established in 1976)
MEALS  IMMUNIZATION
 Process of introducing vaccine into
REMINDERS ON THE USE OF HERBAL MEDICINE the body before infection sets in
1) Boil using a clay pot and remove cover while providing ARTIFICIAL ACTIVE
boiling at low heat IMMUNITY
2) Only one kind of herbal plant for each type of  WHO stated that as many as 2-3 million
symptoms deaths among children per year could have
3) No use of insecticides as these may leave been prevented by ACCESS TO
poison on plants IMMUNIZATION
  SCHEDULE: WEDNESDAY  OPV given simultaneously to all
 Designated NATIONAL children younger than 5 y/o
IMMUNIZATION DAY or “Patak 2) PROCLAMATION NO. 135, s. 2001
Day”  POLIO-FREE MAINTENANCE
 WEEKLY: Rural Health Units IMMUNIZATION CAMPAIGN
 MONTHLY: Barangay Health Stations  Last wild Poliomyelitis case in the
 QUARTERLY: Remote areas (Far-flung) Philippines was in 1993
 Philippines was certified POLIO-FREE
VACCINE PREVENTABLE DISEASES country on October 29,2000 in Kyoto,
1) Tuberculosis – BCG Japan
2) Diphtheria & Pertussis – DPT/Pentavalent  19 years after, On September 19,2019,
3) Measles – Measles Vaccine a new polio outbreak was reported by
4) Poliomyelitis – OPV and IPV POLIO VIRUS 2
a) OPV – Albert Sabin  3 Viral Strains of Polio
b) IPV – Jonas Salk a) Brunhilde Type 1
5) Tetanus b) Lansing type 2
a) CHILDREN = DPT c) Leon type 3
b) Mothers = Tetanus Toxoid 3) PROCLAMATION NO. 4, s. 1998
6) Hepatitis B – HepB vaccine  LIGTAS TIGDAS MONTH
7) Diarrhea caused by Rotavirus – Rotavirus  September 16 – October 14, 1998
vaccine  Free measles vaccines between the
8) Meningitis – PentaHIB vaccine ages of 9 months – less than 15 years
4) PRESIDENTIAL DECREE 996
FALSE TRUE/ABSOLUTE  COMPULSORY basic immunization for
CONTRAINDICATIONS CONTRAINDICATIONS infants and children below 8 years of
Fever NOT more than Convulsions within 7 age
38.5 degrees C days after DPT vaccine 5) REPUBLIC ACT NO. 7846
Seizures 4 days before  COMPULSORY Hepatitis B
DPT 1 immunization among infants &
Vomiting Anaphylaxis to any children less than 8 years old
components of vaccine  Newborn infants of women with
Respiratory Conditions HIV/AIDS with signs and Hepatitis B shall be given
(Cough & Colds) symptoms immunization against Hepatitis B
within 24 hours after birth
Like BROMA vaccines 6) RA No. 10152
a) BCG  MANDATORY infants and Children
b) Rotavirus Health Immunization Act of 2011
c) OPV  TAKE NOTE:
d) Measles a) If the infant is sick, and the
e) parent strongly objects for the
Malnutrition immunization, DO NOT GIVE
IT
Anaphylaxis after a b) Ask the mother to comeback
Diarrhea previous dose when child is well
Hepatitis
Neural Problems FULLY IMMUNIZED CHILD (FIC)
1) Before 12 months
REGULATORY LAWS 2) Before 1st birthday of child he/she must have
1) PROCLAMATION NO. 773, s. 1996 completed:
 Declaring April 17 and May 15, 1996 a) 1 dose of BCG
and every third Wednesday of April b) 3 doses of DPT
and May from 1996 to 2000 as c) 3 doses of OPV
“KNOCKOUT POLIO DAYS” d) 3 doses of HepB
 ONLY OPV doses can lead to polio e) 1 dose of Measles
eradication
FREEZE DRIED: GENERAL PRINCIPLES IN VACCINATING CHILDREN
1) BCG 1) Give doses less than 4 weeks interval may
2) Others: Yellow Fever and HIB lessen the antibody response
2) Lengthening the interval between doses of
MOST SENSITIVE TO HEAT/SUNLIGHT: vaccine leads to a higher antibody levels
1) OPV 3) Avoid using the same arm or leg for more
2) Measles than 1 injection
3) MMR 4) Do not give more than 1 dose of the SAME
VACCINE to a child in one session
MOST SENSITIVE TO COLD/FREEZING 5) If the vaccination schedule is interrupted, it is
1) DPT NOT NECESSARY to RESTART.
2) DT 6) Minimal intervals between doses to catch up
3) TT as quickly as possible if it is interrupted
4) HepB 7) Immunity provided by vaccines is
5) Pentavalent Vaccine ARTIFICIAL ACTIVE:
6) PCV vaccine a) More than 1 vaccine is to be
administered, inject it at different sites
NEW MANDATED VACCINES of body
1) ROTAVIRUS b) Mild asthma, stable cerebral palsy or
 Prevents diarrhea down syndrome is NOT a
2) PNEUMOCOCCAL CONJUGATE VACCINES ( contraindication
PCV13) c) Use single syringe (1 syringe per
 Prevents pneumonia vaccine) when giving more than 1
3) INACTIVATED POLIO VACCINE (IPV) vaccine
 Given to infant at 3 ½ months (14 d) NEVER reconstitute freeze dried
weeks) vaccine anything other than the diluent
 TAKE NOTE: supplied with them
a) Give PCV to infants as a series of 3 e) Effective and still safe if more than 1
doses, 1 dose at each of these ages: vaccine is given on the same day
o 1 ½ months (6 weeks) f) DO NOT ADMINSTER live vaccines to
o 2 ½ months (10 weeks) persons who are significantly immune
o 3 ½ months (14 weeks) compromised
b) Children who miss their shots or start
the series later should still get the COLD CHAIN
vaccine  SYSTEM of storing and transporting vaccines
at recommended temperatures from the
PENTALENT VACCINE point of manufacture to the point of use
 Vaccine (5 in 1) that contains Five antigens:  Primary PURPOSE: MAINTAIN POTENCY of
1) Diphtheria vaccine
2) Pertussis
3) Tetanus VACCINE STORAGE
4) HepB 1) Store VARICELLA at freezing temperatures
5) Haemophilus influenzae type B 2) Temperature should be checked TWICE A
DAY
“BACK TO BAKUNA” Program 3) One in the morning and one in the late
 School based immunization program afternoon
provides free measles and rubella vaccines 4) Refrigerator: Stand-alone refrigerator and
including booster doses of tetanus-diphtheria freezer
vaccines to public school children from 5) Avoid direct contact of vaccine to ice
kindergarten to Grade 7 (ages 5-13 y/o) 6) Goodies, foods and drinks should NEVER be
 For Grade 4 females: HPV immunization, a stored
protection against cervical cancer 7) Ensure to keep refrigerator away from
sunlight and at least (10cm) distance from the
wall
COLD CHAIN REMINDERS:  Used for storing vaccines and diluents
1) NEVER store any vaccine in a dormitory style  E.g.
or bar style combined unit a) BCG
2) NEVER place vaccines and diluents in the b) DPT
DOOR shelves (Temperature is not stable) c) HepB
3) AVOID frequent opening and closing of doors d) TT
4) Place vaccines and diluents in the center of 2) FREEZER
the unit 2 or 3 inches away from walls,  Kept between -15 degrees C to -25
ceiling, floor. And door degrees C
5) AVOID freezing of diluents as the vial may  Average of 20 degrees C
burst when frozen  Used for freezing ice packs
6) DO NOT STORE vaccines in deli, fruit or  For heat sensitive vaccines (OPV &
vegetable drawers or in the door Measles)
7) Place vaccines and diluents with the earliest  OPV is the MOST sensitive to heat and
expiration dates in front of those with later fragile vaccine
expiration dates
8) Do not return reconstituted vaccines (BCG, STORING:
Measles) or opened PCV 10 vials to the 1) FREEZING COMPARTMENTS
refrigerator. They should be discarded at the a) Ice cubes
end of the immunization session or after 6 b) Ice packs
hours, whichever comes first, 2) MAIN COMPARTMENT
9) The refrigerator should not be packed too full a) TOP
(to allow air to circulate) 1. OPV
10) Vaccines should be stored carefully between 2. Measles
+2 degrees C and +8 degrees C at all times b) MIDDLE
11) Freeze-sensitive vaccines (Pentavalent, PCV10, 1. DPT
TT & HepB) should be kept away from the 2. TT
freezing compartment, refrigeration plates, side 3. Diluent
linings or bottom lining of refrigerators and c) LOWER
frozen ice packs 1. Water bottles

WATER BOTTLES STORAGE TIME FRAMES

1) Place water bottles on the top shelf, floor and 1) 6 MONTHS – Regional Level
in the door racks 2) 3 MONTHS – Provincial Level/District Level
2) Putting water bottles in the unit can help 3) 1 MONTH – Main Health Centers with
maintain stable temperatures cause by refrigerator
frequently opening and closing unit doors or 4) NOT MORE THAN 5 DAYS – Health centers
a power failure using transport boxes
3) Label all water bottles DO NOT DRINK
ESSENTIAL ELEMENTS:
REFRIGERATOR 1) Personnel to manage vaccine distribution
1) NO foods, drinks or other drugs are to be kept 2) Equipment for vaccine storage & transport
in a refrigerator 3) Maintenance of equipment
2) Check and record temperature 2x a day in 4) Monitoring
temperature log for 2-7 days 5) COLD CHAIN MANAGER: PHN
3) DEFROST the refrigerator when ice becomes
more than 0,5 cm thick, or once a month, VACCINES:
whichever comes first 1) BCG (Bacillus Chalmette Guerin)
4) Record temperature, date, time and initials of  CONTENT: Live Attenuated Bacteria
the person in monitoring log sheet  TYPE: Freeze Dried
 DOSAGE:
2 COMPARTMENTS: a) Infant/birth: 0.05 mL
1) REFRIGERATOR (Main Compartment) b) Preschool: 0.1 mL
 Kept between +2 degrees C and +8  NUMBER OF DOSES: 1dose
degrees C  ROUTE: ID using 26G needle syringe
 2) Hepatitis B c) SCAR FORMATION
 CONTENT: Plasma Derivative (HbsAg)/  About 5 mm
RNA Recombinant  Scar at 12 weeks after injection
 TYPE: Liquid (2-5 months)
 DOSAGE:  Sign that the child has been
a) Infant/birth: 0.5 mL effectively immunized
 NUMBER OF DOSES:3 doses  ABNORMAL ADVERSE EFFECTS
 ROUTE: IM a) INDOLENT ULCERATION
3) DPT (Diphtheria-Pertussis-Tetanus)  WATCH OUT FOR: Signs of
 CONTENT: DT weakened toxin/ P-killed Infection
bacteria  Abscess formation and swelling
 TYPE: Liquid of glands in armpits
 DOSAGE: 0.5 mL (lymphadenopathy)
 NUMBER OF DOSES: 3 doses  Abscess may be due to:
 ROUTE: IM 1. UNSTERILE needle/syringe
4) OPV (Oral Polio Virus) was used (#1 cause)
 CONTENT: Live Attenuated Virus 2. Too much vaccine was
(weakened) injected
 TYPE: Liquid 3. Wrong technique of
 DOSAGE: 2 drops (0.1 mL) administration
 NUMBER OF DOSES: 3 doses  MANAGEMENT:
 ROUTE: PO 1. Do not incise and Drain
5) Rotavirus Vaccine 2. Use warm water
 CONTENT: Live Attenuated Virus compresses over the
(weakened) injection site or
 TYPE: Liquid suppurating lymph node/s
 DOSAGE: 5 drops (0.5 mL) 4-5 times a day
 NUMBER OF DOSES: 5 doses
 ROUTE: PO HEPATITIS B
6) MEASLES  Transmission at birth is possible give:
 CONTENT: Live Attenuated Virus a) HepB 1 – At Birth
(weakened) b) HepB 2 – 6 weeks
 TYPE: Freeze dried c) HepB 3 – 14 weeks
 DOSAGE: 0.5 mL  When transmission at birth is less likely, the
 NUMBER OF DOSES: 1 dose recommended schedule is:
 ROUTE: SQ a) HepB 1 – 6 weeks
b) HepB 2 – 10 weeks
BCG c) HepB 3 – 14 weeks
 At birth or Any time after birth  COMMON SIDE EFFECTS:
 NORMAL SIDE EFFECTS a) MILD FEVER (1-2 days)
a) KOCH’S PHENOMENON  Teach mother to perform TSB
 Acute inflammatory process  Advise to give Paracetamol every
starting 24 hours after injection 4 hours if temperature is above
and may last 2-4 days 38.5 degrees C
 Wheal formation (small raised  REFER if fever last for 4 days
lump of 10 mm of diameter) b) SORENESS, REDNESS OR SWELLING IN
 Disappears within 30 minutes THE INJECTION SITE
b) ULCER/RED SORE FORMATION  Teach mother to perform COLD
 May appear 2 weeks after injection compress FIRST before HOT
and may persist for another 2 compress
weeks to heal
 Keep dry and clean (Do not put any
ointment on the sore or give the
child any medicine)
DPT MEASLES
 The recommended schedule is: 4 weeks  Regular schedule: 9 months
interval between doses  NOTE: if the child aged 6-9 months when
a) DPT 1 – 6 weeks hospitalized should receive measles vaccine
b) DPT 2 – 10 weeks apart from the scheduled vaccine at 9 months
c) DPT 3 – 14 weeks  In case of outbreak: may be given at 6 months
 MILD REACTIONS: (EARLIEST dose)
a) FEVER  LATE dose: 15 months
 Child may have fever in the  Catch up dose: 4-5 y/o
evening AFTER receiving DPT
vaccine IMPORTANT NOTES:
 Fever should disappear within a 1) It is safe to vaccinate a sick child who is
day suffering from a minor illness
 NOTE: FEVER that begins more 2) When handling vaccines, the FIRST step is to
than 25 hours after a DPT CHECK the vial for EXPIRATION DATE
injection is UNLIKELY to be a 3) Use standard refrigerator with separate
reaction to the vaccine freezer door and seal for vaccines
b) SORENESS 4) Vaccines can be mixed in a single syringe
c) PAIN when:
d) REDNESS OR SWELLING AT INJECTION a) Vaccines are licenses and labeled to
SITE be mixed
 WATCH OUT FOR: ABSCESS FORMATION 5) BCG vaccine protects against TB in infants
 An abscess may develop a week or 6) BCG vaccine amber glass ampules is to
more after a DPT infection due to: protect from ultraviolet and fluorescent light
1. Unsterile needle or syringe to MAINTAIN POTENCY
was used 7) BCG also should be discarded AFTER 6
2. Wrong technique HOURS of reconstitution because of risk of
3. Vaccine was note injected into contamination d/t lack of preservative and
the muscle loss of potency
 DPT vaccine should NOT be given: 8) BCG vaccine is NOT damaged by freezing
a) Children over 5 years of age 9) Store BCG Vaccine and its diluent side-by-side
b) Children who have suffered a severe in a refrigerator or vaccine carrier
reaction to a previous dose of DPT 10) BCG is administered via ID route at (R)
vaccine deltoid
 Instead, a COMBINATION OF DIPHTHERIA 11) NEVER immunize in buttocks, IM vaccines
AND TETANUS TOXOIDS (DT) should be like HepB, DPT, IPV, Pentavalent and PCV
given should be administered muscle of the upper
outer of the thigh
OPV 12) Measles is given ONCE, SQ injection in the
 The recommended schedule is: 4 weeks OUTER UPPER (R) arm
interval between doses 13) The Measles, Mumps, Rubella, Vaccine (MMR)
a) OPV 1 – 6 weeks can be stored either in the freezer or the
b) OPV 2 – 10 weeks refrigerator
c) OPV 3 – 14 weeks 14) Protect reconstituted measles vaccine from
 NO SIDE EFFECT sunlight. WRAP IT WITH FOIL
15) If a child has diarrhea, give OPV as usual but
ROTAVAC administer an extra dose
 The recommended schedule is:  5th dose, at least 4 weeks after he or
d) ROTAVAC 1 – 6 weeks she has received the last dose in the
e) ROTAVAC 2 – 10 weeks to a maximum of schedule
32 weeks 16) Diphtheria and Tetanus toxoid parts re
 Rare and mild side effects damaged by freezing
 Fussiness, mild diarrhea, and vomiting
 17) For outreach session using vaccine carriers or STEP 1: DETERMINE THE ELIGIBLE POPULATION
old box: OUT OF THE GIVEN TOTAL POPULATION
a) Do not let DPT, TT or HepB vaccine
vials touch the cold dogs/ice packs. COMPUTE FOR ELIGIBLE POPULATION
b) Put or wrap newspaper or cardboard  FORMULA: TOTAL POPULATION x Target
around DPT, TT, or HepB to protect Setting = Eligible Population
them from freezing  For Target Setting of Eligible Population:
18) PERTUSSIS vaccine is damaged by heat a) Total number of children & infants for
19) Pertussis causes the fever after DPT shot immunization = 3% or 0.03
20) If a child spits out, regurgitates the vaccine b) Total number of mothers for
drops, or vomits immediately after a dose of immunization = 3.5% or 0.035
OPV, it is safe to repeat the doe (DO NOT BF  EXAMPLE: Midwife Lorna was assigned to
immediately) Bgy. San Roque with 20 000 population. How
many infants are expected to receive measles
VACCINATION CARD injection
a) Date of administration  TP = 20 000
b) Vaccine manufacturer  EP = 3% (Infants)
c) Vaccine lot number  20 000 x 0.03 = 600 infants
d) Name and title of the person who
administered the vaccine STEP 2: DETERMINE THE TOTAL VACCINE
REQUIRED (TVR)
HERD IMMUNITY  FORMULA: Eligible Population x Number of
 Occurs when a high percentage of the doses to complete immunization = TVR
community is immune to a disease (through a  600 infants x 1 dose of measles = 600 TVR
vaccination and/or prior illness) making the
spread of the disease from person to person STEP 3: DETERMINE THE ANNUAL VACCINE DOSES
is unlikely. REQUIRED (AVR)
 FORMULA: Total Vaccine dose Required x
TARGET SETTING Wastage Factor of the vaccine (refer to table
1) BCG above)
 Number of Doses: 1  600 (TVR) x 2 (constant wastage factor of
 Number of Doses per ampule: 20 measles) = 1200 AVR
 Wastage factor: 2.5
2) HepB EXAMPLE 1: Lorna has an eligible target of 600 (0-1
 Number of Doses: 3 y/o) for the current year. If she computes her EPI
 Number of Doses per ampule: 10 target on anti-measles. How many vials of 10 doses
 Wastage factor: 1.10 will she need?
3) DPT  ANSWER: 120 vials
 Number of Doses: 3  600 x1 = 600
 Number of Doses per ampule: 20  600 x 2 = 1200
 Wastage factor: 1.67  1200/10 = 120 vials
4) OPV
 Number of Doses: 3 STEP 4: DETERMINE ANNUAL VACCINE AMPULE OR
 Number of Doses per ampule: 20 VIAL (AVA)
 Wastage factor: 1.67  FORMULA: Annual Vaccine Doses Required
5) MEASLES (AVR)/number of doses per ampule
 Number of Doses: 1  1200 (AVR)/ 10 doses per ampule of measles
 Number of Doses per ampule: 10 = 120 ampules of measles
 Wastage factor: 2
6) TETANUS TOXOID EXAMPLE 2: Nurse Ling Ling has a total eligible
 Number of Doses: 5 target of 205 (mothers), If she computes her EPI
 Number of Doses per ampule: 10 target on Tetanus Toxoid, how many vials of 20 doses
 Wastage factor: 1.67 will she need?
 205 x 5 (doses of TT) = 1025
MATERNAL HEALTH PROGRAM DIRECT MATERNAL DEATHS (HOUSE)
a) Hemorrhage
MCHP b) Obstructed Labor
 The Philippines is tasked to reduce the c) Unsafe Abortion
Maternal Mortality Ratio (MMR) by three d) Sepsis
quarters or 75% by 2015 to achieve its MDG  Endometriosis (most common
 This means a MMR of 112/100, 000 live puerperal sepsis)
births in 2010 e) Eclampsia and PIH
 80/100,000 live births by 2015
DAILY IRON & FOLIC ACID SUPPLEMENTATION
HOME BASED MOTHER’S RECORD (HBMR) DURING PREGNANCY
 Tool used when rendering prenatal care  WHO & National Guidelines recommended all
containing risk factors and danger signs pregnant women should receive a daily Oral
 A system for recording risk factors, early Fe and Folic Acid supplementation dose of
sings of complications, referrals and DAILY 60 mg of Fe + 400mcg (0.4 mg) Folic
treatment of the mother Acid for 6 months (125 days)
 PANEL 1: Maternal Information  To prevent maternal anemia,
(demographics) puerperal sepsis, LBWs and Preterm
 PANEL 2: Danger signs/Risk factors/Present birth
pregnant condition  Folic Acid is the chief
 PANEL 3: Actions by referral  TAKE NOTE: Folic acid should be commenced
 PANEL 4: Family planning/Postpartum Care as early as possible (ideally before
conception) to prevent NTDs
RISK FACTORS
a) Height 145 cm tall (4 ft & 9 in) PRENATAL CONTACT/VISIT
b) Age below 18 y/o (PIH) ; above 35 y/o (H-  8 or more Prenatal contacts for antenatal
mole, Placental Previa) care can reduce perinatal deaths by up to 8
c) Recent pregnancy was C/S delivery per 1000 births when compared to 4 visits
d) Multiparity and last baby born was less than a  It recommends pregnant women to have their
years ago first contact in the FIRST 12 weeks AOG with
e) Family history of DM, Hypertension, and subsequent contacts taking place at:
Heart disease a) 20 weeks AOG
f) Underlying condition like TB, Goiter, b) 26 weeks AOG
Bronchial Asthma, Severe Anemia c) 30 weeks AOG
g) Less than 45 kg or more than 80 kg weight d) 34 weeks AOG
e) 36 weeks AOG
DANGER SIGNS f) 38 weeks AOG
1) Any type of vaginal bleeding g) 40 weeks AOG
2) Headache, Dizziness, Blurred Vision (Pre-
Eclampsia/Gestational HTN) NUTRITION
3) Puffiness of the face and hands (Facial  Emphasize the importance of nutrition during
Edema/Peripheral Edema) each prenatal contacts
4) Pale and Anemic 1) Eat nutritious foods like fruits &
5) Any watery discharges (PROM) vegetables
2) Avoid excessive weight gain
MATERNAL DEATHS 3) Daily oral Fe and Folic Acid (600 mg Fe +
 Maternal Mortality: 10-11 mothers die each 400 mcg Folic Acid)
day d/t pregnancy and delivery complication 4) Daily calcium supplementation (1.5-2 g)
 MATERNAL DEATH:  Prevents eclampsia
 Death of a woman while pregnant or 5) NO SMOKING and NO DRINKING
within 42 days of termination of ALCOHOL
pregnancy
 TETANUS TOXOID IMMUNIZATION TETANUS TOXOID
 Both mother & child are protected against  To protect mother and her baby against
tetanus & neonatal tetanus Clostridium-borne infection; injected TWICE
 A series of 2 doses of TT vaccination must be during pregnancy
received by a women 1month before delivery  Dose: 0.5 mL
to protect baby from neonatal tetanus  Route: IM
 And the 3 booster dose shots to complete the  Site: (R) & (L) Deltoid/Buttocks
5 doses following the recommended schedule  1st Pregnancy (G1) – give TT1 and TT2 (CBQ)
provide full protection for both mother &  2nd Pregnancy (G2) – give TT3 (1st booster dose)
child.  3rd Pregnancy (G3) – give TT4 (2nd booster dose)
 The mother is then called a “FULY  4th Pregnancy (G4) 0 give TT5 (3rd booster dose)
IMMUNIZED MOTHER” (FIM)
 There are many kinds of vaccines used to TAKE NOTE:
protect against tetanus, all of which are 1) If a pregnant mother received TT injection, she
combined with vaccines for other diseases: is protected from tetanus infection through
DT, DTaP, TD, Tdap ARTIFICIAL ACTIVE IMMUNITY
2) 2 TT doses (TT2) protects for 1-3 years
VACCINE MAXIMUM PERCENT DURATION although some studies indicate even longer
AGE PROTECTED PROTECTED protection
INTERVAL 3) TT is SAFE during pregnancy
4) If a pregnant mother has received 2 doses of
TT1 (0.5 As early as None None TT. The baby is protected from tetanus
mL IM) possible neonatorum through NATURAL PASSIVE
during IMMUNITY
pregnancy 5) TT3 is administered 6 months after TT2
6) The nurse understands that the client can be
During 6 considered fully immunized against tetanus if
months of she received how many booster doses of TT?
pregnancy ANSWER: THREE
7) Which of the following dose of TT is given to
TT2 At least 4 80% Gives 1-3 the mother to protect her infant from neonatal
weeks after years tetanus and likewise provide 10 years
TT1 protection protection for the mother? ANSWER: TT4
8) Of the mother receives TT4 vaccine: this will
TT3 At least 6 95% Gives at least give her protection that lasts up to 10 years
9) A pregnant woman had just receive 4th dose of
months after 5 years
TT, subsequently her baby will have
TT2 protection
protection against tetanus for how long?
ANSWER: 1 year
TT4 At least 1 99% Gives at least
year after 10 years INTRAPARTAL CARE:
TT3 or protection  Deliver at the Health Facility
during  FOLLOW UNANG YAKAP PROTOCOL
subsequent 1) Dry thoroughly (first 30 seconds)
pregnancy 2) Skin to skin contact (after 30 minutes)
3) Properly timed cord clamping (within 1-
3 minutes)
4) Early Breastfeeding and Rooming In
TT5 At least 1 99% Gives lifetime
(within 90 minutes)
year after protection
TT4 or
during
subsequent
pregnancy
IMMINENT HOME DELIVERY
 In case of imminent delivery at home, birth
attendants must be aware of the CLEAN
principles of HOME DELIVERY
 5 CLEANS:
1) CLEAN hands of attendant
2) CLEAN surface
3) CLEAN cord
4) CLEAN cord tie without dressing
5) CLEAN and dry wrapping of baby
POSTPARTUM CARE
 Delay facility discharge for at least 24 hours
 Visit women and babies with home births
WITHIN THE FIRST 24 hours
 FIRST 24 hours assess for vaginal bleeding,
uterine contractions, vital signs and voiding
within 6 hours
POSTPARTUM VISIT
 Provide every mother and baby a total of 4
POSTPARTAL VISITS on:
a) 1st visit: 1st day (within first 24 hours)
b) 2nd visit: Day 3 (48-72 hours)
c) 3rd visit: Between 7-14 days
d) 4th visit: 6 weeks
 For a woman who delivered at the health
facility:
a) 1st visit: within FIRST week preferably
2-3 days after delivery
b) 2,d visit: end of puerperium or 4-6
weeks after delivery
MICRONUTRIENT DEFICIENCY (IVI)
a) IRON = causing ANEMIA
b) VITAMIN A = causing NIGHT BLINDNESS
c) IODINE = causing CRETINISM
NUTRITION
 Nutrition LAW: PD 491
 Nutrition month: JULY
 MOST VULNERABLE TO MALNUTRITION:
a) Children
b) Lactating mothers
c) Infants
d) Pregnant
 RA 8976 – Philippine Food Fortification Act of
2000
 FOOD FORTIFICATION:
 Addition of Sangkap Pinoy or
Micronutrient such as Vitamin A, Iron
and Iodine to food.
SANGKAP PINOY SEAL PROGRAM (SPSP)
 A strategy to encourage food manufacturers
to fortify processed foods or food products
with essential nutrients at levels approved by
DOH and use its seal
 The seal is a guide used by consumers in
selecting nutrition’s foods
MANDATORY FOOD FORTIFICATION
1) RICE – with Iron
2) WHEAT FLOUR – with vitamin A and Iron
3) REFINED SUGAR – with vitamin A
4) COOKING OIL – with vitamin A
5) Other staple foods:
a) STAR Margarine (1992)
 FIRST ever product to partner
with DOH and the FIRST to
reserve the Sangkap Pinoy Seal
GOVERNMENT SUPPORT PROGRAMS
1) Sustansya Para Sa Masa
2) Pan De Bida (Pandesal with Vitamin A)
3) NUTRI BAN
4) SALT FORTIFICATION
a) RA 8172 (Act for Salt Iodization
Nationwide –ASIN LAW)
b) Use salt with “FIDEL” seal
(Fortification for Iodine Deficiency
Elimination)
IODINE
 For proper functioning of thyroid, growth and
development of the brain
 Iodine deficiency is a leading cause of
preventable brain damage and reduced IQ
among children worldwide
 Iodine Deficiency Disorder (IDD) during
pregnancy may result in stillbirth,
miscarriage, and congenital abnormalities
such as cretinism
 For iodine supplementation give iodized oil
capsule with 200 mg iodine, 1 cap for 1 year
GOITER
 Common in mountainous or inlands or
uplands areas where iodine content in the
soil, water and food are different
 Endemic goiter is more common among girls
than boys and among women than men.
 Effect of iodine deficiency to fetus may be
born mentally and physically retarded
OBESITY c)
Lightheadedness
 A risk factor for many chronic diseases d)
Easy fatigability
including heart disease, cancer, hypertension e)
Nail brittleness (koilonychia)
and DM. f)
Enlargement of spleen
 ABC for healthy nutrition: g)
SOB
1) Aim for fitness h)
Sore/cramps of muscles (restless legs
2) Build a healthy base syndrome)
3) Choose sensibly  PREVENTION & MANAGEMENT:
a) Liver products
3 SOMATOTYPES OR BODY TYPES b) Lean & Red meats
1) ECTOMORPH = Skinny; Difficulty in gaining c) Legumes
weight d) Leafy green vegetables
 Narrow hips and clavicles 1. Camote (Sweet Potatoes)
 Small joints (wrist/ankles) 2. Kangkong
 Thin build 3. Malunggay
 Stringy muscle bellies  TREATMENT of IDA: FeSO4
 Long limbs a) Mainstay treatment
2) MESOMORPH = Naturally muscular; easy b) Continued for about 2 months after
gain and loses weight correction of the anemia
 Wide clavicles c) Ferrous sulfate is the most common
 Narrow waist and CHEAPEST form of iron utilized
 Thinner joints  MOST COMMON SIDE EFFECTS OF IRON
 Long and round muscle bellies a) Constipation
3) ENDOMORPH = Round; Difficulty in losing b) Unpleasant taste
weight; slower metabolism c) Nausea & Vomiting
 Blocky d) Tarry stool (Dark discolored stool)
 Thick rib cage  NORMAL side effect
 Wide/thicker joints
 Hips as wide (or wider) than clavicles VITAMIN A DEFICIENCY (VAD)
 Shorter limbs  VAD Causes:
 High body fat (Central Obesity) a) Inadequate nutritional intake of
 Pear-shaped Vitamin A rich foods
 High tendency to store body fat b) Lack of fats/oils in diet
c) Rapid utilization of Vitamin A during
IRON DEFICIENCY ANEMIA (IDA) course of illness
 Normal Hgb Level: d) Liver disorders = 80-90% of Vitamin
a) MALES: 14-18 g/dL A is stored in liver
b) FEMALES: 12-16 g/dL e) Long term drinking alcohol lowers
 According WHO, anemia is defined as: Vitamin A levels in the liver
a) Hgb levels <12 g/dL in women  VULNERABLE GROUPS
b) Hgb levels <13 g/dL in men a) Infants
 In children above 2 years old b) Preschoolers
 Anemia is worsened by hookworm and c) Pregnant
whipworm  VAD S/Sx:
 Give Mebendazole + Iron supplement a) NIGHT BLINDNESS (EARLIST SIGN)
 RISK INDIVIDUALS: WOMEN  Impaired dark adaptation d/t
a) Women at childbearing age lack of rhodopsin
b) Old age/elderly (NYCTALOPIA)
c) Menstrual and GI bleeding (heavy) b) XEROPHTHALMIA
d) Enteric parasitism (hookworm, ascaris  Dry, thickened conjunctiva
& trichuris) and cornea
e) Not enough iron intake c) BITOT’S SPOTS
 CLINICAL MANIFESTATIONS: PALENESS  Foamy soapsuds-like spots on
a) Pallor white part of the eye
b) Anorexia
 d) KERATOMALACIA PROTEIN ENERGY MALNUTRITION (PEM)
 Corneal erosions and  TYPES INCLUDE:
ulcerations a) KWASHIORKOR
e) BLINDNESS (END STAGE)  PROTEIN malnutrition
 Irreversible eye blindness predominant
b) MARASMUS
VITAMIN A SUPPLEMENTATION  CALORIE deficiency intake
 Provides PROTECTION UP TO 6 MONTHS c) MARASMIC KWASHIORKOR
 Marked protein deficiency and
SCHEDULE INFANTS PRESCHOOLERS marked calorie insufficiency
(6-11 months) (12-59 months) signs present, sometimes
TODAY 100,000 IU 200,000 IU referred to as the MOST
(Blue capsule) (Red capsule) SEVERE FORM OF
AFTER 6 100,000 IU 200,000 IU MALNUTRITION
MONTHS (Blue capsule) (Red capsule)
Given 100,000 IU 200,000 IU NUTRITIONAL INDICATORS
immediately (Blue capsule) (Red capsule) 1) Arm Circumference (MUAC) – GOLD Standard
upon 2) Low Height for Age (STUNTING)
diagnosis 3) Low Weight for Age (Underweight)
4) Low Weight for Height (Wasting)
(GIVE ONE  TAKE NOTE: classical indicator used by
CAPSULE) experts to diagnose MARASMUS:
Given the next 100,000 IU 200,000 IU a) Weight for Height (WFH) Z score of
day (Blue capsule) (Red capsule) less than -3
Given after 2 100,000 IU 200,000 IU  BEST INDICATOR OF
weeks (Blue capsule) (Red capsule) MORTALITY

VITAMIN A SUPPLEMENTATION FOR PREGNANT MUAC INDICATORS (Mid-Upper Arm Circumference)

AND POSTPARTUM MOTHERS <110 mm RED SEVERE ACUTE Child should
TARGETS SCHEDULE DURATION REMARKS (11.0 cm) COLOUR MALNUTRITION be
PREGNANT 1 capsule of Start from 4th NEVER give (SAM) immediately
10,000 IU month of more than referred for
pregnancy 10,000 IU treatment
TWICE a because it is
week TERATOGENIC
Between RED MODERATE ACUTE
110-125 mm COLOUR MALNUTRITION (MAM)
(Colorless (3-color
capsule) (11.0-12.5 tape)
POSTPARTUM 1 capsule of 1 dose only Lactating cm)
200,000 IU within 1 mothers
month after should receive Or
(Red capsule) delivery up to 200,000 IU
4 deliveries once within ORANGE
the 1st month COLOUR
after delivery
in order to
(4-color
supplement tape)
breast milk Between YELLOW Child is at RISK FOR ACUTE
125-135 mm COLOUR MALNUTRITION and should be
TREATMENT SCHEDULE FOR XERPOHTHALMIA FOR counseled
PREGNANT WOMEN (12.5-13.5
a) Pregnant women with night-blindness cm) Followed up for Growth
b) 1 capsule of 10,000 IU (Colorless capsule) Promotion and Monitoring
c) 1 capsule, once a day regardless of the AOG (GPM)

>135 mm GREEN WELL-NOURISHED CHILD

(>13.5 cm) COLOUR
SERUM ALBUMIN  TAKE NOTE: KWASHIORKOR may also have:
 Found to be a better predictor of a) Dry sparse discolored hair (FLAG
underlying malnutrition than BMI SIGN)
 Most widely used laboratory measures of b) Growth retardation
nutritional status c) Anemia
 Good marker of nutritional status d) Skin lesions
1. Hyperkeratosis
MARASMUS 2. Dermatoses
 Wasting/Withering Malnutrition 3. Dyspigmentation
 Cause by TOTAL CALORIC DEFICIENCY
 HALLMARK SIGN:
a) Visible generalized muscle
wasting/withering
 CLINICAL MANIFESTATIONS: CALORIES
a) Caloric deficiency (deficiency of ALL
NUTRIENTS)
b) Active & Irritable
c) Liver is NOT enlarged (NO FATTY
LIVER)
d) Old man look/Chipmunk face or
Monkey face with Lanugo
e) Retarded growth (Severe)
f) Infants under 1 year old are
commonly affected
g) Eager or Voracious appetite
h) Severe Muscle Wasting
 TAKE NOTE: MARASMUS may also have:
a) Baggy pants appearance (REFER
IMMEDIATELY!)
b) No hair color changes (appears
normal)
c) Loose wrinkled skin/Emaciated look
d) Weight loss
e) Child is like skin & bones (RIBS ARE
VERY PROMINENT)
f) Child may also have diarrhea &
dehydration

KWASHIORKOR
 Edematous Malnutrition
 Caused by PROTEIN DEFICIENCY
 HALLMARK SIGN: Edema of both feet
 CLINICAL MANIFESTATIONS: PROTEINS
a) Pot belly/Large swollen protruding
belly (ENLARGED FATTY LIVER)
b) Ribs are NOT PROMINENT
c) Occurs in children older than 18
months to 2 y/o
d) Thin muscles & small MUAC
e) EDEMATOUS “Moon face” appearance
f) Increased risk of infection
g) No or lack of appetite (anorexia)
h) Sluggish, apathetic, lethargic,
unresponsive