Primary Health Care

PRIMARY
HEALTH
CARE
DOH
(Department of Health)
- is the national agency mandated to lead the
health sector towards assuring quality health care for all
Filipinos.
Vision:
- A leader, staunch advocate and model in
promoting health for all in the Philippines.
Mission:
- Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor and shall lead
the quest for excellence in health.
3 Roles and Functions of DOH:
Legal Basis:
Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health
policies, plans and programs to address national
and sectoral concerns.
2. Administrator of Specific Service
- administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.
DOH Core Values:
- reflects adherence to the highest standards of work.
> Integrity
> Excellence
> Compassion and Respect for human dignity
> Commitment
> Professionalism
> Teamwork
> Stewardship of the health of the people.
Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA)
Framework for its Implementation:

> FOURmula One for Health
* ARROYO HEALTH AGENDA
Goals:
1. Better health outcome
2. Equitable health gain
3. Responsive health system
> UNIVERSAL HEALTHCARE (KALUSUGAN

PANGKALAHATAN) * AQUINO HEALTH AGENDA
> ALL FOR HEALTH TOWARDS HEALTH FOR ALL

* DUTERTE HEALTH AGENDA
Elements of Strategy:
1. Health Financing
– to foster investment of health care
.
2. Health Regulation
– to ensure affordability of resources.
3. Health Delivery System

– to ensure availability and accessibility of
resources.
4. Good Governance
– to enhance the performance of health sector.
8 MILLENIUM DEVELOPMENT GOALS
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
- based on the fundamental values of freedom, equality,

solidarity, tolerance, health, respect for nature and shared
responsibility.
Community
- a group of people with common characteristics
or interest living together within a territory or
geographical boundary.
Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
- combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas
4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health
- is the state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. (World Health Organization)
Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender
New concept in determinants of health
- OLOF (Optimum Level Of Functioning)
Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
5. Socio-Economic – education, employment, housing
6. Health Care Delivery System – availability, accessibility
and affordability of services and facilities
Levels of Clientele:
1. Individual
- “point entry”
2. Family
- center of delivery of care.
3. Group
- point of specific care.
4. Community
- point of entire care
FAMILY – MIDWIFE CONTACT:
I. HOME VISIT
- professional face to face contact done by a midwife
to the family.
Purposes:
1. Give nursing to the sick, post partum mother & newborn.
2. Assess living condition of client and their health
practices.
3. Give health teachings.
4. Establish relationship with health agency and public.
5. Make use of inter-referral system and promote utilization
of community services.
Principles:
1. Must have a purpose and objective.
2. Make use available information about the patient and his
family.
3. Consider and prioritize essential needs of the individual
and family.
4. Should involve the individual and family in planning and
delivery of care.
5. Plan should be flexible.
Important Steps of Home Visit:
1. Greet client and family then introduce yourself.
2. Explain the purpose of the visit.
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place then perform bag
technique
5. Perform nursing care and give health teachings.
6. Record all important data, observation and care
rendered.
7. Make appointment for a return visit.
Phases:
1. Preparatory Phase / Previsit phase
a. review existing records of referral data of the
family
b. notifies the family of the intention to make a
home visit
2. Home Visit Phase / In-home phase
a. actual visits of the family
b. makes plans, interventions, evaluation with the
family and set schedule for the next visit
3. Post Visit Phase
a. records data and plans for the next visit and
referrals
Priorities During Home Visit:
1. Newborn
2. Post partum
3. Pregnant women
4. Morbid individuals
Factors affecting Frequency of Home Visit:

1. Physical, psychological and educational
2. Acceptance of family
3. Policies given by the agency
Bag Technique:
- a tool making use of a public health bag and which
the public health nurse can perform procedures during
home visits.
Rationale :
- Helps render effective care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
*** Open bag TWICE during home visit.
Special Consideration:
B
- bag and its contents must be free from any
contamination.
A
- always perform handwashing.
G
- gather necessary equipments to render effective
nursing care.
Steps in Performing The Bag Technique Actions:
1. Upon arrival, place the bag on the table lined with a clean
paper. (the clean side must be out and folded part, touching
the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific
care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used
and perform handwashing.
10. Open the bag and return all things that were used in their
proper place
11. Remove apron, folding it away fro the person, the soiled
side in and the clean side out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.
A. Benedict’s Test
- to check the presence of sugar in the urine.
- 8-10 gtts of urine, 5ml Benedict’s solution, heat
Interpretation:
Blue :( - )
Green : ( +1 )
Yellow : ( +2 )
Orange : ( +3 )
Red : ( +4 )
B. Acetic Acid Test

- to check the presence of albumin in the urine.
- 2/3 parts of urine in the test tube,
1/3 part of acetic acid, heat
Interpretation:
Clear :(-)
Cloudy : ( + ) albuminuria
PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR
Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.
Universal Goal of PHC :
Health for All
Policy Agenda :
Health for All by the year 2000 ( 3 Objectives)
1. promotion of healthy lifestyles
2. prevention of diseases
3. therapy for existing conditions
Underlying theme :
Health in the Hands of the people by 2020
Mission :
In partnership with the people, provide equity, access
and quality health care especially to the marginalized
Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
Accessibility – refers to the physical distance of a health facility
or the travel time required for people to get the needed or
desired health services.
Availability – is a question of whether the basic health services
required by the people are offered in the health care facilities
and is provided on a regular and organized manner
Affordability – is not only in consideration of the individual and
family to pay for basic health services and public health
services
Acceptability – health care offered is in consonance with the
prevailing culture and traditions of the population
Health Programs that deliver 4 A’s:
1. Botika ng Bayan and Botika ng Barangay

– established drugstores by the Philippines government to
promote equity in health by ensuring the availability and
accessibility of affordable, safe and effective, essential drugs to
all, with priority given to the marginalized, underserved and
hard-to-reach areas.
2. Ligtas sa Tigdas and Pinas
– mass measles immunization campaign
– children 9 months to 8 years old were vaccinated against
measles and rubella.
– a door-to-door campaign
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5. Partnership between the community and the health
agencies in provision of quality life
6. Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization
RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
- Devolution Code (Mandate of Devolution)

Local Government Code
Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
- BHW
- PHW
8 Essential Health Services:
E – Education for health
L – Locally endemic disease control
E – Expanded program for immunization
M – Maternal and child health including responsible
parenthood
E – Essential drugs
N – Nutrition
T – treatment of communicable and non-communicable
diseases
S – Safe water and sanitation
4 Pillars/Cornerstones:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available
Levels of PHC Workers:

1. Village or Brgy. Health Workers
- health auxiliary or volunteers
2. Intermediate Level Health Workers
- Physician - Sanitary Inspector
- Nurse - Midwife
Ratios to catchment population:
Public Health Worker = 1:50,000
Public Health Physician = 1:20,000
Public Health Nurse = 1:20,000
Public Health Midwife = 1: 5,000
Dentist = 1:20,000
LEVELS OF PREVENTION
1.Primary Prevention
- health promotion
- specific protection
Behaviors:
1. Quit smoking
2. Avoid/limit alcohol intake
3. Exercise regularly
4. Eat well-balance diet
5. Reduce fat and increase fiber in the diet
6. Complete immunization program
7. Wear hazard devices in work site
2. Secondary Prevention
- early diagnosis/detection/screening
- prompt treatment
Behaviors:
1. Have annual physical examination
2. Regular Pap smear for women
3. Monthly BSE for women who are 20 yrs old and
above
4. Sputum examination for Tuberculosis
5. Annual stool Guaiac test and rectal exam for clients
over age 50 yrs old
3. Tertiary Prevention
- prevention of complication
- optimal health status after a disease or
disability
Behaviors:
1. Self-monitoring of blood glucose among diabetics
2. Physical therapy after CVA
3. Attending self-management education for diabetes
4. Undergoing speech therapy after laryngectomy
Levels of Health Care and Referral System
1. Primary Level of Care

1. Rural Health Units
2. Community Hospitals and Health Center
3. Private Practitioners (Puericulture Centers)
4. Brgy. Health Stations
- is usually the first contact between the community
members and the others levels of health facility.
- provided by center physicians, public health nurses,
rural health midwives, barangay health workers,
traditional healers
2. Secondary Level of Facilities
1. Provincial/City Health Services and Hospitals
2. Emergency and District Hospitals
- serves as a referral center for the primary health
facilities
- are capable of performing minor surgeries and perform
some simple laboratory examinations
3. Tertiary Level of Facilities

1. National and Regional Health Services
2. Teaching and Training Hospitals
- serves complicated cases and intensive care
ALTERNATIVE HEALTH CARE
Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act
* created the Philippine Institute of Traditional and

Alternative Health Care
Alternative health care modalities practiced:
1. Acupressure
- a method of healing and health promotion that uses the
application of pressure
2. Acupuncture
- a method of healing using special needles to puncture and
stimulate specific anatomical points on the body.
3. Aromatherapy
- the art and science of the sense of smell
4. Chiropractic
- a discipline of the healing arts concerned with therapy of the
spine and pelvis
5. Herbal Medicine/ Phytomedicine
6. Massage
- a method wherein the superficial soft parts of the body are
rubbed for limited therapeutic purposes.
7. Nutritional therapy
- use of food as medicine and to improve health by enhancing
the nutritional value of food components.
8. Pranic healing
- a holistic approach of healing that follows the principle of
balancing energy.
9. Reflexology
- application of therapeutic pressure on the body’s reflex
points to enhance body’s natural healing mechanism and
balance body function
S - Sambong
* anti-edema, anti-urolithiasis
A - Ampalaya
* DM (mild non-insulin dependent )
N - Niyog-niyogan
* anti-helmintic
T- Tsaang Gubat
* diarrhea, stomachache
A - Akapulko (Bayabas-bayabasan)
* anti-fungal
L - Lagundi
* asthma, cough and colds, fever, dysentery
* skin diseases (scabies, ulcer, eczema), wounds
U - Ulasimang Bato (Pansit-pansitan)
* lowers uric acid (rheumatism and gout)
B - Bawang
* lowers cholesterol levels, hypertension, toothache
B - Bayabas
* washing of wounds, diarrhea, gargle, toothache
Y - Yerba Buena
* headache, stomachache, cough and colds,
rheumatism, arthritis
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticides.
2. Use a clay pot and remove cover while boiling at low
heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each sickness.
6. Stop giving in case with untoward reaction.
7. If signs and symptoms are not relieved after 2 or 3
doses, consult a doctor.
PHILIPPINE REPRODUCTIVE HEALTH
- is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity relating to
the reproductive system and to its functions and processes.
Goal:
- To achieve “Better Quality Life among Filipinos”
*Magna Carta of Women
- RA 9710
*Responsible Parenthood and Reproductive Health Act of 2012
- RA 10354
Local Framework Focuses on:
- Health needs of women, men, adolescents, children
and underserved groups.
Main objectives:
1. Reducing maternal mortality rate.

2. Reducing child mortality.
3. Halting and reversing spread of HIV/AIDS.
4. Increasing access to reproductive health information and
services.
10 Elements:
1. Family Planning
2. Maternal and Child Health and Nutrition
3. Adolescent Reproductive Health
4. Prevention and Management of Reproductive Tract Infections
including STIs and HIV/AIDS
5. Prevention and Management of Abortion and its Complication
6. Education and Counseling on Sexuality and Sexual Health
7. Prevention and Management of Breast and Reproductive Tract
Cancers and other Gynecological Conditions.
8. Men’s Reproductive Health
9. Violence Against Women and Children
10. Prevention and Management of Infertility and Sexual
Dysfunctions
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PHILIPPINE FAMILY PLANNING PROGRAM
*** Principal recipients of information, education, communication

and motivation in family planning:
- married couples of reproductive age
*** It requires all couples who want to receive a marriage license
to first undergo a seminar in family planning and responsible
parenthood
- PD 965
Advantages:
1. FP helps families improve their standard of living
2. FP reduces/eliminates fears of unwanted pregnancy
3. FP affords family members time to study or pursue occupational
interest
4 Pillars of PFPP:
1. Responsible Parenthood
2. Respect for Life
3. Birth Spacing
4. Informed Choice
Major target (High Risk Women):
1. Women under 18 years old
2. Women over 34 years old
3. Women suffering from certain medical conditions that
contradict pregnancy
4. Women who have had at least 4 deliveries
*** The Family Code of the Philippines?

- Executive Order No. 209
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The Family Planning Methods:
1. Female Sterilization
- safe and simple surgical procedure which provides
permanent contraception for women who do not want more
children. Also known as BTL that involves cutting or blocking the
two fallopian tubes.
- performed during first 2 weeks of her menstrual cycle or
within the first 3 days after delivery.
2. Male Sterilization
- permanent method wherein the vas deferens (passage of
sperm) is tied and cut or block through a small opening on the
scrotal skin. It is also known as Vasectomy.
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3. Pill
- contains hormones estrogen and progesteron taken daily to
prevent contraceptions. Advised for women who are anemic
because of the reduced menstrual flow.
- taken some time everyday preferably at night.
Common side effects:
- dizziness, headache, nausea, spotting, weight gain, breast
fullness.
Adverse effects: Contraindications:
1. Abdominal pain 1. pregnancy or suspected
2. Chest pain 2. history of diabetes
3. Headache 3. high blood pressure
4. Eyes blurred 4. weak heart
5. Severe leg pain 5. CA of the breast
6. over 50 years old
Important facts to remember about a Pill
1. Pill are advised for women who are anemic because of the
reduced menstrual flow
2. Take pill same time everyday
3. A packet of pills contain 28 tablets; 21 pills are “active pills”, 7
contain no hormones, only iron
4. Follow the direction of the arrows of the pill. When empty, start a
new pack on the next day without missing a day
5. For one missed pill: take the pill as soon as possible; take regular
pill at night
6. For 2 missed pill: take 2 pills next day, then take 2 pills the next
day again
7. For 3 missed pill: discard and substitute method, start on next
pack on next menstrual period.
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4. Male Condom
- thin sheath of latex rubber made to fit on a man’s erect
penis to prevent the passage of sperm cell and sexually
transmitted disease organism into the vagina.
- the shelf life is 3 years in the Phils., if stored in a cool dry
place.
5. Injectables
- contain synthetic hormones, progestin which suppresses
ovulation, thickens cervical mucus, making it difficult for sperm to
pass through and changes uterine lining.
6. Basal Body Temperature
- used to measure changes of temperature during ovulation.
Temp. slightly decreases before ovulation and increases during
ovulation day. It must be measured on the same time of the day,
before rising, with the same thermometer.
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7. Lactating Amenorhea Method or LAM
- temporary introductory postpartum method of postponing
pregnancy based on physiological infertility experienced by Breast
Feeding women.
Criteria:
1. Amenorrhea
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 months
8. Mucus/Billings/Ovulation
- abstaining from sexual intercourse during fertile (wet) days
prevent s pregnancy.
9. Abstinence
- best way to prevent pregnancy and STI’s
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10. Sympto-Thermal Method
- method in identifying the fertile and infertile days of the
menstrual cycle as determined through a combination of
observations made on the cervical mucus, basal body temp
recording and other sign of ovulation.
11. IUD
- changes the nature of internal secretions of woman’s body.,
disturbs transport and decreases number of viable sperms
Contraindications:
1. PID
2. Septic Abortion
3. Endometritis
4. Anemia
5. Suspected pregnancy
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Adverse effects:
1. Period that is late
2. Abdominal pain
3. Increase in temperature
4. Noticeable discharge – foul smelling
5. Severe bleeding
> an outpatient procedure; examined 1 month after insertion,
then after 6 months then after 1 year.
12. Standard Days Method
- A new method of natural family planning in which all users
with menstrual cycles between 26 and 32 days are counseled to
abstain from sexual intercourse on days 8-19 to avoid pregnancy.
-The couples use color coded cycle beads to mark the fertile
and infertile days of the menstrual cycle.
NUTRITION PROGRAMS
Goal:
- To improve the quality life of Filipinos through better
nutrition, increased productivity and improved health.
3 Most Common Deficiencies:

1. Iron
2. Vitamin A
3. Iodine
Programs and Projects:
1. Micronutrient Supplementation
- is one of the interventions to address the health and nutritional
needs of infants and children and improve their growth and
survival.
* Araw ng Sangkap Pinoy (ASAP), Garantisadong Pambata
- addresses health and nutritional needs of 6-71 months old
2. Food Fortification
- to improve the nutritional status of the populace including
children.
- legal basis: RA 8976
4 Food Staples that require Mandatory Fortification:
1. Rice with Iron 3. Oil with Vitamin A
2. Sugar with Vitamin A 4. Flour with Iron and Vitamin A
3. Essential Maternal and Child Health Services
- this ensures the right of the child to survival, development,
protection and participation.
4. Nutrition, information, communication and education
- promotion of 10 Nutritional Guidelines for Filipinos.
1. Eat variety of foods everyday.

2. Promoting exclusive breastfeeding from birth up to 4-6 months.
3. Giving proper advice on proper feeding of children.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calcium-rich foods.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe foods to prevent food-borne diseases.
10. Promoting healthy lifestyles.
5. Home, School and Community Food Production
- establishment of kitchens, gardens in home, schools and in
communities in urban and rural areas.
6. Food Assistance
- it involves complementary feeding for wasted/stunted children
and pregnant women with delivering low birthweight.
7. Livelihood Assistance
- provision of credit and livelihood opportunities to poor
households especially those with malnourished children through
linkage with lending and financial institutions.
Control of Acute Respiratory Infection (CARI)
Objective:
Reduce mortality through early detection.
Contributing Factors to Pneumonia:

1. Mothers failure to recognize signs and symptoms of
Pneumonia.
2. Indiscriminate use of antibiotics.
3. Not standardized management to Pneumonia
Sign of Severe Pneumonia:
- Chest Indrawing
Important Responsibility in preventing unnecessary death from
Pneumonia:
- Provision of careful assessment
National Cancer Control Program
9 Warning Signs:
C – change in blood, bowel/bladder habits
A – a sore that does not heal
U – unusual bleeding/discharge
T – thickening or lump in breast
I – indigestion or difficulty in swallowing
O – obvious change in wart or mole
N – nagging cough or hoarseness
U – unexplained anemia
S – sudden unexplained weight loss
Specific Guidelines for Early Detection of Common Cancers
1. Breast Cancer
A. BSE - cheapest and most affordable
- done 1 week after menstrual period while
taking a shower
B. Mammography
- if a mass detected and confirmed
2. Cervical Cancer
A. Pap Smear
- primary screening tool for women over age
18
3. Colon Rectal Cancer
A. Annual digital rectal exam starting at age 40
B. Annual stool blood test starting at age 50
C. Annual inspection of colon
4. Prostate Cancer
A. Digital rectal exam
B. PSA (prostate Specific Antigen) – confirms
diagnosis
5. Lung Cancer
A. Chest X-ray
B. Sputum Cytology
LEVELS OF PREVENTION:
Primary Prevention:
- elimination of conditions causing cancer
Secondary Prevention:
- Definitive Treatment and Management
(a.) Chemotherapy, (b.) Radiation, (c. )Surgery
Tertiary Prevention:
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
National Voluntary Blood Services Program
- promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood
banks.
Legal basis:
RA 7719 “Blood Services Act of 1994”
Criteria for Eligible donor:
B = BP 90/60 – 160/100mmHg
A = 16 – 65 years old
W = 45 – 50 kgs minimum
A = At least 12.5 hemoglobin
S = Status in good condition
Main Objectives:
1. to promote and encourage voluntary blood donation
by the citizenry and to instill public consciousness of the
principle that blood donation is a humanitarian act
2. to provide adequate, safe, affordable and equitable

distribution of supply of blood and blood products
3. to mobilize all sectors of the community to participate

in mechanisms for voluntary and non-profit collection of
blood
Steps to donate:
1. Go to the nearest center
2. Register a s a donor
3. History taking
4. Vital signs, PE taking
5. Blood test with blood type
Must do after donated blood:
1. Eye on dressing at least 8 hours but not more than 12
hours
2. No lifting heavy objects
3. No smoke for 2 hours, no alcohol for 12 hours
4. Eat regular meals and increase fluids
National TB Control Program
Vision:
- A country where TB is no longer a public health problems.
Mission:
- Ensure that TB DOTS services are available, accessible and
affordable to the communities.
Treatment:
- Quality of SDF (Single Dose Formulation) & FDC (Fixed
Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1st specimen – SPOT specimen collected on the day of
consultation
2nd specimen – early morning specimen on the next day
3rd specimen – SPOT specimen collected on the 2nd day
after submission of early morning specimen
2. Chest X-ray
- to identify the extent of the disease
3. Tuberculin Testing/Mantoux Test/PPD Testing

TB Treatment:
TB Abbreviation
SDF OLD NEW
Rifampicin R R
Isoniazid INH H
Pyrazinamide PZA Z
Ethambutol E E
Streptomycin S S
# of Tablets of FDC of Patient per Body Weight
Body Weight (kg) # of Tablets

30-37 2
38-54 3
55-70 4
>70 5
DOTS
- Direct Observed Treatment Short course
- Main strategy which primary health services around the
world are using to detect and cure TB patients.
Treatment partner:
-watching the TB patient take medicines everyday
during the whole course of treatment.
a. Staff of the Health Care facilities
b. LGU officials
c. Family members of the patient
5 ELEMENTS OF DOTS:
1. Political will
2. Sputum microscopy service
3. Regular drug supply
4. Record of patient’s progress
5. Supervision of drug intake
MATERNAL, NEWBORN & CHILD HEALTH & NUTRITION
Overall Goal:
- To improve the survival, health and well being of
mothers and unborn through a package of services for the
pre pregnancy, prenatal, natal and post natal stages.
Essential Health Service Packages:

A. Prenatal Registration
1St visit – as early in pregnancy as possible before four months
or during the first trimester
2nd visit – during the 2nd trimester
3rd visit – during the 3rd visit
Every 2 weeks – after 8th month of pregnancy until delivery
B. Deliver Tetanus Toxoid Immunization
OLD TT Immunization Schedule:
TT1
= given as early as possible during first pregnancy
TT2
= at least 4 weeks later (1 month)
TT3
= 1st booster dose; 6 months interval from TT2
TT4
= 1 year interval from TT3
TT5
= booster dose 1 year interval from TT4
Lifespan of TT Vaccines:
TT1
= 0; 0
TT2
= 80% protection; 3 yrs protection
TT3
TT4
TT5
= 99% protection; lifetime protection
C. Micronutrient Supplementation
1. Vitamin A
10,000 IU 2X a week starting on
the 4th month of pregnancy
10,000 IU once a day for 4
weeks if with Xeropthalmia
200,000 IU post-partum; one
dose within 4 weeks
2. Iron
60 mg/day 1st trimester
120 mg/day 2nd/3rd trimester
60 mg/day X 3 mos. Post-partum
D. Treatment of Diseases and Other Conditions
- Unconscious
- Difficulty of breathing
- Post partum bleeding
- Parasitism
E. Clean and Safe Delivery
- ensure hygiene during labor and delivery
Qualifications for Home Care Delivery:
1. Full Term 7. No history of previous infection
2. G1-G4 8. No PROM
3. Cephalic Presentation 9. Adequate pelvis
4. No history of previous CS 10. No history of prolonged labor
5. No history of previous Complications
6. Enlargement of abdomen is equal to AOG
3 Priorities for a Safe Home Care Delivery:
1. Clean Hands 2. Clean Surface 3. Clean Cord
Post Partum Visits:

1st visit
– within a week (3-5 days)
2nd visit
– 6th week post delivery
3 Cardinal Signs of Post Partum Infection:

1. Board-like abdomen
2. Fever
3. Foul-smelling vaginal discharges
F. Support Breastfeeding
Rooming –in and Breastfeeding Act of 1992 : RA 7600
New Breastfeeding Act of 2012 : RA 10028
The Philippine Milk Code of 1986 : EO 51
Benefits of BF to Infants:
1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ points
Benefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
Storage Full-term Pre-term
Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
G. Family Planning Counseling

- right choice of FP methods
- birth spacing is …..
3-5 years
NEWBORN SCREENING
- is a simple procedure to find out if a baby has congenital
metabolic disorders that may lead to mental retardation or even
death if left untreated
- ideally done on 48th to the 72nd hours of life but also be done
after 24 hours from birth
- RA 9288
6 TESTED DISORDERS:
1. Congenital hypothyroidism
2. Congenital adrenal hyperplasia
3. Galactosemia
4. Phenylketonuria
5. Glucose-6-phosphate-dehydrogenase
6. Maple syrup urine disease
- obtained from a heel prick
NEWBORN HEARING SCREENING
- RA 9709
- known as the Universal Newborn Hearing Screening and
Intervention Act of 2009 for the early detection of congenital
hearing loss among newborns and referral for early intervention
services to infants with hearing loss.
- the law places on any health care practitioner who delivers or
assists in the delivery of a baby in the Philippines the obligation to
inform the parents or legal guardian of the newborn of the
availability, nature and benefits of hearing loss screening among
newborns 3 months old and below.
- parents or legal guardians who refuse the test shall sign a waiver
Expanded Program on Immunization (EPI)
Legal Basis: PD No. 996
– providing for compulsory basic immunization for
infants and children below 8 yrs old. ( September 16, 1976)
> launched in July 1976
> free vaccines: BCG, DPT, OPV, Measles
Mandatory Infants and Children Health Immunization of 2011

--- RA 10152
Objective:
To reduce morbidity and mortality among infants and
children caused by the 6 childhood immunizable diseases
Target for Immunization Program
a. Infant : 12 months old
b. School Entrants : 6-7 years old
c. Pregnant Mother
Infants:
- 1 BCG
- EO 663
- 3 Hepa B
- RA 7846
- 3 DPT
- 1 Measles
- Proc. 4
- 3 OPV
School entrants:
- 1 booster dose of BCG
Pregnant mothers:
- 5 Tetanus Toxoid
- RA 1066 (tetanus elimination)
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health service
Elements of EPI:
Target setting:
calculation of eligible population
Formula: EP = total population x constant percentage
Constant percentage:
Infants = 2.7%
12-59 month old children = 10.8%
Pregnant Mothers = 3.5%
Cold Chain System
- to maintain potency of the vaccine
Refrigerator:
Freezer:
(-15° to -25 °C) – OPV, Measles
Body:
(2° to 8°C) - DPT, Hepa B, BCG, TT
2 most sensitive to heat vaccine:

OPV & MEASLES
2 least sensitive to heat vaccine:
BCG & TT
HOW LONG CAN VACCINE BE STORED?
DOH
REGIONAL HEALTH OFFICE
DISTRICT/ PROVINCIAL HEALTH OFFICE
HEALTH CENTER
* Health centers using cold box or transport boxes
- 5 days
* Check temperature 2x a day: first and last hour of the
clinic
Vaccine Age Doses Interval ROUTE Dosage
BCG At birth 1 ID(RIGHT deltoid ) 0.05 ml
DPT 6 wks, 3 4 wks. IM (VASTUS 0.5 ml

(Triple) LATERALIS)
-HepB- Hib
OPV 6 wks 3 4 wks. ORAL / Mouth 2-3 gtts
(Sabin)
HEPA B At birth IM (VASTUS 0.5 ml
HBV LATERALIS)
MEASLES 9 -11mos. 1 SUBCUTANEOUS 0.5 ml

AMV1
MMR 12-15 1 SUBCUTANEOUS 0.5 ml
AMV2 mos.
Rotavirus 6 wks 2 4 wks. ORAL 1.5 ml
Pentavalent – Hib
(Penta – hib)
1. Diptheria
2. Pertussis or whooping cough
3. Tetanus
4. Hepatitis – B
5. Hemaphilus influenza type B
- to prevent pneumonia and meningitis to
babies
- injected intramuscularly
- given at age 6 weeks up to 11 months
CONTENT OF VACCINES:
BCG:
- live attenuated bacteria
OPV and MEASLES:
- live attenuated virus
DIPTHERIA & TT:
- weakened bacterial toxins
PERTUSSIS:
- killed bacteria
HEPA B:
- derived from plasma (plasma derivatives)
RNA recombinants
PRINCIPLES OF VACCINATION…
1. No BCG to a child born positive with HIV or AIDS

2. DPT is not given to a child who has recurrent
convulsions or active neurologic disease
3. DPT2 or DPT3 is not given to a child who has had
convulsions or shock w/in 3 days the previous dose but
you can give DT.
4. Don’t immunize children before referral
5. Moderate fever, malnutrition, mild resp. infection,
cough, diarrhea & mild vomiting aren’t contraindication
to vaccination.
6. Safe to administer all EPI vaccines on the same day at
different sites of the body.
7. No food 30 minutes after giving OPV.
8. Assess the child for allergy to egg before giving measles
vaccine.
9. Measles vaccine should be given as soon as the child is
9 months old regardless of whether other vaccines will
be given on that day.
10. Vaccination schedule should not be restarted from
the beginning even if the interval between doses
exceeded.
11. It is safe and effective with mild side effects after
vaccination.
12. Do not repeat BCG vaccination if the child does not
develop a scar after the first injection.
13. Strictly follow the principle of never, ever reconstitute
the freeze dried vaccines to any diluents.
14. Use one syringe, one needle per child during
vaccination.
15. During vaccination, clean the skin with cotton ball,
moistened with water only (boiled H20).
Opened vaccines should be discarded after:
> BCG & Measles
: 4-6 hours
> DPT, OPV, Hepa B & TT
: 8 hours
Open OPV vials can be used for the next immunization if:
a. Expiry date has not passed
b. Vaccines stored at 0°C to 8°C
c. Not taken out at the health center for outreach
activities
FAMILY HEALTH NURSING
FAMILY
- is a group of persons usually living together and composed of
the head and other persons related to the head by blood,
marriage or adoption.
FORMS:
1. Nuclear family – family of marriage, parenthood or procreation
composed of husband, wife and their children – natural, adopted
or both.
2. Dyad family – consisting of husband and wife, such as newly
married couples.
3. Extended family – consisting of 3 generations which may include
married siblings and their families and/or grandparents.
4. Blended family – results from a union where one or both spouses
bring a child or children from a previous marriage into a new living
arrangement.
5. Compound family – where a man has more than one spouse.
Muslims – PD 1083 (Code of Muslim Personal Law of the Phil)
6. Cohabiting family – commonly described as a “live-in”
arrangement between an unmarried couple who are called
common-law spouses and their child or children from such
arrangement.
7. Single parent – results from death of a spouse, separation or
pregnancy outside of wedlock.
FUNCTIONS OF THE FAMILY
1. Procreation
– for reproductive functions and child rearing.
2. Socialization of family members
– involves transmission of the culture of a social group.
* Socialization is the process of learning how to become
productive members of society.
3. Status replacement
– society is characterized by the hierarchy of its members
into social classes. Depending on the degree of social mobility in a
society, the family and the children’s future families may move
from one social class to another.
4. Economic functions
– observes that the rural family is a unit of production where
the family works as a team.
Categories of family health conditions and problems:
1. Wellness states – stated as potential or readiness – a clinical or
nursing judgment about a client in transition from specific level
of wellness or capacity to higher level.
A. Potential for Enhanced Capability for
B. Readiness for Enhanced Capability for
> healthy lifestyle – nutrition/diet, exercise/activity
> parenting
> breastfeeding
> spiritual well-being
2. Health threats – conditions that are conductive to disease,
accident or failure to realize one’s health potential
> broken stairs
> fire hazards
> fall hazards
> strained marital relationship
> improper garbage/refuse disposal
3. Health deficits – instances of failure in health maintenance.
> illness states ( diagnosed or undiagnosed)
> failure to thrive/ develop according to normal rate
> disability – whether congenital or arising from illness like
aphasia, temporary paralysis after a CVA, leg amputation
secondary to diabetes, blindness from measles
4. Stress points of foreseeable crisis – anticipated periods of

unusual demand on the individual or family in terms of
adjustment / family resources.
> marriage
> pregnancy, labor, puerperium
> parenthood
> additional member
> abortion
> divorce or separation
> menopause
Establishing Priorities
There are 4 criteria:
1. Nature of problem presented – categorized into health
threat, health deficit, and foreseeable crisis
2. Modifiability of the problem – refers to the probability of
success in minimizing, alleviating or totally eradicating the
problem through nursing intervention
3. Preventive Potential – refers to the nature and magnitude of
future problems that can be minimized or totally
prevented if intervention is done on the problem
4. Salience – refers to the family’s perception and evaluation of
the problem in terms of seriousness and urgency of
attention needed
roxie
ENVIRONMENTAL HEALTH AND SANITATION
- the study of all factors in man’s physical environment, which
may exercise a deleterious effect on his well-being and survival.
FACTORS:
1. water sanitation 7. steam pollution
2. food sanitation 8. air pollution
3. refuse and garbage disposal 9. noise
4. excreta disposal 10. radiological protection
5. housing 11. institutional sanitation
6. insect vector and rodent control
Legal basis:
PD 856, 1978
Different Laws relating to Environmental Sanitation:
1. Garbage Disposal Law
- PD 825
2. Ecological Solid Waste Management Act
- RA 9003
3. Clean Air Act
- RA 8749
4. Clean Water Act
- RA 9275
5. Toxic Substances and Hazardous and Nuclear Waste Control Act
- RA 6969
WATER SUPPLY SANITATION PROGRAM
Approved type of water supply facilities:
LEVEL I
(Point Source)
- a protected well or a developed spring with an outlet but
without a distribution system.
- serves 15 to 25 households
- outreach must not be more than 250 meters from the
farthest user
LEVEL II
(Communal Faucet System or Stand-Posts)
- a system composed of a source, a reservoir, a piped
distribution network and communal faucets.
- with one faucet per 4-6 households
- located at not more than 25 meters from the farthest
house
LEVEL III
(Waterworks System or Individual House Connections)
- a system with a source, a reservoir, a piped distributor
network and household taps.
- generally suited for densely populated urban areas
- requires minimum treatment or disinfection
PROPER EXCRETA AND SEWAGE DISPOSAL PROGRAM
Approved types of toilet facilities:
LEVEL I
Non-water carriage toilet facility – no water is necessary to
wash the waste into the receiving space.
Ex. Pit latrines, Reed odorless earth closet
Toilet facility requiring small amount of water to wash the waste
into the receiving space.
Ex. Pour flush toilet, Aqua privies
LEVEL II
on site toilet facilities of the carriage type with water-sealed and
flushed type with septic tank/vault disposal facilities
LEVEL III
- water carriage types of toilet facilities connected to septic
and/or to sewerage system to treatment plant
FOOD SANITATION PROGRAM
FOUR RIGHTS IN FOOD SAFETY:

1. Right source
- always buy fresh meat, fish, fruits and vegetables
- check for expiry dates of processed foods
- avoid buying canned foods with dents, bulges, deformation,
broken seals and improper seams
- use clean and safe water
- if doubt of water source – boil water for at least 2 minutes
2. Right preparation
- avoid contact between raw and cooked foods
- always buy pasteurized milk and fruit juices
- wash vegetables well if eaten raw
- wash hands and kitchen utensils before and after preparing food
- sweep kitchen floors to remove food droppings
3. Right cooking
- cook food thoroughly and ensure that temperature on all parts
of the food should reach 70 degrees centigrade
- eat cooked food immediately
- wash hands thoroughly before and after
4. Right storage
- cooked foods should not left at room temperature for NOT more
than 2 hours
- store foods carefully: 4 -5 hours
hot conditions : at least or above 60 degrees centigrade
cold conditions: below or equal to 10 degrees centigrade
- do not overburden the refrigerator
- reheat stored food before eating
--at least 70 degrees centigrade
Rule in Food Safety:

“WHEN IN DOUBT, THROW IT OUT”
VITAL STATISTICS
- refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
Use of Vital Statistics:

1. indices of the health and illness status of a community.
2. serves as bases for planning, implementing, monitoring and
evaluating community health nursing programs and services.
Sources of Data:
1. population census
2. registration of vital data
3. health survey
4. studies and researches
* statistic on population and the characteristics such as age, sex
- Philippine Statistic Authority
* Birth Certificate form
- Form 102; Signatory: Birth Attendant
1. Physician
2. Nurse
3. Midwife
* requires registration of birth within 30 days
- PD 651
* requires registration of births and deaths to the Office of the
Civil Registrar
- RA 3753
A. Cities – City Health officer
B. Municipalities – Municipal Treasurer
* Death Certificate form
- Form 103; Signatory: Either of the following:
1. Health Officer (Physician)
2. Local Chief Executive (City or Municipal Mayor)
3. Licensed Embalmer and Undertaker (LEU)
* reporting should be done within 2 days
1. Crude Birth Rate (CBR)
- a measure of one characteristic of the natural growth or
increase of a population.
total number of live births registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year/midyear pop.
2. Crude Death Rate (CDR)

- a measure of one mortality from all causes which may
result in a decrease of population.
total number of deaths registered in a given calendar
_____________________________________________ X 1000
estimated population as of July 1 of same year/midyear pop.
3. Infant Mortality Rate (IMR)
- measures the risk of dying during the 1st year of life. It is a
good index of the general health of a community.
total number of death under 1 year of age registered
in a given calendar
_____________________________________________ X 1000
total number of registered live births of same calendar year
4. Maternal Mortality Rate (MMR)

- measures the risk of dying from causes related to
pregnancy, childbirth and puerperium.
total number of deaths from maternal causes registered
for a given year
_____________________________________________ X 1000
total number of live births registered of same year
5. Fetal Death Rate (FDR)
- measures pregnancy wastage. Death of the product of
conception occurs prior to its complete expulsion.
total number of fetal deaths registered in a given calendar
_____________________________________________ X 1000
total number of live births registered on same year
6. Neonatal Death Rate (NDR)

- measures the risk of dying the 1st month of life. It serves as
an index of the effects of prenatal care and OB management.
number of deaths under 28 days of age registered
in a given calendar year
_____________________________________________ X 1000
number of live births registered of same year
7. Incidence Rate (IR)
- measures the frequency of occurrence of the phenomenon
during a given period of time.
number of new cases of a particular disease registered
during a specified period of time
_____________________________________________ X 1000
estimated population as of July of same year
8. Prevalence Rate (PR)

- measures the proportion of the population which exhibits
a particular disease at a particular time.
number of new and old of a certain disease
registered at a given time
_____________________________________________ X 1000
total number of persons examined at same given time
9. Attack Rate (AR)
- a more accurate measure of the risk of exposure.
number of persons acquiring a disease registered
in a given year
_____________________________________________ X 100
number of exposed to same disease in the same year
10. Case Fatality Ratio (CFR)

- index of a killing power of a disease and is influenced by
incomplete reporting and poor morbidity data.
number of registered deaths from a specific disease
for a given year
_____________________________________________ X 100
number of registered cases from same specific disease
in same year
COMMUNICABLE DISEASE PREVENTION
AND CONTROL
1. TUBERCULOSIS
Nature:
- is considered as the world’s deadliest disease and
remains as a major public health problem in the Philippines.
Causative Agent:
- Tubercle bacilli
- Mycobacterium tuberculosis and M. Africanum
Modes of Transmission:
- airborne droplet
- direct invasion through mucous membranes or
breaks in the skin
- bovine tuberculosis - ingestion oof unpasteurized
milk and milk products
Methods of Control: Preventive Measures
1. Prompt diagnosis and treatment of infectious cases
2. BCG vaccination of newborn, infants and grade I/school
entrants health nursing and outreach services
3. Educate the public in mode of spread and methods of
control and the importance of early diagnosis
4. Improve social conditions, which increase the risk of
becoming infected such as overcrowding
5. Make available medical, laboratory and x-ray facilities for
examination of patients, contacts and suspects and
facilities for early treatment of cases and person at high
risk of infection and beds for those needing hospitalization
6. Provide public health nursing and outreach services for
home supervision of patients
TB Category and Treatment:
Category I - new smear positive

- new smear negative with extensive
- parenchymal lesions on chest x-ray
Treatment:
Intensive Phase - 2HRZE
Maintenance Phase – 4HR
Category II - treatment failure

- relapse
- return after default
Treatment:
Intensive Phase – 2HRZES/1HRZE
Maintenance Phase – 5HRE
Category III - new smear negative PTB with minimal
parenchymal lesions on chest x-ray
Treatment:
Intensive Phase - 2HRZE
Maintenance Phase – 4HR
Category IV - chronic (still smear positive after supervised

re-treatment)
Treatment:
- Refer to specialized facility/ NTP Coordinator
2. LEPROSY
Nature:
- is a chronic mildly communicable disease that mainly
affects the skin, the peripheral nerves, the eyes and mucosa
of the upper respiratory tract.
- also known as Hansen’s disease, Hansenosis,
Leontiasis
Causative Agent:
- Mycobacterium leprae/ Hansen’s bacillus
- airborne (inhalation of droplets/spray from coughing
and sneezing of untreated leprosy patient)
- prolonged skin-to-skin contact
Signs and Symptoms:
a. Early signs and symptoms
- change in color –either reddish or white
- loss of sensation on the skin lesion
- decrease/loss of sweating and hair growth over the
lesion
- thickened and/ or painful nerves
- muscle weakness or paralysis of extremities
- pain and redness of the eyes
- nasal obstruction or bleeding
- ulcers that do not heal
b. Late signs and symptoms
- loss of eyebrows (madarosis)
- inability to close eyelids (lagophthalmos)
- clawing of fingers and toes
- contractures
- sinking of the nosebridge
- enlargement of the breast in males or gynecomastia
- chronic ulcers
Prevention:
1. BCG vaccination
2. Avoidance of prolonged skin to skin contact with active
untreated case
3. Good personal hygiene
4. Adequate nutrition
5. Health Education
Management/Treatment:
- Domiciliary Treatment (RA 4073) advocates home treatment
A. Paucibacillary – 6-9 months
- non-infectious type (tuberculoid and indeterminate)
- Rifampicin and Dapsone
B. Multibacillary – 24-30 months
- infectious types (lepromatous and borderline)
- Rifampicin, Clofazimine, Dapsone
3. SCHISTOSOMIASIS
Nature:
- it is also called “Bilhariasis or Snail fever”. Mostly
affects farmers and their families in the rural area.
Causative Agent:
- Schistosoma Japonicum
- carried by a tiny snail oncomelania quadrasi(snail –
vector) in a contaminated fresh water
Signs and Symptoms:
- diarrhea - bloody stools
- enlargement of abdomen - spleenomegaly
- weakness - anemia
- inflamed liver
Prevention:
1. Proper disposal of feces and urine
2. Proper irrigation of all stagnant bodies of water
3. Prevent exposure to contaminated water (wearing of
rubber boots)
4. Eradication of breeding places of snails
5. Use of molluscicides
Drug of Choice
- Praziquantel (Biltricide)
4. FILARIASIS
(Elephantiasis, Filarioidea, infection)
Nature:
- progresses to become chronic, debilitating and
disfiguring, since its symptoms are often unnoticed
and unfamiliar to health workers.
Causative Agent:
- Wuchereria bancrofti, Burgia malayi
- through bites from an infected female mosquito
primarily Aedes poecilius that bites at night
Signs and Symptoms:
- chills, fever, myalgia, lymphangitis with gradual
thickening of the skin
a. Acute Stage
1. Lymphadenitis – inflammation of lymph nodes
2. Lympangitis – inflammation of the lymph vessels
b. Chronic Stage
1. Hydrocoele – swelling of the crotum
2. Lymphedema – temporary swelling of the upper and
lower extremities
3. Elephantiasis – enlargement and thickening of the skin
of the lower and/or upper extremities, scrotum, breast
Prevention and Control
A. Measures aimed to control the vector
1. Environment al sanitation such as proper drainage and
cleanliness of surroundings
2. Spraying with insecticides
B. Measures aimed to protect the individual and families

1. Use of mosquito nets
2. Use of long sleeves, long pants and socks
3. Application of insect repellants Screening of house
4. Health education
C. Drug of choice:
- Diethylcarbamazine Citrate (Hetrazan)
5. MALARIA
(Marsh fever, Periodic fever, King of Tropical diseases)
Nature:
- intermittent and remittent fever caused by a protozoan
parasite that invades the red blood cells.
Causative Agent:
- Plasmodium falciparum, P. vivax, P. ovale, P. malariae
Signs and Symptoms:
- recurrent fever preceded by chills and profuse
sweating, malaise, anemia
Drug of choice:
Chloroquine. It must be taken at weekly intervals starting from
1-2 weeks before entering the endemic area.
Modes of Transmission
– Vector (Female anopheles mosquito)
Prevention and Control:

1. Mosquito control
2. Chemical methods – use of insecticides
3. Biological methods – stream seeding
4. Zooprophylaxis – larvae – eating fish farm animals should
be kept near the house
5. Environmental methods – cleaning and irrigating canals
6. Screening of houses
7. Educational methods
8. Mechanical methods – use of fly swats or traps
9. Universal precaution
10. Screening of blood donors
6. DENGUE HEMORRHAGIC FEVER (DHF)
(Break bone or Dandy fever, Dengue shock syndrome)
Nature:
- occurs when someone is bitten by a mosquito or
exposed to blood infected with the dengue virus.
Signs and Symptoms:
- restlessness - acute or sudden fever
- severe abdominal pain - bleeding or bruising under the skin
- cold or clammy skin - nosebleeds
- large decrease in blood pressure (shock)
- mosquito bite (Aedes Aegypti)
Diagnostic Test:
- Tourniquet Test (Rumpel Leads Test)
Management:
1. For fever; give paracetamol. For muscle pains and for
headache; give analgesic. DON’T give ASPIRIN.
2. Encourage oral fluid intake of ORS.
3. Advise patient to avoid dark-colored foods that can mask
bleeding.
4. Ensure strict bed rest and protect patient from trauma to
reduce the risk of bleeding.
5. For nose bleeding, maintain an elevated position and apply
ice compress to promote vasoconstriction.
6. Blood transfusion should be given as soon as severe
bleeding is suspected or recognized.
7. In cases of shock, place patient in dorsal recumbent
position to promote circulation.
8. Monitor Laboratory results.
Control Measures:
1. Eliminate vector by:
a. Changing water and scrubbing sides of lower vases
once a week
b. Destroy breeding places of mosquito by cleaning
surroundings
c. Proper disposal of rubber tires, empty bottles and cans
d. Keep water containers covered.
2. Avoid too many hanging clothes inside the house
3. Residual spraying with insecticides
7. CHIKUNGUNYA
Nature:
- is a viral disease which is transmitted to humans by
infected mosquitoes.
- originate from a verb in the Kimokonde language,
meaning “to become contorted”
Signs and Symptoms:
- fever - muscle pain
- joint pain - joint swelling
- headache - rash
- mosquito bite (Aedes Aegypti; Aedes Albopictus)
Diagnostic Test:
- Serological - ELISA(immunosorbent assays)
> presence of IgM and IgG
Treatment and Management:
1. Get plenty of rest.
2. Drinks fluids to prevent dehydration
3. Medications to relieve symptoms such as paracetamol,
naproxen, ibuprofen. DON”T give ASPIRIN.
8. MEASLES
Nature:
- an infectious viral disease causing fever and a red on the
skin, typically occurring in childhood.
- also called “Rubeola “
Signs and Symptoms:
- cough - sore throat
- runny nose - fever
- inflamed eyes - red, blotchy skin rash
* Koplik spots – pathognomonic sign
Sources of Infection:
- Secretion of nose and throat of infected persons
Mode of Transmission:
- By droplet spread or direct contact with infected persons, or
indirectly through articles freshly soiled with secretions of
nose and throat, in some instances, probably airborne.
Methods of Prevention and Control:
1. Avoid exposing children to any person with fever or with
acute catarrhal symptoms.
2. Isolation of cases from diagnosis until 5-7 days after the
onset.
3. Disinfection of all articles soiled with secretion of nose and
throat.
4. Administration of measles vaccine.
Patient’s Care:
1. Protect eyes of patients from glare of strong lights as they
apt to be inflamed.
2. Keep the patient in an adequately ventilated room but free
from drafts and chilling to avoid complications of pneumonia
3. Teach, guide and supervise correct technique of giving
sponge bath
9. GERMAN MEASLES
Nature:
- is a viral infection that causes a red rash on the body
- also known as “Rubella “
Signs and Symptoms:
- pink or red rash that begins on the face and then
spreads downward to the rest of the body
- mild fever
- runny or stuffy nose
- headache
- muscle pain
- inflamed or red eyes
Causative Agent:
- togavirus
- by direct contact with nasal or throat secretions of
infected individuals.
- breathing in droplets that are spread into the air when
an infected person sneezes, coughs or talks.
Prevention and Treatment
1. Give paracetamol for fever and pain relief medication
2. Encourage plenty of fluids
3. Isolation until fully recovered
4. MMR vaccination
10. CHICKEN POX
Nature:
- an infectious disease causing a mild fever and a
rash of itchy inflamed blisters.
- is also known as “Varicella”
Causative Agent:
- Human herpesvirus
Signs and symptoms:
- rash that turns into itchy, fluid filled blisters
- high temperature (fever), aches and headache
- loss of appetite or feeding problems
Source of Infection:
- Secretion of respiratory tract of infected persons. Lesions of
skin are of little consequence. Scabs themselves are not
infective.
- Direct contact or droplet spread
-Indirect through articles freshly soiled by discharges of
infected persons.
1. Case over 15 years of age should be investigated to
eliminate possibility of smallpox.
2. Report to local authority
3. Isolation.
4. Concurrent disinfection of throat and nose discharges.
5. Exclusion from school for 1 week after eruption first
appears and avoid contact with susceptible.
11. DIPHTHERIA
Nature:
- acute febrile infection of the tonsil, throat, nose,
larynx or a wound marked by a patch or patches of grayish
membrane.
Causative Agent:
- Corynebacterium diphtheria (Klebs-Loeffer bacillus)
-Discharges and secretions from mucus surface of nose and
nasopharynx and from skin and other lesions
-Contact with a patient or carrier or with articles soiled with
discharges of infected persons. Milk has served as a vehicle.
1. Active immunization of DPT.
2. Pasteurization of milk.
3. Education of parents.
4. Reporting of the case to the Health Officer for proper
medical care.
12. PERTUSSIS
Nature
- is highly contagious, acute respiratory illness
characterized by fits of coughing
- also known as “whooping cough”
Causative Agent:
- Hemophilus Pertussis or Borget Gengou Bacillus
-Discharges from laryngeal and bronchial mucous membrane
of infected persons
Signs and Symptoms:
- runny nose
- low-grade fever
- tiredness
- mild or occasional cough – coughing may last for
several weeks, sometimes 10 weeks or 2-3 months
- Direct spread through respiratory and salivary
contacts. Crowding and close association with patients
facilitate spread.

1. DPT immunization
2. General care of nose and throat discharges
3. Special attention to diet is needed if patient vomits after
cough paroxysms
4. Observe for signs of complications and report immediately
to the physician for desirable treatment
13. TETANUS NEONATORUM AND
TETANUS AMONG OLDER AGE GROUPS
Nature:
- acute disease induced by toxin of tetanus bacillus
growing anaerobically in wounds and at site of umbilicus
among infants.
Causative Agent:
- Tetanus bacillus (clostridium tetani)
- immediate source of infection is soil, street dust, animal
and human feces.
- usually occurs through contamination of the unhealed
stump of the umbilical cord.
Signs and Symptoms:
- spasm and stiffness in the jaw muscles
- stiffness of the neck muscles
- difficulty swallowing
- stiffness of the abdominal muscles
- painful body spasms lasting for several minutes, typically
triggered by minor occurrences, such as a draft, loud
noise, physical touch or light
1. Pregnant women should be actively immunized in regions
where tetanus neonatorum is prevalent.
2. Licensing of midwives into professional supervision and
education as to methods, equipment and techniques of
sepsis in childbirth.
3. Health education of mothers, relatives and attendants in
the practice of strict aseptic methods of umbilical care in
the newborn.
Patient’s Care:
***Employ measures which decreases frequency and severity
of convulsions:
> Keep patient away from noise, bright lights or anything
else that will irritate him/her.
> Administer prescribed medication by the physician and
observe and report untoward effects to the physician.
14. INFLUENZA
Nature:
- is a highly contagious viral infection of the respiratory
passages commonly know as “the flu”
Causative Agent:
- Influenza Virus
- discharges from the mouth and nose of infected persons.
- by direct contact, through droplet infection, or by articles
freshly soiled with discharges of nose and throat of
infected person, airborne..
Signs and Symptoms:
- high fever - muscle pains
- runny nose - headache
- sore throat - coughing
- feeling tired

1. Education of the public as to sanitary hazard from spitting,
sneezing and coughing.
2. Avoid use of common towels, glasses and eating utensils.
3. Active immunization with influenza vaccine
15. PNEUMONIAS
Nature:
- an acute infectious disease of the lungs usually caused
by the pneumoccocus resulting in the consolidation of one
or more lobes of either one or both lungs.
Etiology:
> majority of cases due to Diploccocus pneumoniae
> occasionally pneumoccocus of Friedlander
> Viruses
Predisposing Cause:
- fatigue
- overexposure to inclement weather
(extreme heat or cold)
- exposure to polluted air
- malnutrition
Signs and Symptoms:
- rhinitis/common cold - chest indrawing
- rusty sputum - productive cough
- fast respiration - high fever
- vomiting at times - convulsions may occur
- flushed face - dilated pupils
- severe chill in children - pain over affected leg
- highly colored urine with reduced chlorides and
increased urates
Management:
1. Bed rest.
2. Adequate salt, fluid, calorie and vitamin intake.
3. Tepid sponge bath for fever
4. Frequent turning from side to side
5. Antibiotics
6. Pneumonia vaccine - as prevention
16. CHOLERA
Nature:
- an acute serious illnes characterized by sudden onset of
acute and profuse odorless diarrhea, vomiting, severe
dehydration, muscular cramps, cyanosis and in severe
cases collapse.
- also called “El Tor”
Causative agent:
- Vibrio El Tor
- vomitus and feces of infected persons and feces of
convalescent or healthy carriers
Mode of transmission:
- food and water contaminated with vomitus and stools of
patients and carriers
1. Report case at once to Health officer.
2. Bring patient to hospital for proper isolation and prompt
and competent medical care.
3. All contacts of the cases should submit themselves for
stool examination and be treated according if found or
discovered positive.
Patient’s Care:
1. Continue and increase frequency of breastfeeding.
2. Give additional fluids, “am”, soup, cereals, mashed
vegetables.
3. Coconut water is said to be rich in potassium, one of the
electrolytes found in choleric stools.
4. Make patient as comfortable as possible
5. Give ORESOL according to required amount based on
age.
17. TYPHOID FEVER
Nature
- an infectious bacterial fever with an eruption of red spots
on the chest and abdomen and severe intestinal irritation.
- is also known as “Enteric fever”
Causative Agent:
- Salmonella typhosa, typhoid bacillus
- feces and urine of infected persons.
- direct or indirect contact with patient or carrier. Principal
vehicles are food and water. Contamination is usually by
hands of carrier. Flies are vectors.
Signs and Symptoms:
- poor appetite - abdominal pain
- headaches - generalized aches and pains
- fever - lethargy (if untreated)
- Intestinal bleeding or perforation
- diarrhea or constipation
1. Sanitary disposal of human feces.
2. Sanitary supervision of processing, preparation and
serving of food particularly of those eaten raw.
3. Adequate provision for safe washing facilities.
4. Fly control and screening to protect foods against fly
contamination.
5. Protection of infected individual contacts and environment.
6. Isolation of patient during acute illness.
7. Rigid personal precautions by attendants.
18. HEPATITIS A
Nature:
- a form of hepatitis occurring either sporadically or in
epidemics and caused by viruses introduced by fecally
contaminated water or food.
Etiology:
- Hepatitis A virus
Predisposing Factors:
- poor sanitation
- contaminated water supplies
- unsanitary method of preparing and serving of food
- malnutrition
- disaster and wartime conditions
Signs and Symptoms:
- influenza-like such as headache
- malaise and easy fatigability
- anorexia and abdominal discomfort/pain
- nausea and vomiting
- fever
- lymphadenopathy
- jaundice accompanied by pruritus
- bilirubinemia with clay-colored stools
Management/Treatment:
1. Prophylaxis – “IM” injection of gamma globulin
2. Complete bed rest
3. Low fat diet but high in sugar
Preventive Measures:
1. Immunization with Hepatitis B.
2. Wear protected clothing as gowns, mask, gloves when
dealing with blood semen, vaginal fluids and secretions.
3. Wash hands and other skin areas immediately and
thoroughly after contact with these fluids
4. Avoid injury with sharp instrument as needles, scalpel, etc.
5. Use disposable needles and syringes only once and
discard properly.
6. Sterilized instruments used for circumcision, ear holing,etc.
7. Avoid sharing of toothbrush, razors and other instruments.
8. Observe “safe sex”
9. Make sure that blood products for transfusion have been
properly screened for Hepatitis B.
10. Observe good personal hygiene.
11. Have adequate sleep, rest, exercise and eat adequate
nutritious foods.
Prevention and Control:
1. Ensure safe water for drinking
2. Sanitary method in preparing, handling and serving food
3. Proper disposal of feces and urine
4. Washing hands very well before eating and after using the
toilet
5. Separate and proper cleaning of articles used by patient
19. HEPATITIS B
Nature:
- is a viral infection that attacks the liver and can cause
both acute and chronic disease.
Signs and Symptoms:
- loss of appetite
- easy fatigability
- malaise
- joint and muscle pain
- low grade fever
- nausea and vomiting
- right-sided abdominal pain
- jaundice
- dark-colored urine
a. From person to person
> Contact with infected blood, sexual contact, sharing of
personal items
b. Parental transmission
> Blood and blood products, use of contaminated
instruments
c. Perinatal transmission
> Occurs during labor and delivery
20. LEPTOSPIROSIS
(Canicola, Weils disease)
Nature:
- infectious bacterial disease that affects humans and
animals. Rats is the main host although pigs, cattles,
rabbits and other wild animals can also serve as reservoir
hosts.
Causative Agent:
- Leptospira interrogans
- inoculation into broken skin, ingestion
Source of Infection
- urine and excreta of rodents and infected
Symptoms:
- high remittent fever 4-7 days
- headache
- chills
- muscle aches
- vomiting
- jaundice
- red eyes
- abdominal pain
Drug of Choice:
- Penicillin, Tetracycline, Erythromycin
Prevention:
- Eradication of source.
21. RABIES
(Hydrophia, Lyssa)
Nature:
- a contagious and fatal viral disease of dogs and other
mammals that causes madness and convulsions,
transmissible through the saliva to humans.
Causative Agent:
- Rhabdovirus
- by bites of a rabid animal whose saliva has the virus
Signs and Symptoms:
- tingling/twitching sensation
- fever - loss of appetite
- headache - nausea
- muscle aches - fatigue
Management/Prevention:
1. The wound must be immediately and thoroughly washed
with soap and water.
2. The patients may be given antibiotics and anti-tetanus
immunization.
3. Consult a veterinarian or trained personnel to observe the
pet for 14 days for signs of rabies.
4. Be a responsible pet owner
> have a pet immunized at 3 months of age and every
year thereafter
> never allow pets to roam the streets
> take care of your pet; bathe, feed them regularly with
adequate food, provide them with clean sleeping quarters.
> your pet’s action is your responsibility
5. Consult for rabies diagnosis and surveillane of the area.
6. Mobilize for community participation.
C O P A R
COMMUNITY ORGANIZING PARTICIPATORY ACTION
RESEARCH
DEFINITIONS:
- A social development approach that aims to
TRANSFORM the APATHETIC, INDIVIDUALISTIC, and
VOICELESS POOR into DYNAMIC, PARTICIPATORY
and POLITICALLY responsive community.
- A process, by which a community identifies its

needs and objectives, develops confidence to take action
in respect to them and in doing so, extends and develops
cooperative and collaborative attitude and practices in
the community.
IMPORTANCE OF COPAR:
> COPAR is an important tool for community
development and people empowerment as this:
 helps the community workers generate community

participation in development activities.
 maximizes community participation and involvement.
 prepares people/clients to eventually take over the

management of development programs in the future
PRINCIPLES OF COPAR:
1. People, especially he most OPPRESSED,

EXPLOITED, AND DEPRIVED ( women sectors,
children, handicapped, elderly, youth ) open to
change, have the capacity to change, and are able
to bring about change.
2. COPAR should be based on the interest of the
POOREST SECTORS of society.
3. COPAR should LEAD TO SELF-RELIANT
COMMUNITY AND SOCIETY.
PROCESS USED:
 A PROGRESSIVE CYCLE OF ACTION-
REFLECTION-ACTION which begins with small, local
and concrete issues identified by the people and the
evaluation and reflection of and on the action taken by
them.
 CONSCIOUSNESS-RAISING through experiential

learning is central to the COPAR process because it
places emphasis on learning that emerges from
concrete action and which enriches succeeding action.
 COPAR is PARTICIPATORY AND MASS-BASED
because it is primarily directed towards and biased in
favour of the poor, the powerless and the oppressed.
 COPAR is GROUP-CENTERED AND NOT LEADER

ORIENTED. Leaders are identified, emerged and tested
through action rather than appointed or selected by some
external force or entity.
COMMUNITY ORGANIZING
Stage 1. Community Analysis

- the process of assessing and defining needs,
opportunities and resources involved in initiating
community health action program.
5 Components:
1. demographic, social and economic profile
2. health risk profile
3. health/wellness outcome profile
4. survey of current health promotion programs
5. studies conducted in certain target groups
Steps:
1. Define the community.
2. Collect data.
3. Assess community capacity.
4. Assess community barriers.
5. Assess readiness for change.
6. Synthesis data and set priorities
Stage 2. Design and Initiation
1. Establish a core planning group and select a local

organizer.
2. Choose an organizational structure.
a. Leadership board or council – existing local leaders
working for a common cause
b. Coalition – linking organization and groups to work on
community issues
c. Lead or official agency – a single agency takes the
primary responsibility of a liaison for health promotion
activities in the community.
d. Grass-roots – informal structure in the community like
the neighborhood residents
e. Citizen panels – a group of citizens (5-10) emerge to
form a partnership with a government agency.
f. Networks and consortia – network develop because
of certain concerns.
3. Identify, select and recruit organizational members.

4. Define the organization mission and goals.
5. Clarify roles and responsibilities of people involved in the
organization.
6. Provide training and recognition.
Stage 3. Implementation
– put design into action.
1. Generate broad citizen participation.

2. Develop a sequential work plan.
3. Use comprehensive, integrated strategies.
4. Integrate community values into the programs, materials
and messages.
Stage 4. Program Maintenance
– at this point the program has experienced some
degree of success and has weathered through
implementation programs.
To maintain and consolidate gains of the program, the

following are essential:
1. Integrate intervention activities into community networks.
2. Establish a positive organizational culture.
3. Establish an ongoing recruitment plan.
4. Disseminate results.
Stage 5. Dissemination - Reassessment
* continuous assessment is a part of the monitoring

aspect in the management of the program. Formative
evaluation is done to provide timely modification of
strategies and activities.
1. Update the community analysis. Is there a change in

leadership, resources and participation?
2. Assess effectiveness of interventions/programs.
3. Chart future directories and modifications.
4. Summarize and disseminate results.
PHASES OF COPAR
A. Pre-Entry Phase
> Community consultation/dialogues
> Setting of issues/considerations related to site location
> Development of criteria for site selection
1. high percentage of the family income is below the
national poverty threshold
2. high malnutrition rate
3. lack of primary or secondary hospital within a 30-
minute ride from the area
4. area must not have relative peace and order problem
5. acceptance of the community
> Site selection
> Preliminary social investigation
>Networking with LGU’s, NGO’s and other departments
B. Entry Phase
> Integration with the community
> Sensitization of the community; information campaign
> Continuing/Deepening social investigation
> Core group formation
1. belongs to the poor sector of the society
2. responsible and committed
3. able to communicate
> Coordination with other community organization
> Self-Awareness and Leadership Training (SALT)/
Action Planning
Best technique to identify potential leaders:
- observe people who are active in small
mobilization activities that motivate residents to start
working.
C. Community Study/Diagnosis Phase
> Selection of the research team

> Training on data collection methods and techniques
> Planning for the actual gathering of data
> Data gathering
> Training on data validation
> Community validation
> Presentation of the community study/ diagnosis and
recommendations.
> Prioritization of community needs/problems for action
D. Community Organization and Capability Building
Phase
> Community meetings to draw up guidelines for the
organization
> Election of officers
> Delineation of the roles, functions and task of officers
and members
> Action-Reflection-Action session
- tool used to develop team-building and to promote an
avenue to verbalize feelings, opinions and suggestions and
enable them to participate in decision-making
> Team building exercises
> Working out legal requirements for the establishment of
the CHO
> Training of the CHO officers/ community leaders
E. Community Action Phase
> Organization and training of CHW’s
> Setting-up of linkages/network referral system
> Project Implementation Monitoring Evaluation (PIME)
of health services
> Initial identification and implementation of resource
mobilization schemes
F. Sustenance and Strengthening Phase
- begins when the community organization has already
established community members who are actively
participating in community wide undertakings activities.
> Formulation and ratification of constitution and by-laws
> Identification and development of “Secondary” leaders
> Setting up and institutionalization of a financing
scheme for the community health activities
> Formalizing and institutionalization of linkages,
networks and referral systems
> Continuing education and upgrading of community
leaders, CHW’s and CHO members
> Development of medium/ long term community health
and development plans
CRITICAL STEPS (ACTIVITIES) IN BUILDING PEOPLE
AND ORGANIZATION
1. INTEGRATION
***A community becoming one with the people in order to:
A. Immerse himself in the poor community
B. Understand deeply the culture, economy leaders, history
rhythms and life style in the community.
2. SOCIAL INVESTIGATION
- a systematic process of collecting and analyzing data to
draw a clear picture of the community.
- a process of systematically learning and analyzing the
various structures and forces in the community
> Also known as the “Community Study”
3. TENTATIVE PROGRAM PLANNING
- CO to choose one issue to work on in order to
begin organizing the people.
4. GROUNDWORK
- going around and motivating the person on a one
on one basis to do something on the issue that has been
chosen.
5. THE MEETING
- people collectively ratifying what have already
decided individually. The meeting gives the people the
collective power and confidence .Problems and issues
are discussed.
5. ROLE PLAYING
- means to act out meeting that will take place
between the leaders of the people and the government
representative’s .It is the way of training the people to
anticipate what will happen and prepare themselves for
such eventually.
6. MOBILIZATION OF ACTION
- actual experience of the people in confronting the
powerful and the actual exercise of the people power.
7. EVALUATION
- the people reviewing the steps 1-6 so as to
determine whether they were successfully or not on their
objectives.
8. REFLECTION
- dealing with deeper, on going concerns to look at
the positive values CO is trying to build in the
organization. It gives as the people time to reflect on the
starch reality of the life compared in the ideal.
9. ORGANIZATION
- the people organization is the result of many
successive and similar actions of the people .A final
organizational structure is set up with elected officers and
supporting members.
What is IMCI?
Integrated Management of Childhood Illness (IMCI)

is a strategy for reducing the mortality and morbidity
associated with the major causes of childhood illness.
IMCI is an integrated approach to child health that

focuses on the well-being of the whole child.
The IMCI strategy :
• promotes the accurate identification of childhood
illnesses;
• ensures appropriate integrated treatment of all major
illnesses;
• strengthens the counseling of caregivers;
• identifies the need of and speeds up the referral of severely
ill children.
In the home setting:

• it promotes appropriate care-seeking behaviors;
• improved nutrition and preventative care;
• and the correct implementation of prescribed care.
2 Age Categories in IMCI:
1. Young Infant
– up to less than 1 week up to 2 months
(1 week up to 1 month and 29 days)
2. Young Child
– 2 months up to 5 years
(2 months up to 4 years and 11 months)
Principles in IMCI:
1. All sick children must be examined for
GENERAL DANGER SIGNS:
C
> convulsions (fits, jerky movement, spasm)
U
> unable to drink or breastfeed (not eat)
V
> vomiting
A
> abnormally sleepy (difficult to awaken)
2. Assess for MAIN SYMPTOMS:
For Older children For Young infants:
a. Cough/DOB a. Local bacterial infection
b. Diarrhea b. Diarrhea
c. Fever c. Jaundice
d. Ear problems
3. Assess for nutritional status, immunization status, vitamin

A status, feeding problems and other potential problems.
4. Only a limited number of carefully-selected clinical signs

are used.
5. A combination of individual signs leads to a child’s
classification(s) rather than a diagnosis.
× identify illness = Dx
√ classify illness = classification
6. The guidelines do not describe the management of

trauma or other acute emergencies d/t accidents or
injuries.
7. IMCI management procedures use a limited number of

essential drugs and encourage active participation of
caretakers.
8. An essential component of the IMCI guidelines is the

counseling of caretakers.
THE IMCI STRATEGY
ASSESS THE CHILD
Check the child for Danger Signs
Then Ask: For any “yes” answer

Does the child have cough or •Ask further
difficult breathing? questions
Does the child have diarrhea? •LOOK,LISTEN, FEEL
Does the child have Fever? •Based on this
Does the child have ear problem classify illness
Then Check the child for malnutrition and anemia

Then check the child’s immunization status
Then check the child for other problems
Classify Illness
Pink classification
Yellow classification
Green classification
Identify Treatment
urgent pre-referral treatment and referral,

or
specific medical treatment and advice, or
simple advice on home management
Treat the Child
Teach the mother to give oral drugs at home

Teach the mother to treat local infections at home
Give intramuscular drugs in clinic
Give Increased fluids for diarrhea and continue feeding
If the child needs to be referred, give appropriate pre-
referral treatment
Counsel the mother
Using the process: ASK, PRAISE, ADVISE, CHECK

Food and feeding problem
Fluid intake during illness
When to return
Care for Development
Her own health
Follow - up
health-care provider gives appropriate follow-up

care, as indicated in IMCI guidelines
If necessary, reassess the child for any new
problems.
Assess and Classify A Sick Child
Aged 2 months to 5 years
1. Ask the mother what the child’s problems are?

greet the mother appropriately
use good communication skills
listen carefully to what the mother tells you
use words that the mother will understand
give the mother time to answer questions
ask additional questions if the mother is not
sure about her answer
2. Determine if it is an initial visit
For ALL sick children ask the mother about the child’s problem, check for general danger signs
and then
ASK: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
If YES
If NO
IF YES, ASK: LOOK, LISTEN, FEEL:
 For how long?  Count the breaths in one

minute.
The child
 Look for chest indrawing must be
 Look and listen for stridor calm
 Look and Listen for wheeze
 Fast breathing is:  If wheezing and weather fast
2 mos – 12 mos. 50 breaths breathing, give a trial of rapid
per minute or more acting bronchodilator up to 3
12 mos – 5 yrs. 40 breaths times 15 – 20 mins. apart.
per minute or more Reassess
CLASSIFY the child's illness using the colour-coded classification table

for cough or difficult breathing.
Then ASK about the next main symptoms: diarrhoea, fever, ear problems. CHECK for malnutrition and anaemia,
immunization status and for other problems
Classify Cough
SEVERE
 Any general danger sign or PNEUMONIA
 Lower chest indrawing or OR
 Stridor in calm child VERY SEVERE
DISEASE
 Fast Breathing (if wheezing, PNEUMONIA

go directly to treat
wheezing)
 No signs of pneumonia or NO PNEUMONIA:

very severe disease COUGH OR COLD
Treatment
Safe remedies:
- Instruct
- Follow –up care NO PNEUMONIA:
COUGH OR COLD
after 5 days
1. Give 3 days antibiotic.
1st line of drugs:
Amoxicillin 2 times daily for 3 days
2nd line of drugs:
Cotrimoxazole 2times daily for 3 days
2. Soothe the throat & relieve the cough using safe
remedies: PNEUMONIA
- B, T, L, C
Breastmilk, Tamarind, Luya, Calamansi)
•Never give cough syrup, antitussive, decongestant,
mucolytics.
3. Instruct the mother when too return the baby
immediately.
4. Follow up after 2 days.
Pre-referral Treatment:
1. Give 1st dose antibiotic
SEVERE
2. Give Vitamin A PNEUMONIA
- 2 months to 12 months: OR
100,000 IU (blue) VERY SEVERE
-12 months to 5 y/o : DISEASE
200,000 IU (red)
3. Treat the child to prevent lowering of the

blood sugar (hypoglycemia)
How to prevent lowering of blood sugar level:
*If the child is able to breastfeed:

*If the child is not able to breastfeed but is able to swallow
- give 30-50 ml milk or sugar H2O p.o.
(sugar H2O: 4 tsp. sugar+200 ml H2O)
*Not able to swallow but conscious:
- Insert NGT
*If the child is unconscious:
- (IVF) D10W 5 ml/kg body weight for a few minutes
For ALL sick children ask the mother about the child’s problem, check for general danger signs, ask about cough or
difficult breathing and then
ASK: DOES THE CHILD HAVE DIARRHEA?
If NO
Does the child have diarrhea

IF YES, ASK: LOOK, LISTEN, FEEL:
 For how long? • Look at the child's general condition.

 Is there blood in the stool Is the child:
Abnormally sleepy or difficult to awaken?
Restless or irritable?
 Look for sunken eyes.
 Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
 Pinch the skin of the abdomen.
Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
CLASSIFY the child's illness using the color-coded classification tables for
diarrhea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.
Classify Diarrhea
SIGNS CLASSIFY AS
Two of the following signs:
 Lethargic or unconscious
 Sunken eyes
 Not able to drink or drinking poorly SEVERE DEHYDRATION
 Skin pinch goes back very slowly
Two of the following signs:

 Restless, irritable
 Sunken eyes SOME DEHYDRATION
 Drinks eagerly, thirsty
 Skin pinch goes back slowly
Not enough signs to classify as some or severe

dehydration. NO DEHYDRATION
SIGNS CLASSIFY AS
Dehydration present SEVERE PERSISTENT DIARRHEA
No dehydration PERSISTENT DIARRHEA
• Blood in the stool DYSENTERY

Treatment:
Severe Dehydration
PINK
PLAN C
Give IVF : D5LR

< 12 mos. old : 100ml/kg within 6 hrs
12 mos. up to 5 y.o. : 100ml/kg within 3 hrs
Some Dehydration
YELLOW
PLAN B
Give ORS for the 1st 4hrs

Amount of ORS = weight (kg) x 75 = ml/cc
> after 4 hours, re-assess child for signs of dehydration
> if still some dehydration, continue ORS for 4 hours
Age Amount of ORS
1 week up to 4 mos. old 200-400 ml

4 mos. up to 12 mos. 400-700 ml
12 mos. up to 2 years old 700-900 ml
2 years old up to 5 years old 900-1400 ml
Mild vomiting during ORT

= stop ORS in 10 mins, after 10 mins continue ORS
but give it in a slow manner
Severe Vomiting during ORT
= stop ORS → IVF or refer!
No Signs of Dehydration
Green
PLAN A
Give ORS if with watery or loose stool

1 week up to 2 y/o = 50-100 ml ORS
2 y/o up to 5 y/o = 100-200 ml ORS
If there’s no watery/loose stool (4 Home Rule Management):
1. Continue feeding (BRAT diet)
2. Give extra fluids; soups, milk, plain water, juice, rice water
3. Give Zinc supplement for 10-14 days to increase immune system
4. Advise mother when to return baby immediately.
PERSISTENT DIARRHEA (Young child)
Yellow
1. Give Vit. A
2. Advise mother recommended feeding
3. Follow-up after 5 days
→ if still breastfeeding:
= breastfeed day and night
→ if taking milk supplements:
= replace milk supplements with increased breastfeeding
= replace half of the milk & nutrient rich, semi-solid foods
* Do not use condensed or evaporated milk
= because it is high in CASEINE
SEVERE PERSISTENT DIARRHEA
Pink
1. Give Vitamin A
2. Give IVF = Plan C
DYSENTERY (Young Infant) DYSENTERY (Child)
Pink Yellow
Referral Ciprofloxacin 2 times daily

for 3 days
Cholera:
First Line Antibiotic:

> Tetracycline
Second Line Antibiotic :

> Erythromycin
FEVER
difficult breathing, diarrhea and then
ASK: DOES THE CHILD HAVE FEVER?
Does the child have fever?

(by history or feels hot or temperature 37.5 C** or above)
IF YES:
If No Decide the Malaria Risk: Yes or No
THEN ASK: LOOK AND FEEL:
 Look or feel for stiff neck.

 Look for runny nose.
 For how long?
 If more than 7 days, has fever been present every day? Look for signs of MEASLES
 Has the child had measles within the last 3 months?  Generalized rash and
 One of these: cough, runny nose, or red eyes.
If the child has measles now or within the last 3 months:  Look for mouth ulcers.
Are they deep and extensive?
 Look for pus draining from the eye.
 Look for clouding of the cornea.
Decide Dengue Risk: Yes or No
Ask: Look and Feel:
o Has the child had any bleeding from the nose or gums, or •Look for bleeding from the nose or gums?
in the vomitus or stool? •Look for skin petechiae
o Has the child had black vomitus? •Feel for cold and clammy?
o Has the child evacuated black stool? •Check for slow capillary refill.
o Has the child had persistent abdominal pain? •If none of the above ask , look and feel signs are
o Has the child been persistent vomiting? present and the child is 6 months and older and fever
has been present for more than 3 days, perform
tourniquet test.
CLASSIFY the child's illness using the colour-coded classification tables for fever.
Then ASK about the next main symptom: ear problem, and CHECK for malnutrition and anaemia, immunization status
and for other problems.
Malaria Risk
Signs Classification
 Any general danger signs Very Severe Febrile Disease/Malaria
 Stiff neck
 Blood Smear (+)
 If Blood smear is not done; Malaria
 No runny nose, and
 No measles, and
 No other cause of fever
 Blood Smear (-) or
 Runny nose, or Fever: Malaria Unlikely
 Measles, or
 Other cause of fever
No Malaria Risk
 Any general danger sign Very Severe Febrile Disease
 Stiff Neck
 No signs of very febrile disease Fever: No Malaria

Malaria Risk Treatment
> Give paracetamol for fever
Fever: Malaria
> Advise mother when to return immediately
Unlikely
> Follow-up after 2 days
> Give paracetamol for fever
> Bring the child if there’s CUVAS
> Follow-up after 2 days Malaria
> Give antimalarial drugs
First Line Antibiotic: Arthemeter + Lumefantrine
Second Line Antibiotic: Chloroquine, Primaquine,
Sulfadoxine and Pyremethamine
1. Give first dose antibiotic
2. IM Quinine
Very Severe Febrile
3. Give paracetamol Disease/Malaria
4. Treat lowering of blood sugar
5. REFER!
No Malaria Risk Treatment
> Give Paracetamol for fever

> Advise mother when to return Fever: No Malaria
immediately
> Give Paracetamol for fever Very Severe

> Treat lowering of blood sugar Febrile Disease
> Refer!
Measles
 Any general danger signs or

 Clouding of the cornea, or Severe Complicated Measles
 Deep and extensive mouth ulcers
 Pus draining from the eyes, or Measles with Eye or Mouth

 Mouth Ulcers Complications
 Measles now or within the last three Measles

months
Dengue Hemorrhagic Fever

 Bleeding from the nose or gums, or
 Bleeding in stools or vomitus, or
 Skin petechiae, or Severe Dengue Hemorrhagic Fever
 Cold and clammy extremities, or
 Persistent abdominal pain, or
 Persistent vomiting, or
 Torniquet test positive
 No signs of severe dengue hemorrhagic Fever: Dengue Hemorrhagic Fever

fever Unlikely
Measles Treatment
*Pre-referral Tx:
> Give Vitamin A
> Apply tetracycline on eyes if with eye
Severe
complication Complicated
> Give 1st dose of antibiotic Measles
> Refer!
Don’t give/apply gentian violet on mouth ulcers
> Give Vitamin A

> Apply tetracycline on eyes QID
> Apply Gentian Violet (half Measles with Eye
or Mouth
strength) on mouth BID Complications
Give Vitamin A Measles

Dengue Hemorrhagic Fever Treatment
Pre-referral treatment:
Severe Dengue
1. Rapid fluid replacement Hemorrhagic Fever
2. Paracetamol for fever of 38.5 ˚C without
ASA
3. Treat child to prevent lowering of blood
sugar
4. REFER!
1. Give Paracetamol for fever of 38.5 ˚C w/o
ASA
2. Advise to bring if signs of severe dengue Fever: Dengue
Hemorrhagic Fever
fever occurs Unlikely
3. Follow up after 2 days
Ear Problem
difficult breathing, diarrhoea, fever and then
ASK: DOES THE CHILD HAVE AN EAR PROBLEM?
If No If Yes
IF YES, ASK: LOOK AND FEEL:
If yes, for how long?

 Is there ear pain?  Look for pus draining from the ear.
 Is there ear discharge?  Feel for tender swelling behind the
ear.
CLASSIFY the child's illness using the color-coded classification table for
ear problem.
Then CHECK for malnutrition and anemia, immunization status and for other problems.
Classify Ear Problem
SIGNS CLASSIFICATION
 Tender swelling behind the ear. MASTOIDITIS
 Pus is seen draining from the ear and

discharge is reported for Less than 14 ACUTE EAR
days, or INFECTION
 Ear pain.
 Pus is seen draining from the ear and CHRONIC EAR
discharge is reported for 14 days or more. INFECTION
 No ear pain and NO EAR INFECTION
No pus seen draining from the ear.
Ear Problem Treatment
* Give 1st dose antibiotic
* Give Paracetamol for ear pain MASTOIDITIS
* Refer!
* give 3 days antibiotic

* dry the ear by wicking (roll soft cloth in a wick) ACUTE EAR
* give Paracetamol for ear pain INFECTION
* follow-up after 5 days
* dry ear by wicking CHRONIC EAR
* follow-up after 5 days INFECTION
* No treatment needed NO EAR INFECTION

Malnutrition and Anemia
For ALL sick children ask the mother about the child’s problem, check for general danger
signs, ask about cough or difficult breathing, diarrhoea, fever, ear problem and then
CHECKFOR MALNUTRITION AND ANEMIA
CHECK FOR MALNUTRITION AND AN EMIA.
If Yes
If No Check for Malnutrition
LOOK AND FEEL:
 For All Children

 Determine the weight for age
 Look for visible severe wasting.
 Look for edema of both feet.
 For children aged 6 mos. or more determine if MUAC I is less than
11 cm.
Check for Anemia
LOOK AND FEEL:
 Look for palmar pallor. Is it:
Severe palmar pallor?
Some palmar pallor?
CLASSIFY the child's illness using the color-coded classification table

for malnutrition and anemia.
Then CHECK immunization status and for other problems.

Classify Malnutrition
SIGNS CLASSIFICATION
If age up to 6 mos.
- Visible severe wasting or Edema of both feet. SEVERE
• If age 6 months and above and MUAC less than MALNUTRITION
11 mm or
- edema of both feet, Visible severe wasting
 Very low weight for age. LOW WEIGHT
 Not very low weight for age and no other signs NOT VERY LOW WEIGHT
or malnutrition.
Classify Anemia
 Severe palmar pallor SEVERE ANEMIA
Some palmar pallor ANEMIA

 No palmar pallor NO ANEMIA
Malnutrition and Anemia
Severe Anemia/ Anemia Low Weight No Anemia, Not

Severe Very Low
Malnutrition * Give 30 days * Counsel Weight
of 10 ml or mother
* Give Vitamin A 2 tsp Iron * Follow up after * Assess the
* Refer! * Deworm: 5 days child’s feeding
Mebendazole
Albendazole No feeding * Counsel the
* Follow up problem: mother
after 14 days * Give Vit. A
* Follow-up after
30 days
Check Immunization Status, Vitamin A and Deworming Status
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing, diarrhoea, fever, ear problem, and then check for
malnutrition and anaemia and
CHECK IMMUNIZATION STATUS.
AGE VACCINES
IMMUNIZATION Birth BCG Hep B 1
SCHEDULE: 6 weeks DPT-1 OPV-1 Hep B 2
10 weeks DPT-2 OPV-2
14 weeks DPT-3 OPV-3 Hep B 3
9 months Measles
DECIDE if the child needs an immunization today, or if the mother should be told to
come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child if the
child is well enough to go home.
Then CHECK for other problems.
Vitamin A Prophylaxis Routine Worm Treatment

The first dose at 6 mos. Or Give every child mebendazole every
above and subsequent dose 6 mos. From age 1 year and record in
every 6 mos. the child’s card
Assess and Classify Sick Young Infant Aged up to 2 Mos.
For ALL sick young infants check for signs of POSSIBLE BACTERIAL INFECTION.
ASK: LOOK, LISTEN, FEEL:

 Is the infant having difficulty in  Count the breaths in one minute.
feeding? Repeat the count if elevated.
 Has the infant had convulsions?  Look for severe chest indrawing.
 Look at the umbilicus. Is it red or draining pus?
Does the redness extend to the skin?
 Measure axillary temperature
 Look for skin pustules. Are there many or severe
pustules?
 Look at the young infant's movements.
Does the infant move on his own?
Does the infant move only when stimulated?
Does the infant not moving at all
CLASSIFY the infant's illness using the colour-coded classification table for possible
bacterial infection.
Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status
and for other problems.
Classify Sick Young Infant
• Not Feeding well or

• Convulsions or
• Fast breathing (60 breaths per minute or
more) or VERY SEVERE
• Severe chest indrawing or DISEASE
• Fever (37.5° C* or above or feels hot) or
• low body temperature (less than 35.5°C*
or feels cold)
• Movement only when stimulated or no
movement at all
• Umbilical red or draining pus or LOCAL BACTERIAL
• Skin pustules INFECTION
• No signs of very severe disease or local SEVERE DISEASE OR
bacterial infection LOCAL BACTERIAL
DISEASE UNLIKELY
TREATMENT
1. Give first dose antibiotic:
Gentamycin - (IM) Right
Vastus lateralis VERY SEVERE
Benzyl penicillin: Left DISEASE
Vastus lateralis
2. Keep warm
3. Treat child to prevent hypoglycemia
4. Refer.
1.Give 3 days antibiotics P.O.
2.Apply gentian violet on affected area LOCAL BACTERIAL
(FULL STRENGHT) INFECTION
3.Follw-up after 2 days.
SEVERE DISEASE OR
LOCAL BACTERIAL
DISEASE UNLIKELY
Assess Jaundice
Look:
Look for jaundice (yellow eyes and skin)
Look at young infant’s palms. Are they yellow
Classify Jaundice
 Any jaundice if age less than 24 hours or
Yellow palms and soles at any age SEVERE JAUNDICE
 Jaundice appearing after 24 hours of age

and JAUNDICE
Palms and soles are not yellow
 No Jaundice NO JAUNCICE
Check for Low Weight Infants for Age in Breastfed Infants
ASK: Look, Listen and Feel
 Is the infant breastfed? If yes,
How many times in 24 hours? •Determine the weight
 Does the infant usually receive for age
any •Look for white ulcers
other foods or drinks? or white patches in the
If yes, how often? mouth
 What do you use to feed the
infant?
ASSESS BREASTFEEDING:
 Has the infant breastfed in the If the infant has not fed in the previous hour, ask the mother to put her infant to
previous hour? the breast. Observe the breastfeed for 4 minutes.
(If the infant was fed during the last hour, ask the mother if she can wait and tell
you when the infant is willing to feed again.)
 Is the infant able to attach?
no attachment at all not well attached good attachment
TO CHECK ATTACHMENT, LOOK FOR:
 Chin touching breast
 Mouth wide open
 Lower lip turned outward
 More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)
 Is the infant suckling effectively (that is, slow deep sucks, sometimes
pausing)?
no suckling at all not suckling effectively suckling effectively
Clear a blocked nose if it interferes with breastfeeding.
 Look for ulcers or white patches in the mouth (thrush).
Classify the Feeding Problem
Not well attached to breast, or

 Not sucking effectively, or
 Less than 8 breastfeeds in 24
hours, FEEDING
or PROBLEM OR LOW
 Receives other foods or drinks, or WEIGHT FOR AGE
 Low weight for are age, or
 Thrush (ulcers or white patches in
mouth).
 Not low weight for age and no other NO FEEDING

signs of inadequate feeding. PROBLEM
RECOMMENDED FEEDING
At birth up to 6 months
> exclusively breastfeed
> 8 times or more than 8 times within 24 hours.
SIGNS OF HUNGER:
1. Beginning to fuss.
2. Sucking fingers and fist
3. Sucking movements with their lips.
>6 months up to 12 months:
breastfeeding + 3 times a day complementary food.
If not on breastfeeding:
5 times a day complementary food.
>12 months up to 2 years old:

breastfeeding + 5 times a day of complementary food.
>At birth up to 4 months:

exclusive breastfeeding 8 times in 24 hrs.
>4 months up to 6 months:

breastfeeding with complementary food 1-2 times a day
Gentian Violet:
Half strength: for mouth ulcers

=15 ml GV+30-45 DW = .25% concentration
Full strength: skin pustules &

umbilical redness or pus
=15 ml GV+15 ml DW = .5% concentration
Preparation and Application of Gentian Violet
Mouth ulcers Skin pustules Umbilical Redness/Pus
1. Wash hands 1. Wash hands 1. Wash hands
2. Clean affected area 2. Clean affected 2. Clean affected area

using soft cloth area using soft using 70% alcohol
dipped in salt water cloth soaked with
soap & water
3. Paint GV 3. Paint GV 3. Paint GV
4. Wash hands 4. Wash hands 4. Wash hands

.

Primary Health Care

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Primary Health Care

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PRIMARY

Framework for its Implementation:

> UNIVERSAL HEALTHCARE (KALUSUGAN

> ALL FOR HEALTH TOWARDS HEALTH FOR ALL

3. Health Delivery System

- based on the fundamental values of freedom, equality,

Factors affecting Frequency of Home Visit:

B. Acetic Acid Test

1. Botika ng Bayan and Botika ng Barangay

- Devolution Code (Mandate of Devolution)

Levels of PHC Workers:

1. Primary Level of Care

3. Tertiary Level of Facilities

* created the Philippine Institute of Traditional and

1. Reducing maternal mortality rate.

*** Principal recipients of information, education, communication

*** The Family Code of the Philippines?

3 Most Common Deficiencies:

1. Eat variety of foods everyday.

Contributing Factors to Pneumonia:

2. to provide adequate, safe, affordable and equitable

3. to mobilize all sectors of the community to participate

3. Tuberculin Testing/Mantoux Test/PPD Testing

Body Weight (kg) # of Tablets

Essential Health Service Packages:

Post Partum Visits:

3 Cardinal Signs of Post Partum Infection:

G. Family Planning Counseling

Mandatory Infants and Children Health Immunization of 2011

2 most sensitive to heat vaccine:

REGIONAL HEALTH OFFICE

DISTRICT/ PROVINCIAL HEALTH OFFICE

BCG At birth 1 ID(RIGHT deltoid ) 0.05 ml

DPT 6 wks, 3 4 wks. IM (VASTUS 0.5 ml

MEASLES 9 -11mos. 1 SUBCUTANEOUS 0.5 ml

1. No BCG to a child born positive with HIV or AIDS

4. Stress points of foreseeable crisis – anticipated periods of

FOUR RIGHTS IN FOOD SAFETY:

Rule in Food Safety:

Use of Vital Statistics:

2. Crude Death Rate (CDR)

4. Maternal Mortality Rate (MMR)

6. Neonatal Death Rate (NDR)

8. Prevalence Rate (PR)

10. Case Fatality Ratio (CFR)

Category I - new smear positive

Category II - treatment failure

Category IV - chronic (still smear positive after supervised

B. Measures aimed to protect the individual and families

Prevention and Control:

Methods of Prevention and Control:

Methods of Prevention and Control:

- A process, by which a community identifies its

 helps the community workers generate community

 maximizes community participation and involvement.

 prepares people/clients to eventually take over the

1. People, especially he most OPPRESSED,

 CONSCIOUSNESS-RAISING through experiential

 COPAR is GROUP-CENTERED AND NOT LEADER

Stage 1. Community Analysis

1. Establish a core planning group and select a local

3. Identify, select and recruit organizational members.

1. Generate broad citizen participation.