COMMUNITY HEALTH NURSING (PART 1) COMMUNITY PARTICIPATION

⮚ Citizens and communities have a right

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

COLD CHAIN REMINDERS:

 1) NEVER store any vaccine in a dormitory style ⮚ E.g.
or bar style combined unit a) BCG
2) NEVER place vaccines and diluents in the b) DPT
DOOR shelves (Temperature is not stable) c) HepB
3) AVOID frequent opening and closing of doors d) TT
4) Place vaccines and diluents in the center of 2) FREEZER
the unit 2 or 3 inches away from walls, ceiling, ⮚ Kept between -15 degrees C to -25
floor. And door degrees C
5) AVOID freezing of diluents as the vial may ⮚ Average of 20 degrees C
burst when frozen ⮚ Used for freezing ice packs
6) DO NOT STORE vaccines in deli, fruit or ⮚ For heat sensitive vaccines (OPV &
vegetable drawers or in the door Measles)
7) Place vaccines and diluents with the earliest ⮚ OPV is the MOST sensitive to heat and
expiration dates in front of those with later fragile vaccine
expiration dates
8) Do not return reconstituted vaccines (BCG, STORING:
Measles) or opened PCV 10 vials to the 1) FREEZING COMPARTMENTS
refrigerator. They should be discarded at the a) Ice cubes
end of the immunization session or after 6 b) Ice packs
hours, whichever comes first, 2) MAIN COMPARTMENT
9) The refrigerator should not be packed too full a) TOP
(to allow air to circulate) 1. OPV
10) Vaccines should be stored carefully between 2. Measles
+2 degrees C and +8 degrees C at all times b) MIDDLE
11) Freeze-sensitive vaccines (Pentavalent, PCV10, 1. DPT
TT & HepB) should be kept away from the 2. TT
freezing compartment, refrigeration plates, side 3. Diluent
linings or bottom lining of refrigerators and c) LOWER
frozen ice packs 1. Water bottles

WATER BOTTLES STORAGE TIME FRAMES

1) Place water bottles on the top shelf, floor and 1) 6 MONTHS – Regional Level
in the door racks 2) 3 MONTHS – Provincial Level/District Level
2) Putting water bottles in the unit can help 3) 1 MONTH – Main Health Centers with
maintain stable temperatures cause by refrigerator
frequently opening and closing unit doors or 4) NOT MORE THAN 5 DAYS – Health centers
a power failure using transport boxes
3) Label all water bottles DO NOT DRINK
ESSENTIAL ELEMENTS:
REFRIGERATOR 1) Personnel to manage vaccine distribution
1) NO foods, drinks or other drugs are to be kept 2) Equipment for vaccine storage & transport
in a refrigerator 3) Maintenance of equipment
2) Check and record temperature 2x a day in 4) Monitoring
temperature log for 2-7 days 5) COLD CHAIN MANAGER: PHN
3) DEFROST the refrigerator when ice becomes
more than 0,5 cm thick, or once a month, VACCINES:
whichever comes first 1) BCG (Bacillus Chalmette Guerin)
4) Record temperature, date, time and initials of ⮚ CONTENT: Live Attenuated Bacteria
the person in monitoring log sheet ⮚ TYPE: Freeze Dried
⮚ DOSAGE:
2 COMPARTMENTS: a) Infant/birth: 0.05 mL
1) REFRIGERATOR (Main Compartment) b) Preschool: 0.1 mL
⮚ Kept between +2 degrees C and +8 ⮚ NUMBER OF DOSES: 1dose
degrees C ⮚ ROUTE: ID using 26G needle syringe
⮚ Used for storing vaccines and diluents 2) Hepatitis B
 ⮚ CONTENT: Plasma Derivative (HbsAg)/ ✔ About 5 mm
RNA Recombinant ✔ Scar at 12 weeks after injection
⮚ TYPE: Liquid (2-5 months)
⮚ DOSAGE: ✔ Sign that the child has been
a) Infant/birth: 0.5 mL effectively immunized
⮚ NUMBER OF DOSES:3 doses ⮚ ABNORMAL ADVERSE EFFECTS
⮚ ROUTE: IM a) INDOLENT ULCERATION
3) DPT (Diphtheria-Pertussis-Tetanus) ✔ WATCH OUT FOR: Signs of
⮚ CONTENT: DT weakened toxin/ P-killed Infection
bacteria ✔ Abscess formation and swelling
⮚ TYPE: Liquid of glands in armpits
⮚ DOSAGE: 0.5 mL (lymphadenopathy)
⮚ NUMBER OF DOSES: 3 doses ✔ Abscess may be due to:
⮚ ROUTE: IM 1. UNSTERILE needle/syringe
4) OPV (Oral Polio Virus) was used (#1 cause)
⮚ CONTENT: Live Attenuated Virus 2. Too much vaccine was
(weakened) injected
⮚ TYPE: Liquid 3. Wrong technique of
⮚ DOSAGE: 2 drops (0.1 mL) administration
⮚ NUMBER OF DOSES: 3 doses ✔ MANAGEMENT:
⮚ ROUTE: PO 1. Do not incise and Drain
5) Rotavirus Vaccine 2. Use warm water
⮚ CONTENT: Live Attenuated Virus compresses over the
(weakened) injection site or
⮚ TYPE: Liquid suppurating lymph node/s
⮚ DOSAGE: 5 drops (0.5 mL) 4-5 times a day
⮚ NUMBER OF DOSES: 5 doses
⮚ ROUTE: PO HEPATITIS B
6) MEASLES ⮚ Transmission at birth is possible give:
⮚ CONTENT: Live Attenuated Virus a) HepB 1 – At Birth
(weakened) b) HepB 2 – 6 weeks
⮚ TYPE: Freeze dried c) HepB 3 – 14 weeks
⮚ DOSAGE: 0.5 mL ⮚ When transmission at birth is less likely, the
⮚ NUMBER OF DOSES: 1 dose recommended schedule is:
⮚ ROUTE: SQ a) HepB 1 – 6 weeks
b) HepB 2 – 10 weeks
BCG c) HepB 3 – 14 weeks
⮚ At birth or Any time after birth ⮚ COMMON SIDE EFFECTS:
⮚ NORMAL SIDE EFFECTS a) MILD FEVER (1-2 days)
a) KOCH’S PHENOMENON ✔ Teach mother to perform TSB
✔ Acute inflammatory process ✔ Advise to give Paracetamol every
starting 24 hours after injection 4 hours if temperature is above
and may last 2-4 days 38.5 degrees C
✔ Wheal formation (small raised ✔ REFER if fever last for 4 days
lump of 10 mm of diameter) b) SORENESS, REDNESS OR SWELLING IN
✔ Disappears within 30 minutes THE INJECTION SITE
b) ULCER/RED SORE FORMATION ✔ Teach mother to perform COLD
✔ May appear 2 weeks after injection compress FIRST before HOT
and may persist for another 2 compress
weeks to heal
✔ Keep dry and clean (Do not put any
ointment on the sore or give the
child any medicine)

c) SCAR FORMATION DPT

 ⮚ The recommended schedule is: 4 weeks ⮚ NOTE: if the child aged 6-9 months when
interval between doses hospitalized should receive measles vaccine
a) DPT 1 – 6 weeks apart from the scheduled vaccine at 9 months
b) DPT 2 – 10 weeks ⮚ In case of outbreak: may be given at 6 months
c) DPT 3 – 14 weeks (EARLIEST dose)
⮚ MILD REACTIONS: ⮚ LATE dose: 15 months
a) FEVER ⮚ Catch up dose: 4-5 y/o
✔ Child may have fever in the
evening AFTER receiving DPT IMPORTANT NOTES:
vaccine 1) It is safe to vaccinate a sick child who is
✔ Fever should disappear within a suffering from a minor illness
day 2) When handling vaccines, the FIRST step is to
✔ NOTE: FEVER that begins more CHECK the vial for EXPIRATION DATE
than 25 hours after a DPT 3) Use standard refrigerator with separate
injection is UNLIKELY to be a freezer door and seal for vaccines
reaction to the vaccine 4) Vaccines can be mixed in a single syringe
b) SORENESS when:
c) PAIN a) Vaccines are licenses and labeled to be
d) REDNESS OR SWELLING AT INJECTION mixed
SITE 5) BCG vaccine protects against TB in infants
⮚ WATCH OUT FOR: ABSCESS FORMATION 6) BCG vaccine amber glass ampules is to protect
✔ An abscess may develop a week or from ultraviolet and fluorescent light to
more after a DPT infection due to: MAINTAIN POTENCY
1. Unsterile needle or syringe 7) BCG also should be discarded AFTER 6
was used HOURS of reconstitution because of risk of
2. Wrong technique contamination d/t lack of preservative and
3. Vaccine was note injected into loss of potency
the muscle 8) BCG vaccine is NOT damaged by freezing
⮚ DPT vaccine should NOT be given: 9) Store BCG Vaccine and its diluent side-by-side
a) Children over 5 years of age in a refrigerator or vaccine carrier
b) Children who have suffered a severe 10) BCG is administered via ID route at (R)
reaction to a previous dose of DPT deltoid
vaccine 11) NEVER immunize in buttocks, IM vaccines
⮚ Instead, a COMBINATION OF DIPHTHERIA like HepB, DPT, IPV, Pentavalent and PCV
AND TETANUS TOXOIDS (DT) should be given should be administered muscle of the upper
outer of the thigh
OPV 12) Measles is given ONCE, SQ injection in the
⮚ The recommended schedule is: 4 weeks OUTER UPPER (R) arm
interval between doses 13) The Measles, Mumps, Rubella, Vaccine (MMR)
a) OPV 1 – 6 weeks can be stored either in the freezer or the
b) OPV 2 – 10 weeks refrigerator
c) OPV 3 – 14 weeks 14) Protect reconstituted measles vaccine from
⮚ NO SIDE EFFECT sunlight. WRAP IT WITH FOIL
15) If a child has diarrhea, give OPV as usual but
ROTAVAC administer an extra dose
⮚ The recommended schedule is: ✔ 5th dose, at least 4 weeks after he or
d) ROTAVAC 1 – 6 weeks she has received the last dose in the
e) ROTAVAC 2 – 10 weeks to a maximum of schedule
32 weeks 16) Diphtheria and Tetanus toxoid parts re
⮚ Rare and mild side effects damaged by freezing
⮚ Fussiness, mild diarrhea, and vomiting

17) For outreach session using vaccine carriers or

MEASLES old box:
⮚ Regular schedule: 9 months
 a) Do not let DPT, TT or HepB vaccine
vials touch the cold dogs/ice packs. COMPUTE FOR ELIGIBLE POPULATION
b) Put or wrap newspaper or cardboard ⮚ FORMULA: TOTAL POPULATION x Target
around DPT, TT, or HepB to protect Setting = Eligible Population
them from freezing ⮚ For Target Setting of Eligible Population:
18) PERTUSSIS vaccine is damaged by heat a) Total number of children & infants for
19) Pertussis causes the fever after DPT shot immunization = 3% or 0.03
20) If a child spits out, regurgitates the vaccine b) Total number of mothers for
drops, or vomits immediately after a dose of immunization = 3.5% or 0.035
OPV, it is safe to repeat the doe (DO NOT BF ⮚ EXAMPLE: Midwife Lorna was assigned to
immediately) Bgy. San Roque with 20 000 population. How
many infants are expected to receive measles
VACCINATION CARD injection
a) Date of administration ✔ TP = 20 000
b) Vaccine manufacturer ✔ EP = 3% (Infants)
c) Vaccine lot number ✔ 20 000 x 0.03 = 600 infants
d) Name and title of the person who
administered the vaccine STEP 2: DETERMINE THE TOTAL VACCINE
REQUIRED (TVR)
HERD IMMUNITY ⮚ FORMULA: Eligible Population x Number of
⮚ Occurs when a high percentage of the doses to complete immunization = TVR
community is immune to a disease (through a ⮚ 600 infants x 1 dose of measles = 600 TVR
vaccination and/or prior illness) making the
spread of the disease from person to person is STEP 3: DETERMINE THE ANNUAL VACCINE DOSES
unlikely. REQUIRED (AVR)
⮚ FORMULA: Total Vaccine dose Required x
TARGET SETTING Wastage Factor of the vaccine (refer to table
1) BCG above)
⮚ Number of Doses: 1 ⮚ 600 (TVR) x 2 (constant wastage factor of
⮚ Number of Doses per ampule: 20 measles) = 1200 AVR
⮚ Wastage factor: 2.5
2) HepB EXAMPLE 1: Lorna has an eligible target of 600 (0-1
⮚ Number of Doses: 3 y/o) for the current year. If she computes her EPI
⮚ Number of Doses per ampule: 10 target on anti-measles. How many vials of 10 doses
⮚ Wastage factor: 1.10 will she need?
3) DPT ✔ ANSWER: 120 vials
⮚ Number of Doses: 3 ✔ 600 x1 = 600
⮚ Number of Doses per ampule: 20 ✔ 600 x 2 = 1200
⮚ Wastage factor: 1.67 ✔ 1200/10 = 120 vials
4) OPV
⮚ Number of Doses: 3 STEP 4: DETERMINE ANNUAL VACCINE AMPULE OR
⮚ Number of Doses per ampule: 20 VIAL (AVA)
⮚ Wastage factor: 1.67 ⮚ FORMULA: Annual Vaccine Doses Required
5) MEASLES (AVR)/number of doses per ampule
⮚ Number of Doses: 1 ⮚ 1200 (AVR)/ 10 doses per ampule of measles
⮚ Number of Doses per ampule: 10 = 120 ampules of measles
⮚ Wastage factor: 2
6) TETANUS TOXOID EXAMPLE 2: Nurse Ling Ling has a total eligible
⮚ Number of Doses: 5 target of 205 (mothers), If she computes her EPI
⮚ Number of Doses per ampule: 10 target on Tetanus Toxoid, how many vials of 20 doses
⮚ Wastage factor: 1.67 will she need?
✔ 205 x 5 (doses of TT) = 1025

STEP 1: DETERMINE THE ELIGIBLE POPULATION MATERNAL HEALTH PROGRAM

OUT OF THE GIVEN TOTAL POPULATION
MCHP b) Obstructed Labor
⮚ The Philippines is tasked to reduce the c) Unsafe Abortion
Maternal Mortality Ratio (MMR) by three d) Sepsis
quarters or 75% by 2015 to achieve its MDG ✔ Endometriosis (most common
⮚ This means a MMR of 112/100, 000 live puerperal sepsis)
births in 2010 e) Eclampsia and PIH
⮚ 80/100,000 live births by 2015
DAILY IRON & FOLIC ACID SUPPLEMENTATION
HOME BASED MOTHER’S RECORD (HBMR) DURING PREGNANCY
⮚ Tool used when rendering prenatal care ⮚ WHO & National Guidelines recommended all
containing risk factors and danger signs pregnant women should receive a daily Oral
⮚ A system for recording risk factors, early sings Fe and Folic Acid supplementation dose of
of complications, referrals and treatment of DAILY 60 mg of Fe + 400mcg (0.4 mg) Folic
the mother Acid for 6 months (125 days)
⮚ PANEL 1: Maternal Information ✔ To prevent maternal anemia, puerperal
(demographics) sepsis, LBWs and Preterm birth
⮚ PANEL 2: Danger signs/Risk factors/Present ⮚ Folic Acid is the chief
pregnant condition ⮚ TAKE NOTE: Folic acid should be commenced
⮚ PANEL 3: Actions by referral as early as possible (ideally before
⮚ PANEL 4: Family planning/Postpartum Care conception) to prevent NTDs

RISK FACTORS PRENATAL CONTACT/VISIT

a) Height 145 cm tall (4 ft & 9 in) ⮚ 8 or more Prenatal contacts for antenatal
b) Age below 18 y/o (PIH) ; above 35 y/o care can reduce perinatal deaths by up to 8
(H-mole, Placental Previa) per 1000 births when compared to 4 visits
c) Recent pregnancy was C/S delivery ⮚ It recommends pregnant women to have their
d) Multiparity and last baby born was less than a first contact in the FIRST 12 weeks AOG with
years ago subsequent contacts taking place at:
e) Family history of DM, Hypertension, and a) 20 weeks AOG
Heart disease b) 26 weeks AOG
f) Underlying condition like TB, Goiter, c) 30 weeks AOG
Bronchial Asthma, Severe Anemia d) 34 weeks AOG
g) Less than 45 kg or more than 80 kg weight e) 36 weeks AOG
f) 38 weeks AOG
DANGER SIGNS g) 40 weeks AOG
1) Any type of vaginal bleeding
2) Headache, Dizziness, Blurred Vision NUTRITION
(Pre-Eclampsia/Gestational HTN) ⮚ Emphasize the importance of nutrition during
3) Puffiness of the face and hands (Facial each prenatal contacts
Edema/Peripheral Edema) 1) Eat nutritious foods like fruits &
4) Pale and Anemic vegetables
5) Any watery discharges (PROM) 2) Avoid excessive weight gain
3) Daily oral Fe and Folic Acid (600 mg Fe +
MATERNAL DEATHS 400 mcg Folic Acid)
⮚ Maternal Mortality: 10-11 mothers die each 4) Daily calcium supplementation (1.5-2 g)
day d/t pregnancy and delivery complication ✔ Prevents eclampsia
⮚ MATERNAL DEATH: 5) NO SMOKING and NO DRINKING
✔ Death of a woman while pregnant or ALCOHOL
within 42 days of termination of
pregnancy

TETANUS TOXOID IMMUNIZATION

DIRECT MATERNAL DEATHS (HOUSE) ⮚ Both mother & child are protected against
a) Hemorrhage tetanus & neonatal tetanus
 ⮚ A series of 2 doses of TT vaccination must be ⮚ To protect mother and her baby against
received by a women 1month before delivery Clostridium-borne infection; injected TWICE
to protect baby from neonatal tetanus during pregnancy
⮚ And the 3 booster dose shots to complete the ⮚ Dose: 0.5 mL
5 doses following the recommended schedule ⮚ Route: IM
provide full protection for both mother & ⮚ Site: (R) & (L) Deltoid/Buttocks
child. ⮚ 1st Pregnancy (G1) – give TT1 and TT2 (CBQ)
⮚ The mother is then called a “FULY ⮚ 2nd Pregnancy (G2) – give TT3 (1st booster dose)
IMMUNIZED MOTHER” (FIM) ⮚ 3rd Pregnancy (G3) – give TT4 (2nd booster dose)
⮚ There are many kinds of vaccines used to ⮚ 4th Pregnancy (G4) 0 give TT5 (3rd booster dose)
protect against tetanus, all of which are
combined with vaccines for other diseases: TAKE NOTE:
DT, DTaP, TD, Tdap 1) If a pregnant mother received TT injection, she
is protected from tetanus infection through
VACCINE MAXIMUM PERCENT DURATION ARTIFICIAL ACTIVE IMMUNITY
AGE PROTECTED PROTECTED 2) 2 TT doses (TT2) protects for 1-3 years
INTERVAL although some studies indicate even longer
protection
TT1 (0.5 As early as None None 3) TT is SAFE during pregnancy
mL IM) possible 4) If a pregnant mother has received 2 doses of
during TT. The baby is protected from tetanus
pregnancy neonatorum through NATURAL PASSIVE
IMMUNITY
During 6 5) TT3 is administered 6 months after TT2
months of 6) The nurse understands that the client can be
pregnancy considered fully immunized against tetanus if
she received how many booster doses of TT?
TT2 At least 4 80% Gives 1-3 ANSWER: THREE
weeks after years 7) Which of the following dose of TT is given to
TT1 protection the mother to protect her infant from neonatal
tetanus and likewise provide 10 years
protection for the mother? ANSWER: TT4
TT3 At least 6 95% Gives at least
8) Of the mother receives TT4 vaccine: this will
months after 5 years
give her protection that lasts up to 10 years
TT2 protection
9) A pregnant woman had just receive 4th dose of
TT, subsequently her baby will have protection
TT4 At least 1 99% Gives at least against tetanus for how long? ANSWER: 1 year
year after 10 years
TT3 or protection INTRAPARTAL CARE:
during ⮚ Deliver at the Health Facility
subsequent ⮚ FOLLOW UNANG YAKAP PROTOCOL
pregnancy 1) Dry thoroughly (first 30 seconds)
2) Skin to skin contact (after 30 minutes)
3) Properly timed cord clamping (within
1-3 minutes)
TT5 At least 1 99% Gives lifetime 4) Early Breastfeeding and Rooming In
year after protection (within 90 minutes)
TT4 or during
subsequent
pregnancy

TETANUS TOXOID
IMMINENT HOME DELIVERY
 ⮚ In case of imminent delivery at home, birth ⮚ A strategy to encourage food manufacturers
attendants must be aware of the CLEAN to fortify processed foods or food products
principles of HOME DELIVERY with essential nutrients at levels approved by
⮚ 5 CLEANS: DOH and use its seal
1) CLEAN hands of attendant ⮚ The seal is a guide used by consumers in
2) CLEAN surface selecting nutrition’s foods
3) CLEAN cord
4) CLEAN cord tie without dressing MANDATORY FOOD FORTIFICATION
5) CLEAN and dry wrapping of baby 1) RICE – with Iron
2) WHEAT FLOUR – with vitamin A and Iron
POSTPARTUM CARE 3) REFINED SUGAR – with vitamin A
⮚ Delay facility discharge for at least 24 hours 4) COOKING OIL – with vitamin A
⮚ Visit women and babies with home births 5) Other staple foods:
WITHIN THE FIRST 24 hours a) STAR Margarine (1992)
⮚ FIRST 24 hours assess for vaginal bleeding, ✔ FIRST ever product to partner
uterine contractions, vital signs and voiding with DOH and the FIRST to
within 6 hours reserve the Sangkap Pinoy Seal

POSTPARTUM VISIT GOVERNMENT SUPPORT PROGRAMS

⮚ Provide every mother and baby a total of 4 1) Sustansya Para Sa Masa
POSTPARTAL VISITS on: 2) Pan De Bida (Pandesal with Vitamin A)
a) 1st visit: 1st day (within first 24 hours) 3) NUTRI BAN
b) 2nd visit: Day 3 (48-72 hours) 4) SALT FORTIFICATION
c) 3rd visit: Between 7-14 days a) RA 8172 (Act for Salt Iodization
d) 4th visit: 6 weeks Nationwide –ASIN LAW)
⮚ For a woman who delivered at the health b) Use salt with “FIDEL” seal
facility: (Fortification for Iodine Deficiency
a) 1st visit: within FIRST week preferably Elimination)
2-3 days after delivery
b) 2,d visit: end of puerperium or 4-6 IODINE
weeks after delivery ⮚ For proper functioning of thyroid, growth and
development of the brain
MICRONUTRIENT DEFICIENCY (IVI) ⮚ Iodine deficiency is a leading cause of
a) IRON = causing ANEMIA preventable brain damage and reduced IQ
b) VITAMIN A = causing NIGHT BLINDNESS among children worldwide
c) IODINE = causing CRETINISM ⮚ Iodine Deficiency Disorder (IDD) during
pregnancy may result in stillbirth,
NUTRITION miscarriage, and congenital abnormalities
⮚ Nutrition LAW: PD 491 such as cretinism
⮚ Nutrition month: JULY ⮚ For iodine supplementation give iodized oil
⮚ MOST VULNERABLE TO MALNUTRITION: capsule with 200 mg iodine, 1 cap for 1 year
a) Children
b) Lactating mothers GOITER
c) Infants ⮚ Common in mountainous or inlands or
d) Pregnant uplands areas where iodine content in the
⮚ RA 8976 – Philippine Food Fortification Act of soil, water and food are different
2000 ⮚ Endemic goiter is more common among girls
⮚ FOOD FORTIFICATION: than boys and among women than men.
✔ Addition of Sangkap Pinoy or ⮚ Effect of iodine deficiency to fetus may be
Micronutrient such as Vitamin A, Iron born mentally and physically retarded
and Iodine to food.

SANGKAP PINOY SEAL PROGRAM (SPSP) OBESITY

 ⮚ A risk factor for many chronic diseases d)
Easy fatigability
including heart disease, cancer, hypertension e)
Nail brittleness (koilonychia)
and DM. f)
Enlargement of spleen
⮚ ABC for healthy nutrition: g)
SOB
1) Aim for fitness h)
Sore/cramps of muscles (restless legs
2) Build a healthy base syndrome)
3) Choose sensibly ⮚ PREVENTION & MANAGEMENT:
a) Liver products
3 SOMATOTYPES OR BODY TYPES b) Lean & Red meats
1) ECTOMORPH = Skinny; Difficulty in gaining c) Legumes
weight d) Leafy green vegetables
✔ Narrow hips and clavicles 1. Camote (Sweet Potatoes)
✔ Small joints (wrist/ankles) 2. Kangkong
✔ Thin build 3. Malunggay
✔ Stringy muscle bellies ⮚ TREATMENT of IDA: FeSO4
✔ Long limbs a) Mainstay treatment
2) MESOMORPH = Naturally muscular; easy b) Continued for about 2 months after
gain and loses weight correction of the anemia
✔ Wide clavicles c) Ferrous sulfate is the most common
✔ Narrow waist and CHEAPEST form of iron utilized
✔ Thinner joints ⮚ MOST COMMON SIDE EFFECTS OF IRON
✔ Long and round muscle bellies a) Constipation
3) ENDOMORPH = Round; Difficulty in losing b) Unpleasant taste
weight; slower metabolism c) Nausea & Vomiting
✔ Blocky d) Tarry stool (Dark discolored stool)
✔ Thick rib cage ✔ NORMAL side effect
✔ Wide/thicker joints
✔ Hips as wide (or wider) than clavicles VITAMIN A DEFICIENCY (VAD)
✔ Shorter limbs ⮚ VAD Causes:
✔ High body fat (Central Obesity) a) Inadequate nutritional intake of
✔ Pear-shaped Vitamin A rich foods
✔ High tendency to store body fat b) Lack of fats/oils in diet
c) Rapid utilization of Vitamin A during
IRON DEFICIENCY ANEMIA (IDA) course of illness
⮚ Normal Hgb Level: d) Liver disorders = 80-90% of Vitamin
a) MALES: 14-18 g/dL A is stored in liver
b) FEMALES: 12-16 g/dL e) Long term drinking alcohol lowers
⮚ According WHO, anemia is defined as: Vitamin A levels in the liver
a) Hgb levels <12 g/dL in women ⮚ VULNERABLE GROUPS
b) Hgb levels <13 g/dL in men a) Infants
⮚ In children above 2 years old b) Preschoolers
⮚ Anemia is worsened by hookworm and c) Pregnant
whipworm ⮚ VAD S/Sx:
⮚ Give Mebendazole + Iron supplement a) NIGHT BLINDNESS (EARLIST SIGN)
⮚ RISK INDIVIDUALS: WOMEN ✔ Impaired dark adaptation d/t
a) Women at childbearing age lack of rhodopsin
b) Old age/elderly (NYCTALOPIA)
c) Menstrual and GI bleeding (heavy) b) XEROPHTHALMIA
d) Enteric parasitism (hookworm, ascaris ✔ Dry, thickened conjunctiva and
& trichuris) cornea
e) Not enough iron intake c) BITOT’S SPOTS
⮚ CLINICAL MANIFESTATIONS: PALENESS ✔ Foamy soapsuds-like spots on
a) Pallor white part of the eye
b) Anorexia
c) Lightheadedness d) KERATOMALACIA
 ✔ Corneal erosions and ⮚ TYPES INCLUDE:
ulcerations a) KWASHIORKOR
e) BLINDNESS (END STAGE) ✔ PROTEIN malnutrition
✔ Irreversible eye blindness predominant
b) MARASMUS
VITAMIN A SUPPLEMENTATION ✔ CALORIE deficiency intake
⮚ Provides PROTECTION UP TO 6 MONTHS c) MARASMIC KWASHIORKOR
✔ Marked protein deficiency and
SCHEDULE INFANTS PRESCHOOLERS marked calorie insufficiency
(6-11 months) (12-59 months) signs present, sometimes
TODAY 100,000 IU 200,000 IU referred to as the MOST
(Blue capsule) (Red capsule) SEVERE FORM OF
AFTER 6 100,000 IU 200,000 IU MALNUTRITION
MONTHS (Blue capsule) (Red capsule)
Given 100,000 IU 200,000 IU NUTRITIONAL INDICATORS
immediately (Blue capsule) (Red capsule) 1) Arm Circumference (MUAC) – GOLD Standard
upon 2) Low Height for Age (STUNTING)
diagnosis 3) Low Weight for Age (Underweight)
4) Low Weight for Height (Wasting)
(GIVE ONE ❒ TAKE NOTE: classical indicator used by
CAPSULE) experts to diagnose MARASMUS:
Given the next 100,000 IU 200,000 IU a) Weight for Height (WFH) Z score of
day (Blue capsule) (Red capsule) less than -3
Given after 2 100,000 IU 200,000 IU ✔ BEST INDICATOR OF
weeks (Blue capsule) (Red capsule) MORTALITY

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

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

>135 mm GREEN WELL-NOURISHED CHILD

(>13.5 cm) COLOUR

PROTEIN ENERGY MALNUTRITION (PEM) SERUM ALBUMIN

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

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

⮚ TAKE NOTE: KWASHIORKOR may also have: