Chn

 

COMMUNITY HEALTH NURSING

Community ö a group of people with common characteristics or inherent living together within a territory or geographical boundary. ö place where people are found. COMMUNITY AS THE CLIENT/PATIENT IN CHN ö client- well; patient- sick World views on Community: 1. Fam Family ily,, c comm ommuni unity, ty, and soc societ iety y Levels of Contradictions: Individual  Intrapersonal Family  Intrafamili Intrafamilial/ al/ Interpersonal Community- Intracommunity/ Interfamili Interfamilial al Society  strong regional, parochial, Intrasocietal/ Intercommunity 2. Contraindications/ Contraindications/ conflicts 3. Change COMMUNITY AS SETTING IN CHN PRACTICE - place where people under usual or normal conditions are found (ex. Schools) - outside of purely curative institutions (hosp is not a part of population) HEALTH1. illn illnes ess sc con onti tinu nuum um mo mode dell ö degree of client wellness ranging from optimum wellness to death ö dynamic state, matters as a person adopts to changes in internal & external envi Coital debut- sex before age 20- increase cervical CA 2.

high lev level el wellness wellness modelmodel- mai maintain ntain a continuu continuum m balance balance & purposeful purposeful dir directi ection on with envi envi ö progress to a higher level of fxn to live to the fullest potential 1978- UNICEF & WHO- Alma Ata, R Russia ussia ö Global health situation ö Strategy/ approach: PHC ö Goal: HEALTH FOR ALL BY 2000 (old) 1994- Riga ö HEALTH FOR ALL BY 2000 AND BEYOND! 1979  Alma Ata declaration ö

PHC as the thrust of DOH VISION of DOH ö HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE PEOPLE BY 2020 MISSION of DOH ö In partnership with the people, provide equity & access & quality health services especially to the marginalized segment of the population

VISION & GOAL- same with DOH, PHC program 3.

Agent Agent-host -host environmen environmentt m modelodel- (EPIDEM (EPIDEMIOLO IOLOGIC) GIC) ö interplay of agent (causative etiologic factor)

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1. Hea Healt lth h belie belieff mode modell – –pre preven venti tive ve ö relationship bet. a person’s belief & his behavior in health ex. HIV infectn (commercial (commercial sex farers, sea worker workers, s, medical team Susceptibility, possible MOT (mode of transmission)--- unprotected sex- occupational hazard Susceptibility, Prevention: A bstinence   B e faithful C orrect, consistent, continuous use of condom D o not penetrate (SOP) HIV infected age groups Males age 40-49 Seafarers ratio: get 1: 5pregnant, comm  Anal sex- won’t common on in rural   Females 20-29 Vaginal: 1: 1000  Anal: 1: 200

2. Evol Evolution utionary ary based modelmodel- illn illness ess & death serve serve an evoluti evolutionary onary fxnfxn- survival survival of the fittest fittest 3. Healt Health h promotion promotion m modelodel- di direct rected ed at inc increase rease cl clients ients w well-b ell-being eing 4. WHO de defi fini niti tion on Health- a state of complete physical, mental, & social well-being and not merely an absence of a dse, illness or infirmity WHO: health is a social phenomenon phenomenon ö it is a result of interplay of diff societal factors: -biological - Physical- heat, temp - Ecological- adaptation to envi - Political - Economic - Social cultural ö it is an outcome of many theories Descartes – dualism Multi Casual theory- holistic- General systems theory Community health ö Part of paramedical & medical intervention/ approach concerned on the number of the whole population  AGENT (Etiologic)- virus, bacteria 1. bio infection infectionss- fungi fungi,, p proto rotozoa, zoa, helminthe helminthes, s, ectoparasites 2. che chemi mical cal-- carcinog carcinogens ens,, poiso poisons, ns, allerg allergens ens ex. GMO’s – carcinogen MSG- poison 3. me mech ch-- car car acc accid iden ents ts,, etc etc 4. env envir ironm onment ental/ al/phys physica icall- heatst heatstrok roke e 5. nut nutrit ritive ive-- e exce xcess ss or def defici icienc ency y 6. psyc psycho hollogic ogical al

HOST Intrinsic factors and environmental factors 1. Incre ncreas asiing age age 2. sex (m or f)   F- weak emotional; morbidity: common diseases   M- mortality ( killer dses) 3. behavior4. edu educat cation ional al at attai tainme nmentnt- o occu ccupat pation ion 5. pri prior or imm immuno unolog logicic- res respon ponse se Extrinsic factors 1. nat natura urall bou bounda ndarie riess- physic physical al environmental, geography 2. bi biol olog ogiical e env nvii 3. soc socioe ioecon conomi omic c envienvi- politic political al bounda boundary ry 2

 

 Aims: 1. Promotion of health 2. Prev Preven enti tion on of il illn lnes ess s 3. Mgt of factor factors s affe affecti cting ng heal health th INDIVIDUAL:  Anatomy Physio Patho

APPLIED STUDY: Structure Function Malfunction

Community: Demography- study o off population Sociology Epidemiology- study of dses

COMMUNITY HEALTH / PUBLIC HEALTH WINSLOW ö sci and art of preventing dse, prolonging life, promoting health & efficiency through organized community effort ö To enable each citizen to realize his birth right of health and longevity. ö Major concepts: i. Heal Health th pro prom motio otion n ii. Peopl People’s e’s participat participation ion towar towards ds se self-r lf-relian eliance ce HANLON ö most effective total dev & life of the indiv & his society PURDOM ö applies holism in early years of life, young, adults, mid year & later  ö prioritzes the survival of human being Nursing- assisting sick individual to become healthy and healthy individual achieve optimum wellness Early years- fetus- 12 years/ younger adults- 12-24 years Orem- self care, autonomy, independent patient Theoretical bases of CHN practice Theories and principles: 1. Nursing 2. PH Community health nsg—by Maglaya ö the utilization of the nsg process in the diff levels of clientele- indiv, families, pop grps, and comm. concerned with i. prom promot otio ion no off he heal alth th ii ii.. prev preven enti tion on of dses dses ii iii. i. di disa sabi bili lity ty and and rreh ehab ab Goal:: to raise the level of health of the Goal the citizenry by helping comm. & families families to cope with the disc discontinuities ontinuities in & threats to health in such a way as to maximize their potential for high-level wellness. WHO CHN ö

Special field of nursing that combines the skills of nsg, PH, and some phases of social assistance & functions as part of the total PH program for the: 1. prom promot otio ion n of heal health th 2. impr improveme ovement nt of tthe he conditi conditions ons in the the social social and and physi physical cal envi envi 3. reh rehab ab of of illne illness ss a asnd snd disabi disabilit lity y

ö

CHN is learned practice discipline with the ultimate goal of contributing, as individual and in collaboration with others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care.

ö

CHN is service rendered by a professional nurse with the comm., grps, fam, and indiv at home, in H ctrs, in clinics, in school, in places of work for the ff: 1. prom promo o of of h hea eallth 2. prev preven enti tion on of il illn lnes ess s

Jacobson

Freeman

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3. car care e of the sick sick at home home an and d re rehab hab Philosophy ö ö

Dr. Margaret Shetland philo of CHN is based on the the WORTH AND DIGNITY of man

Basic concepts of CHN 1. prim primary ary ffocus/ ocus/ emphasisemphasis- healt health h promo promo 7 dses dses preventi prevention on primary goal- self reliance in health or enhanced capabilities ultimate goal- raise level of # of citizenry Philo of CHN- Worth and dignity of man 2.

CHN pr practic actices es -to benefi benefitt ( indiv, indiv, ffam, am, sp special ecial pop, comm. comm.)) - CHN is integrated and comprehensive 3. CHN are generalis generaliststs- m matter atter of c comm. omm. health health work work 4. all all ttyp ypes es and and lev level els so off HC HC

Levels of HC: PHC- comm. SHC- regional, provincial, district, municipal, and local hosp (complicated sx) THC- sophisticated med ctr—heart ctr, QI, KI 5. Natu Nature re of CHN practi practice ce re require quires s knowledge knowledge on bi biologi ological, cal, social sciences sciences 6. Impl Implicit icit in C CHN HN is the the nsg nsg p pract ractice ice (ADPIE) (ADPIE) Basic principles of CHN: (adopted fr Gardner, Cobb & Jones) 1. The comm comm.. is the pati patient ent in CHN, CHN, the fami family ly is the unit unit of care and th the e 4 levels of clientel clientele e are: a. indiv b. pop grp ( th those ose who share share com common mon cha char, r, dev st stages ages and commo common n exposu exposure re to th the e problems ex. Children, elderly) c. family d. comm. 2. In CHN CHN,, the client iis s considered as an A ACTIVE CTIVE partner NO NOT T PASSIVE PASSIVE rrecipient ecipient of care-participatory approach Client- active participant, full involvement recipient care 3. CHN pr practice actice is affected by devts in Health technology, iin n particular particular,, changes in society, in general. general. 4. The goal of CHN is achi achieved eved thr through ough mult multisect isectoral oral effortsefforts- coo coordina rdinated ted with other other sectors. sectors. 5. CHN is a par partt of health care care system system and the lar larger ger huma human n services services syste system.m.- Nsg practi practice, ce, human human servi service ce Nsg fxn 1. Ind Indepe epende ndentnt- w with ithout out supe supervi rvisio sion n of MD 2. Coll Collabora aborativetive- in coll collabora aboration tion wit with h other H team ( inter interdisci disciplin plinary, ary, intrasect intrasectoral oral)) Basic Concepts of CHN (fr DOH bk) 1. Prim Primary ary focus focus is on hea health lth promotx promotx.. The com comm. m. H nurse nurse by the nature nature of her work ha has s the opportun opportunity ity & responsibility for eval the health status of people & groups & relating them to practice. 2. CHN pr practic actice e is extended extended to benef benefit it not onl only y the indi indiv v but the whole whole family family and community community.. 3. Community health nurses are generali generalists sts in terms of their practice practice through life’s continuumcontinuum- its full range range of health problems and needs. 4. Contact wit with h the client client and/or family family may c continue ontinue over a long period of time which which includes all ages and and all types of health care. 5. the nature of CHN practice requires requires that current know knowledge ledge derived fr the biological and social sciences, ecology, clinical nsg, and community health organizations be utilized. 6. The dynam dynamic ic proces process s of assessi assessing, ng, plann planning, ing, imp impleme lementing nting and in interve tervening, ning, pro provide vide periodic periodic measurements of progress, eval, and a continuum of the cycle until the termination of nsg is implicit in the practice of CHN. Summary: 1.

Prim Primary ary focus/ focus/ empha emphasis sis – health health promotion promotion & dse preve preventx ntx Primary goal: self reliance in health or enhanced capabilities of people Ultimate goal: raised the level of healthe of o f citizenry Philosophy of CHN- worth and dignity of man 4

 

2. CHN P Pract racticeice- to benefit benefit indiv, indiv, fam, fam, spe special cial pop, c comm. omm. 3. CHN are generalis generaliststs- integrate integrated d an and d co compreh mprehensiv ensive e 4. Al Alll ttyp ypes es and and lev level els so off HC HC ö Primary HC- mgt at the level of comm. ö Secondary HC- managed H problems regional, provincial, district, municipal & local hosps (for  complicated pregnancies) ö Tertiary HC- sophisticated medical centers, NCMH, Lung Ctr. Heart Ctr, 5. Natu Nature re of CH CHN N practice practice req requires uires k knowle nowledge dge on biol biological ogical,, social social sciences. sciences. 6. Impl Implicit icit in in CHN is the the nsg pr process ocess w w/c /c is an in indepen dependent dent nsg a actio ction n ADPIE ADPIE Key principles in CHN (page 19) 1.

Recog Recognized nized ne needs eds of indi indiv v famil families ies and common common provider provider is the the basis for C CHN HN practice practice CHN process  Assessment- data collectx collectx (fam, c comm.) omm.) Data analysis- H problems Community dx with people (people’s participation)  Active and full involvement of people people in decision making. making. 2. Know Knowledge ledge and understa understanding nding of agen agency cy object objectives ives & polic policies ies facilita facilitates tes goal achieveme achievement nt Planning: 1. pr prio iori riti tiza zati tion on 2. goa goal se setting 3. obj objectives 4. actions 5. evalu evaluation ation// outcom outcome e in indicat dicators ors –cri –criteria teria// s standar tandard d ö measure outcome ö Criteria/ obj 3. Fa Fami mily ly is un unit it of se serv rvic ice e 4. Res Respec pectt val values, ues, c cust ustoms oms an and d beliefs beliefs of cl clien ients ts Implementation ö pt/ ct- comm. ö Focus of care: indiv, families, sp grps, g rps, comm.. ö  Attitude: non-judgmental non-judgmental 5. Healt Health h educ educ a and nd counsel counselinging- vital parts of CHN CHN Health educator- counselor—have the same goal: behavioral change Difference bet: Health educator – gives advice Counselor- gives options (never gives direct advice) 6. Coll Collabora aborative tive w worki orking ng rel with with health health team ffacil acilities ities g goal oal achievem achievement ent ö nurse coordinator of health services 7. Peri Periodic odic and c contai ontaining ning evaluation evaluation is necess necessary ary 8. Con Contin tinuin uing g staf stafff educeduc- upgrad upgrade e msg pract practice ice 9. Inde Indege geno nous us an and de exi xist stin ing g  Appropriate technologytechnology- methods & te tech ch that are: 1. scient scientif ifica icall lly y soundsound- exper experime imenta ntatio tion n 2. so soci cial ally ly ac acce cept ptab able le 10. Indiv, famil families, ies, & comm. must must actively participate participate in decision decision making 11. supervision of nsg service by qualifi qualified ed personnel 12. accurate recording/ rreporting eporting serve as eval & guide for future future actions

Who supervises the nurse in 1. CH N Nsg sg prac practic ticee- R RN N super supervis vision ion 2. Pro Projec ject/ t/ progr program am imple implemen mentat tation ion – –MD MD 3. Mg Mgt, t, & adm admin in con conce cern rnss- May Mayor  or  a. MD b. RN super upervi viso sor  r  c. Major   d. All of them

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Roles of the PHN  Clinician who is a health care provider, taking care of the sick people at home or in the RHU.  Health educator, who aims towards health promo & illness preventx through dissemination of correct info; educating people  Facilitator, who establishes multi-sectoral linkages by referral system  Supervisor, who monitors & supervises the performance of midwives 

In the event that the Municipal Health Officer (MHO) is unable to perform his duties/fxns or is not available, the PHN will take charge of the MHO’s responsibilities

Roles of the PHN II and III Qualifications: BSN + RN in the Phil Qualifications: 1. Plan Planner/ ner/ prog programm rammerer- ident identifies ifies ne needs, eds, pri prioriti orities es & problem problems s if indiv, fams, fams, & comm. ö formulates nsg component of H plans ö In doctorless areas, she is responsible for the formulation of the municipal health plan ö Provides technical assistance to rural health midwives in health matters like target setting. 2. Provi Provider der of Nsg car caree- provi provides des dire direct ct nsg care to the the sick, di disable sabled d in the homes homes,, clini clinics, cs, schools, schools, or  places of work ö provide continuity of patient care 3. Manag Manager/ er/ supervisor supervisor-- for formulat mulates es car care e pla plan n for the: 4 Clientele: a. Requisitions, allocates, distributes materials materials (meds & medical supplies & records & reports equips

4. 5. 6.

7.

b. Interprets regular and implements programs, c. Conducts supervisory visits & policies, meetingsmemoranda, to diff RHMs&&circulars gives feedbacks on accomplishments Comm organizer- motivates & enhance community community participation in terms of planning, org, implementing implementing and evaluating H programs/ services. Coordinator of Health Services- coord with with other health team & other gov’t org (GOs & NGOs) to other  health programs as envi sanitation health educ, dental health & mental health. Trainer/ H Health ealth educator/ counselor- conducts traini training ng for RHMs, BHWs, BHWs, hilots hilots who aim towards towards H promo & illness prevention through dissemination of correct info; ö educating people Resea Researcher rcher-- coord coordinate inates s with govt govt & NGO NGOs s in the impleme implementati ntation on of studies/ studies/ rresear esearches ches ö Participates in the conduct of surveys studies & researches on Nsg and H related subjs.

Responsibilities of CHN 1. Be a part in deli delivering vering an overall h health ealth pl plan; an; its iimplementatio mplementation n & eval eval for comm. comm. 2. Prov Provide ide q quali uality ty nsg nsg services services to 4 llevels evels of cl client ientele ele 3. Maintain c coordinati oordination/ on/ lin linkages kages of nsg service with ot other her health team members NGO/GO in the provision of PH services- multisectoral app 4. Conduct research relevant relevant to to CHN services to improve provision of health health service- research—to improve HC 5. Provide opportu opportunities nities for pr professional ofessional growth and co continuing ntinuing educ for for staff devt. Sources of CHN CHN standards: BON & P PNA NA Multisectoral approach: ö other sectors ö intersectoral linkages ö own sector  ö intrasectoral linkages ö comm. based referral network The CHN Process 1. Assessment –collection of data ( subjective: expressed by b y client or SO; objective: measurable- interview and observations,sensed, intrn) - analysis of data 6

 

7. 8. 9. 10.

Nsg Dx Planning Im Impl plem emen enta tati tion on Evaluation- measurable outcome or ob objective jective

4 tools/ instruments for data collection: 1. Nu Nurs rsin ing g his histo tory ry – s sub ubjj 2. PE- Obj 3. Lab- Obj 4. Pro Proces cess s rec record ording ing-- obj ((ana analyz lyzed ed by R RN) N) DataGroup analysis data- cues- health problem Nsg Dx- health problem r/t etiology ( somethind that we can intervene) Planning-goal Implementation Evaluation DEVELOPMENTAL MODEL by Evelyn Duvalll Stages of Family Dev’t. Stage 1- Beginning family - marital & sexual adjustment, fxnal, communication, adjustment to roles, pre-natal educ. Stage 2- Early childbearing - changing roles, parenting Stage 3- Families with preschool children - discipline, childbearing, accidents, poisoning, CD Stage 4- Families with school age children - balancing time and energy to meet demands of work, children’s needs & activities, adults social interests, harmony in marital & in-laws relations. Stage 5- Families with teenagers - open comm.., continuing intimacy in marital relation, peer pressure, sex educ. Stage 6- Launching ctr  - releasing children as adults, reestablishing marital dyad, identifying post parental interest, grandchildren, divorce/ separatx, menopause Stage 7- Middle Aged Families - rebuilding marriage & maintaining satisfying rel with aging parents children with their families, retirement plans, health, new career. Stage 8 – Aging ( retirement & old age) - continuous maintenance of fam rel, income changes & living arrangements physiologic aspects of  aging, death of spouse. 8 Family tasks or Basic Tasks: physical maintenance • • allocation of resources- income given to wife division of labor – joint parenting • • socialization of family members • reproduction, recruitment & release • maintenance of order- high crime rate • placement of members in larger society- indication family’s success • maintenance of motivation and morale Structural fxnal Model ( Ruth Freeman) Initial data base Family structure and characteristics nuclear- basic family extended- in-law relations, or grandparents relations ö ö

members of household in relation to head demographic data (sex- male or female, age, civil status) live-in- married/ common law wife male- patriarchal female- matriarchal 7

 

ö ö ö

type & structure of family dominant members in health general family relationship

 Assessment: Family Family ö initial data base ö 1st level assessment ö 2nd level assessment Socio- economic & cultural factors ö

resources & expenses educ attainment ö ethnic background ö religious affiliations ö SO ( do not live with the family but influences decisions) ö Influences to larger comm. Environmental factors ö housing- # of rooms for sleeping ö kind of neighborhood ö social & health facilities available ö comm. & transportatx facilities Health assessment of a member- PE Value placed on prevention of dse ö immunization ö compliance behavior  ö

First Level Assessment 1. Healt Health h Threat- conditi conditions ons conducive conducive to dse, acc accident idents s or failure to realize realize one’s one’s health potenti potential al ö healthy people ö ex. Family hx of illness- hereditary like DM, HPN  nutritional problems- eating salty foods  personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking  inherent personality char- short temperedness, short attn span  short cross infectx  poor home envi  lack/inadequate immunization  hazards- fire, falls, or accidents  family size beyond what resources can provide 2.

Healt Health h DeficitsDeficits- inst instances ances of failure failure in healt health h maintenance maintenance ( dse, disa disabili bility, ty, dev’tl dev’tl lag) ö

3.

-ex. Dse/ illness- URTI, marasmus, scabies, edema  disabilities- blindness, polio, colorblindness, deafness  dev’tl problems like mental retardatx, gigantism, hormonal, dwarfism

Stre Stress ss points/ points/ Foreseeabl Foreseeable ec crisi risis s Situa Situations tions ö anticipated periods of unusual demand on indiv or fam in terms of adjustment or family resources ( nature situatxs) ö ex. Entrance in sc school hool  adolescents (circumcision, menarchs, pubarche  courtship (falling in love, breaking up)  marriage, pregnancy, abortion, puerperium  death  unemployment, transfer or relocation  graduation, board exam

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Second Level Assessment ö Recognition of the problem  decision on appropriate health action  care to affected family member   provision of healthy home environment  utilization of comm. resources for health care

Family Health Nursing Diagnosis ö combination of health problems and health

ö

Ex. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit problem prioritization

Nature of the problem Health deficit Health threat Foreseeable crisis

=3 =2 =1

A. 2 x 1= 0.61 3 B. 3 x 1 = 1 3

wt.= 1 pt.

Preventive potential (ability) High Moderate Low

=3 =2 =1

A. 3 x 1 = 1 3 B. 3 x 1 = 1 3

wt. = 1 pt.

Modifiability Easily modifiable Partially modifiable Not modifiable

=2 =1 =0

A. 1 x 2 = 1 2 B. 2 x 2 = 2 2

wt. = 2 pts.

Salience High (serious- immediate action) Moderate (serious not immediate) Low (not felt)

=2 =1 =0

A. 0 x 1 = 0 2 B. 1 x 1 = 0.5 2

Ex. A. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit. B. Inability to provide care to a pregnant member with anemia as a health deficit r/t knowledge deficit. Score= add all ( the higher the score, the higher the problem) Formula: _________given score_______ x weight Increase possible score Who to visit last?  Health D A – adolescent with psychological problems Health D B – DM Health D C – pregnant Health D D – typhoid (RN shd practice aseptic technique) Clue: identify nature of problem first Top Priority Health case A unemployment HD B anemia in pregnancy HD C scabies HT D poor home environment Population groups- composed of indivs Vulnerable grps: or “High Risk Groups” (before) ö infants & young children – dependent to caretakers 9

 

ö ö ö ö ö

schoolage- most neglected adolescents – identify crisis, HIV mothers – 1/3 of pop health problem (pregnancy, delivery, puerperium) males – too macho to consult old people – degenerative dse.

Specialized fields: 1.

Comm Community unity Mental Mental Hea Health lth Nsg- a unique unique process wh which ich incl includes udes an integrati integration on of concepts concepts fr nsg, mental mental health, social psychology, psychology, community networks and the basic sciences. Focus: mental H promotion- no need to identify dse, increase mental wellness of people

Psychiatric Nsg- focus: mental dse preventx Focus: mental dse preventx- indentify dse & shorten dse process 1. Occup Occupatio ational nal H Nsg- applica application tion of Nsg Nsg princi principles ples & proc procedures edures iin n conserving conserving H of workers workers in all occupations.  Aims: Health Health promotion & prevention prevention of dses & injuries From industrial to service 2.

Schoo Schooll Healt Health h Nsg- the ap applica plication tion of ns nsg g theories theories & princ principles iples in th the e care of the school school pop Components: School H services- maintain school clinic, screening all children- visual, hearing, scoliosis Health instruction- health educ/ counselor direct & undirect Healthful school living- health monitor  ö mental health- substance abuse, sexual H ö environmental health- food sanitation, water supply, safe environment, safe toilet ö school comm. linkage- comm. organizer   ASSESSMENT OF COMMUNITY  ASSESSMENT COMMUNITY HEALTH HEALTH NEED NEEDS S Community Dx- descriptive research ö profile general picture of comm. ö process by which the people in the conn & H team assess the comm. H problems & needs as bases for H programs devt. ö  A learning process process for the comm. to identify their their own H problems problems & needs ö  A profile that that deposits the H problems & potentials potentials of the comm. comm. 2 types of community dx 1. Comprehensive- provides the general health profile of the comm. 2. Specific or problem oriented- yields a comprehensive profile of a particular H problem. Steps: Preparatory phase 1. Site selection- location of 1st criteria poor community- bec. Vulnerable to dse- H problem free from other agency 2. Pr Prepa eparat ratio ion n if if the the commun community ity 3. Statement of obj- dependent of comm. dx 4. Iden Identify tify meth methods ods & inst instrume ruments nts ffor or d data ata collect collection ion  A. Method of survey- quest questionnaire ionnaire - census (100%) most ideal, enumeratx of data conducted 6 mos. - Sample survey- most practical study representative representative of a comm. Size matters in terms of validity B. Inte Interv rvie iew w meth method od instrument- interview guide/ schedule - Reco C. Re cord rds s rrev evie iew w - instrument: checklist D. Ocu Ocular lar insp inspect ection ion// obse observa rvati tion on 10

 

instrument: checklist E. Partic Participa ipant nt obs observ ervati ation on 5. Fin Finali alize ze sam sampl plin ing g de desig sign n & metho methods ds  A. Probability- equal chances- random- ( simple, str stratified, atified, clust cluster) er) B. Non- pr probabi obability lity-- everyone everyone wil willl not have have equal c chances hances// not equal equal 6. Ma Make ke a ti time meta tabl ble e

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Implementation 1. Da Data ta Phase coll collec ecti tion on 2. Dat Data a orga organiz nizati ation/ on/ col collat latio ion n 3. Data Pres Presentat entation ion (narrative (narrative,, tu tubular bular,, graphic graphical) al) 4. Data ata Anal nalys ysiis 5. Ide Identi ntific ficati ation on of of he healt alth h probl problems ems 6. Pr Prior ioriti itizat zatio ion n of he healt alth h probl problems ems 7. De Deve velo lopm pmen entt of a hea healt lth h plan plan 8. Vali Validati dation on and and feedbac feedbackk- p presen resentati tation on of results results Evaluation Phase 1. Pr Proc oces ess s eval evalua uati tion on 2. Pr Prod oduc uctt ev eval alua uati tion on Statistics- (science) collection, organization, analysis, interpretation of numerical data. Biostatistics- refers refers to the application of statistical method to the life science like biology, medicine.  A. Demography- study of pop size, composition composition & spatial di distribution stribution as af affected fected by births, deaths and migration. Phenomenon of variation ö tendency of a measurable character to change from 1 indiv or 1 setting to another or from 1 instant of time to another within the same indiv or setting Types of data: 1. Const Constantant- value value remains remains the same from from person person to person person,, time to ti time, me, place place to place Ex. Minutes/ hour, speed 2. Vari Variab able le-- ex. T Tem empe pera ratu ture re Qualitative- categories are simply used to label to distinguish & group to another, rather than a basis for  saying that 1 group is greater, higher than the other. Ex. Sex, Religion, Color  Quantitative- numerical ö can be measured e. temp ö discrete- whole number or integral values ö continuous- fractions, decimals, can attain any decimal Sources of Demographic Data: 1. Survey a. Census Types: De Jure- data fr place of origin De Facto0 registration where it happened Ex. If death happened at PGH, report in Manila regardless of place of  residency—report to that place b. Sampl ample e su surv rvey ey 2. Continuing Population Registers- used computers to monitor their birth record. 3. Other records & registration systems Sources of data on health 1. Vi Vita tall regis registr trat atio ion n recor records ds ö RA 3753 ( Civil Registry Law) registration of births, b irths, deaths to local registrars (city health officer or  municipal treasurer) 11

 

Problem: under registration & de facto registration Unreported birth- unreported death Weekl Weekly y reports reports fr field he health alth personnel personnel R RA A 3573 ( Law on rep reportin orting g of notifi notifiable able dse) dse) ö report to provincial & duty health office ö midwife reports – under supervision of the nurse ö report within 24H –measles or polio ö report within a week- tetanus neonatorum, severe & acute diarrhea, HIV ö Problems: under reporting- crisis oriented, concept in health, sx, dx, syndromic approach. Popul Populatio ation n censuscensus- shd shd have interval, interval, accurate accurate e estim stimatio ation n ö

2.

3.

4. Ind Indiv. iv. Heal Health th re recor cords/ ds/ ffami amily ly re recor cords ds ö birth cert., school clinic records, employment records, health ctr records, hosp records, health facility logbooks, death cert 5. Publ ublic icat atiions ons Demography- study of pop size, composition & spatial distribution as affected by births, deaths and migration.

Components: Population Size: 5. Na Natu tura rall iinc ncre reas ase e ((NI NI)) NI= birth – deaths 6. Ne Nett mig migra rati tion on (NM (NM)) NM= in-migrants – outmigrants (immigrants) (emigrants) 7. Growth Rate Crude birth rate/ 1000 – crude death rate/ 1000= current growth rate/ 1000 Ex. 26/1000- 6/1000= 20/1000 pop growth rate Population Composition: 1. Age d dis istri tribut bution ion – perc percent ent iin n terms terms of a age ge grp grp 2. Me Medi dian an age age – middl middle e mo most st a age ge MA 20yo 50%= 20yo 50%= 20yo MA younger  3. Depen Dependency dency ratio= ratio= number number of dependent dependent (0-14 (0-14)) +65 100 indiv in the prod age ( 15-64 yo) 4. Sex ratio – num number ber of of mal males es for for every every 1 100 00 fe female males s Males x 100 Females = SR = 100 (M-F) SR > 100 ( M) SR < 100 ( F) 5. Popul Populatio ation n pyramidpyramid- dou double ble bar g graph raph depicti depicting ng the age & s sex ex str structur ucture e of the pop 6. Publ Public ic he heal alth th-- SR= SR= 10 105 5 (birth) SR = age SR

= poor countries

SR = rural communities 0-1 vulnerable age for boys 0-6 7. other other ch char arac acte test stic ics: s: ö ö ö ö

occupational groups economic grps educ attainment ethnic grps- visayan %, bicolano % 12

 

Population Distribution 1. Urban Urban-- ruralrural- % of pop in urba urban n - % of pop in rural Ex. NCR region Urban 100 % 27 Rural 0 % 73 2.

shows shows the propo proportio rtion n of peopl people e livi living ng in urban compared compared to rural areas

Crow Crowding ding Index- no. of household household members members Room for sleeping -

indicates the ease by which a CD can be transmitted fr 1 host to another susceptible susceptible host

3. Population Density-

-

ex. 20 = 4/rm 4

no. of indiv or Square km

indiv 2 Km

determines congestion of the place

Vital Statistics ö direct health indicator  ö the application of statistical measures to vital events (births or fertility, deaths or mortality, and common illnesses or morbidity) that is utilized to gauge the levels of health, illness and health services of a community. VS= numerator x factor  Denominator  1. Numerator A. fertility- number of birth mortality- no. death morbidity- no. of cases B. Numerator is always < denominator  Quotient is always < 1 decimal no. C. Factor- 1000 (100%) – 100,000 Ex. CBR There is 0.0064 births/indiv = 6.4 X 1000 How to read: there are 6 births in every 1000 pop There are ANS (numerator) in every factor (denominator)   Fertility Rate 1. CBR (Crude birth rate)- relative pop due to births Total number of births in a calendar year  CBR= Birth x 1000 Pop ex. 25.8= CBR There are 26 births in every 1000 pop 2. General Fertility Rate (GFR) - true fertility rate – specific segments of pop that is fertile ________Birth___________ _______Birth___________ x 1000 GFR= _ Pop of women (15 to 44 yo) Ex. GRF=32 There are 32 birt births hs in every woman iin n 15-44 Mortality Rates 1.Crude Death Rate ____ x 1000 Decrease in pop due to death CDR= death x 1000 Pop Ex. CDR= 6 there are 6 in every 1000 pop 13

 

2. Specific Mortality RateRate- can apply to any pop grp g rp SMR = death from or particulare grp x 1000 Pop of that grp a. SMR (males) = death (males) x 1000 pop of males b. SMR (females) = death of females 15-44 pop of females 15-44  Infant Mortality Rate: Rate: IMR= Death Death 0 -1 -1 year x 1000 Births  Neonatal Mortality Rate: Rate: NMR= deaths 0-28 days x 1000 

Post Neonatal Mortality Rate: Rate:

Births PNMR = deaths 28 days to 1 year x 1000 Births

NMR + PNMR = IMR Neonatal deaths + Post neonatal deaths= Infant deaths Ex. Birth 200 NMR= 20 Death – 28 to 1 NMR + PNMR = IMR 20 + 10 = 30 (ANS) 2 _ x 1000 = 1000 = 10 200 100 

Maternal Mortality Rate (MMR) MMR= death of women r/t pregnancy, delivery, & puerperium x 1000 Birthsdeaths in every 1000 births Ex. IMR = 30 There are 30 infant NMR = 20 There are 20 neonatal deaths in every 1000 births PNMR = 10 MMR = .92 

Proportionate Mortality Rate = PMR ( for any grp) PMR= death from a particular grp x 100 total death Ex. 52% PMR of males = deaths of males x 100 total deaths In every 100 death, 52 are males

PMR = deaths 0-1

x 100

0.1 0.1 tota totall dea death ths s PROPORTIONATE MORTALITY INDICATOR  A. Swaroop’s Index = SI SI = death of 50 yrs & up x 100 total deaths The SI, the better the situation is! B. Relat Relative ive importa importance nce of a kill killer er ( TB, TB, hear heartt dse, diarr diarrhea) hea) Death due to TB x 100 total deaths PMR

= 30% TB --In every 100 deaths, 30 are due to TB 

Case Fatality Rate (CFR) ö How is survival rate, how strong is killing power, prognosis CFR= death due to part cause x 100 14

 

total cases Ex. CFR

= 98 HIV

 ___death HIV ___ x 100 Total cases of TB In every 100 cases of HIV, there are 98 deaths



Cause-of-death Rate (mortality rate) Cause-of-death Rank as a killer 

ö

C of DR= death due to particular cause x 100,000 total pop Ex. C of DR

=320 TB

In every 100,000 pop there are 320 deaths due to TB 

Prevalence Rate = (Morbidity rate) ö Rank as a common dise PR = old and new case of TB x 100,000 TB total pop Ex. PR = old & new case of TB x 100,000 TB Ex. PR = 326 TB There are 326 cases of TB out of 100,000 population.



Incidence Rate IR= ___new cases___ x 100,000 pop at risk

Epidemiologyö study of distribution of dse or physiologic condition among human pop & the factors affecting such distribution. ö distribution means the frequency of dses and physiologic cond in terms of who gets sick where and when. Basic Concepts: 1. Epi Epidem demiol iologi ogic c Tri Triadad- A Agen gentt- ho hostst- e envi nvi 2. transm transmiss ission ion of C CD D–c comm ommon on vehi vehicle cle,, source- serial- transfer- propagated fr host to host 3. Incub Incubation ation prd- ffrr every every of p pathog athogens ens up to to appearance appearance of the the 1st s/sx 4. Herb ImmunityImmunity- % of immu immune ne pop- some iindiv ndiv are are immune immune Dengue- aedes – daytime C  Arthropod malaria – anopheles- nighttime L E A Neem tree Types of Immunity 1. Passive- quick to come, quick to go Natural- in water, breast feeding 15

 

 Artificial- serum globulin, antiserum, antitoxin antitoxin 2. Active- slow to come, slow to go Natural active- getting the dse itself   Artificial- tetanus toxoid Preg 1 --- 4th month --------------------------TT1 --- 8th month (before delivery) ---- TT2 Preg 2 -------------------------------------------------------------------------------------- TT3 ( 1st booster dose) Preg 3 ------------------------------------------------------------------------------------ TT4 (2nd booster dose) Preg 4 --------------------------------------------------------------------------------------TT5 ------TT5 (3rd booster dose) Factors affecting distribution of Dse 1. Person ö exposure, susceptibility or response to agents. ö influenced by intrinsic characteristic ö genetic/ family, human behavior, prior immunologic experience ö age, sex, ethnic grp, physiologic status Some identified increase risk grps. ö mothers, infants, and young children ö school children, old people, contacts ö people far fr medical assistance ö people in areas with endemic dse ö people at certain times  Attack Rate- incidence of ill illness ness among exposed pop Number of cases x 100 Pop at Risk 2. Place- extrinsic factors, existence of etiologic factors & exposure & susceptibility of human host influenced by extrinsic factors. 3. Time- temporal patterns- fluctuations of incidence a. short term- fluctuations - time of day - days of the week b. cyclic pattern- regular pattern seasonal cydicity – annual cydicity secular dycylicity – every other year typhoid, measles Patterns of dse occurrence  Epidemic- a situation when there is a high incidence of new cases of a specific dse in excess of the expected. - when the proportion of the susceptible are high compared to the proportion of the immunes. - ex. 20-30 dses that you don’t know Current number of cases exceeds the usual expectancy.  Endemic- Habitual presence of a dse in a given geographic location accounting for the low number of both immunes and susceptible. - causative factor is constantly available or present to the area Ex. Malaria, constant  Sporadic- dse. Occurs every now and then affecting only a small number of people relative to the total pop - intermittent - on and off  _______________   Pandemic- global occurrence of a dse, bigger pop -- Patient epidemic- easily the person can identify the cause  _______________  Common Epidemiologic Studies:

  Retrospective (Past)

Cross- sectional (Present)

Prospective Cohort (future) 16

 

Case control study

prevalence study- old and new cases - get prevalence of dse (Lung CA) - get prevalence of risk factor (smoking)

Independent variable (cause) Dependent (effect) National Health Situation Health Indices I. Basic Health Indicators Nutrition DiseaseLeading Patternscauses of Morbidity Context of CHN: health situation Nutrition- under nut of 0-6 yo Commerciogenic malnutrition 1998- 6 out of 10 fil (0-6) are undernourished  Anemia- 48% of filipinos 58 % are pregnant women

1. 2. 3.

2001-1999 diarrhea bron onc chitis pneumonia

10 Leading Causes of Morbidity 1998 1. diarrhea 2. pneumonia 3. bron onc chitis

1. 2. 3.

1997 diarrhea pneumonia bronchitis

4 5.. 6. 7. 8. 9. 10.

iH nP fluNenza TB dse ses s of of tthe he hear heartt malaria measles var varice icell lla a

4 5.. 6. 7. 8. 9. 10.

4 5.. 6. 7. 8. 9. 10. 10.

iTnB fluenza malaria dses dses of the hear heartt measles varicella de deng ngue ue

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

1998 dse ses s of of tthe he hear heartt ds dse e of th the e vas vascul cular ar sys syste tem m pneumonia ma mali lign gnan antt neop neopla lasm sm accidents TB COPD DM oth ther er pes pesp dse nep nephri hriti tis s

iH nP fluNenza TB malaria dses ses o off tthe he hear heartt dengue var varice icella lla

10 Leading causes of Death 1995 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

dses dses of the the he hear artt ds dses es of va vasc scul ular ar sy syst stem em pneumonia ma mali lign gnan antt neop neopllasm asm TB accidents COPD DM othe otherr resp respir irat ator ory yd dse se nep nephri hritis tis

II. Other indicators A. Infant Mortality Rate UNICEF 53.95 in 1998 DOH 18.7 17.3 Global indicator for IMR : 50 Increase IMR- decrease MCHS (poor nutrition and child health service) 10 Leading Causes of Infant Deaths (1998) 1. Respiratory conditions of fetus and NB 2. Pneumonia 17

 

3. Congenital Anomalies 4. Birth injuries and conditions r/t difficult labor  5. Diarrheal dse 7. Septicemia 8. Meningitis (no BCG) 9. Avitaminosis & other nutritional deficiencies 10. Measles (complications underlying cause of death)   Increase IMR= decrease MCHS Poor maternal child health service B. Maternal Mortality Rate Leading causes of maternal deaths 1. Norm Normal al delivery delivery and other complica complications tions r/ r/tt pregnancy pregnancy occurr occurring ing in the course course of labor, delivery, delivery, and puerperium 2. HPN compl complicati icating ng pregnanc pregnancy, y, child childbirt birth h and puerperium puerperium 3. Post Post part partum um he hemo morr rrha hage ge 4. Pre Pregna gnancy ncy wi with th abort abortive ive outcom outcome e 5. He Hemo morr rrha hage ge rr/t /t pre pregna gnanc ncy y Life expectancy at birth—life span either: age specific spe cific or sex specific Median Age- 20.1 years - The Philippines is an agricultural country- 55% E. Crude rates 1. CBR- ____  2. CDR- ____  HEALTH CARE DELIVERY SYSTEM “The totality of all policies, facilities, equipments, products, human resources, and services which address the health needs, problems, problems, and concerns o off the people. It is large, complex, complex, multi-level multi-level and multi-disciplinary.” multi-disciplinary.” FOUR QUESTIONS: Who are served?—only a few bec only a few can afford a fford Who provides the services? –health professionals Where are the services given? – hospitals- access physical inaccessibility- financial What is the focus of care? – curative   Participation Participatio n in the production process _____ ability to satisfy basic need  

health status

5 Major Functions: 1. Ensure equal access to basic health services 2. Ensure formulation of nat’l policies for proper division of labor & proper coordination of operations among the government agency jurisdictions. 3. Ensure a minimum level of implementation nationwi nationwide de of services regarded as public health goods – family planning, EPI, ____, _____  4. Plan and establish arrangements for the public health systems to achieve economies of scale—Phil Health 5. Maintain a medium of regulations and standards to protect consumers and guide providers —Sentrong Sigla- training and infrastructure Local Gov’t Units RA 7160 Local Govt Code – local health board- Governor  ö Municipal health officer- mayor  ö  Assist ____ - municipal municipal ö Provincial health officer  Health Promotion- no threats, no risk- approach behavior  Health Prevention- identified health problem- avoidance behavior  Private Sector  ö

composed of both commercial and business orgs, non- business orgs 18

 

NGOs  Assumes the ff roles: ö Policy and Legislative Advocates ö Organizers, Human Rights Advocates ö Research and Documentation ö Health Resource Dev Personnel ö Relief and Disaster Mgt ö Networking THE NATIONAL HEALTH PLAN National Health Plan- a long-term directional directional plan for health. This is the blueprint defining the country’s health. PROBLEMS POLICIES STRATEGIES THRUSTS Goal: (To improve the health situation) - To enable the Filipino pop to achieve a level of health which will allow Filipinos to lead a socially and economically-productive economically-product ive life, with longer life expectancy, low infant mortality, low maternal mortality, and less disability through measures that will guarantee access of everyone to essential HC. Broad Objectives:  Promote equity in health status among all a ll segments of society   Address specific health health problems of the population  Upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective e ffective one in the provision of solutions to changing the health needs of the population 

Promote active and sustained people’s participation in HC.

MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” ö refers to the 23 programs, projects, activities of the DOH for the year 1993, which marks the beginning of  its journey towards DOG vision. “ Health for more in ‘94” ö activities in 1994 focused on Cancer prevention, reproductive health, mental health, and maintenance of a safe envi. “ Health Focus in 1995” – “ Think Health, Health Link” ö a national and multi-sectoral health promotion strategy aimed at conveying health messages to people wherever they are aimed at building supportive environments through advocacy, community action and networking. “Health Sector Reform Agenda” ö emphasizing on improvements in health care delivery by maximizing people’s participati participation on in health “ Sentrong Sigla Movement” ö pertains to development & implementation of standards to provide quality health services to the people. Strategies and Methodologies ö Strategies and Health Status Targets to Achieve Objectives Strategies to promote equity in health: --priority for the vulnerable and marginalized Marginalized people- those who live geographically and culturally isolated areas; are victims of poverty, armedconflict, man-made and naturall disasters and poor envi conditions. Vulnerable sector of the pop—composed of infants (0mo-1yr) and children (1-4yo), women or reproductive age (15-44 yo), youth and adolescents and the elderly (65 and above). Primary Health Care as the Key Approach

19

 

1.

Health Pr Promotionomotion- consists consists of activities directed towards incr increasing easing the level of well-being & actualizing actualizing the health potentials of indiv, families, communities, societies - Goals: Goals: wellness level – no risk factor, no thr threats eats

Differences with Dse Prevention: ö not dse/ dysfunction or health problem specific ö approach _____ behavior not “avoidance behavior” ö risk to expand positive potential for healthful prevention thwarts the the occurrence of pathogens with _ ____ ___ __  health & well-being. Levels of Health Promotion 1. 2. 3. 4. 5.

In Indi div v wel welln lnes ess s fami family ly well wellne ness ss comm commun unit ity y well wellne ness ss envi enviro ronm nmen enta tall wel welln lnes ess s soci societ etal al we well llne ness ss

Methods of health promotion: 1. health educ 2. good n nu utritx 3. per person sonali ality ty devdev- gro groomi oming ng an and d hygien hygiene e 4. provi provision sion of adequat adequate e housi housing, ng, rec recreati reation, on, and am amenabl enable e worki working ng condi condition tion

HEALTH PROMOTION AND DISEASE PREVENTION IN THE CONTEXT OF A PATHOGENESIS 

Health promo



Healthy person---------person-----------time--------time--------------------------------- healthy person (pathway of health) No risks, no threats, no problems

Pathway of dse---recovery Permanent Death

s/sx-self-medication -health seeking behavior 

2.DISEASE PREVENTION: PRIMARY LEVEL OF DSE PREVENTION -Still healthy - prevention and dse - risk factors and threats present

kuto- kalachuchi, malunggay, Acapulco, madre de cacao

 A. Through people ex. 1. immunization immunization-- method of health promotion 2. chemoprophylaxis - intake of drugs, ex. Vit C to avoid URTI   3. RSH ( reproduction and sexual healthhealth- _______ 

ö ö ö ö ö

Family solidarity Safe motherhood Child survival responsible parenthood (child spacing # of preg ideal thing) women health safe motherhood child survival. Ideal age to get pregnant: 20-30yo ( Less than 18-20=with risks) ( more than 30-35 with risks) ideal number of pregnancies= 3 (4 kids- with risks, >4 incr increase ease risk) ideal interval= 3 years (every 2 years with risk, every year= with risk) what to discuss: basic human sexual response

2 types of family planning method 20

 

1. spacing # of preg ideal timing 2. permanent method B. Through Environmental Control 1. Safe water supply - physical characteristics - chemical characteristics-with minerals in H2O- hard water (better!), little mineral in water( soft water) - biological- (-) for e.coli Common household water fxn= boil H2O Boil with low fire, wait 5 mins agter boiling Sedimentation Aeration Filtration- fr ascariasis due to airborn solid block Water supply- 25 meters away fr toilet, pig pen, poultry refuse disposal system 2. Food Sanitation/ good food hygiene Ensure the health of the ff: 1. sou source rces s of raw raw foodfood- wi witho thout ut pesti pesticid cides es no double dead meat 2. food ood han andl dler ers s 3. en envi viro ronm nmen enta tall sani sanita tati tion on 4. saf safe e ex excre cretal tal dis dispos posal al ((toi toilet lets) s) a. needs H2O b. no need need for for H2O

water Nee Needs trans plant No ttrds rans antr sanspla plan plant t nt

Ci Ciste rn flush with sewa ewage sys system -ci -cistern ster stern n fl ffllush ush ush w w wiith ith s se sep pti tic cgettan ank k tem

No water

 

Flying Fly ing sauc aucerer-pai sys system tem (ebucket ket latrine ine) )st, ttw 1 . PI P IT-s pri pr ivy vy> > pail ant antilipol po lo, bor bor(buc h hol ole, e, clatr om ompo pos win > ventilate 1 improved pit- less smell > reed odorless earth closet (ROEC) 2. overhung latrine (batalan) – bangin 3. cat-hole latrine

Consider culture of the peoplePublic toilet- disadvantage- pay, maintenance -very old, young -typhoon & night – dangerous 4. Refuse ManagementManagement- solid and semi-solid waste excluding human excretal Garbage- fruit peelings, left over food- biodegradable Rubbish- broken glass, plastic- non-biodegradable  Acceptance refuse mgt mgt 1. open b bur urn ning 2. composting 3. burial No-no: open dumping Community Level a. Sanitary Landfill problem: prone to scavenging b. incinerator- no residue, pure smoke 5. Vector animal reservoir control 6. Disinfestations & sterilization 7. Good living & working condition 8. Health educ Health promotion best source of prevention Secondary prevention- early dse prompt intervention to halt pathological process to shorten duration, severity & return to normal fxn at earliest possible time. 21

 

Screening methods - mass screening- shd be simple & inexpensive - case finding- dse of leading causes of morbidity Gold Standard for TB test: Culture and Sensitivity Sputum smear microscopy- TB test - contact tracing- pt with dse- check source of infectx fr family - multiple screening- HIV test - surveillance a. pre-t pre-test est counsel counselinging- rrisk isk ap apprais praisal al for for dse preventio prevention n - risk situation, risk behavior  b. ELISA I c.

d. e.

-

Po Post st test test cou couns nsel elin ing g behavioral modification- IMPT uniqueness of indiv risk factor: increase probability of dse ELISA II Weste Western rn bl block ock ttestest- (-) o orr (+) resu result lt wi with th post post cou counseli nseling ng Ochar 

Characteristics of an ideal screening test: 1. Sensi Sensitivi tivityty- true positi positive ve rate or strength strength of as associat sociation ion bet pr presence esence of dse dse & sx 2. Specificity Tertiary Prevention- during symptomatic phase - defects or disability is present - rehab is goal, resting to an optimum level of functioning within the constraints of disability - rehab states when indiv enters facility Methods: People’s participation People’s participation (continuous & sustained)  Awareness raising raising Organizing Mobilizing  Awareness ability ability to identify or ____ personal concerns & troubles to bigger context

3. Community Organizing – CO Levels of Awareness: Political socializationsocialization- highest level of a. people with common problems/concerns will mobilize - test of unity & will lead as guide to future actions Political mobilization-common mobilization-common Interest aggregation – people with problems will grp together & relate to one another, *identifies a common problem crying, wailing, Interest articulation- people recognized problems & ___ diff ways; crying, swearing due to a problem. People recognizes the prob & expresses itit Culture of silence/passivitysilence/passivity- lowest/ low salience salience to existing problem. People are not aware “naturalizing” “naturalizing” but not considered considered as a problem. problem. ex. Battered wife Key concepts and Principles of CO: 1. obj analys analysis is of obj object ective ive c cond onditi itions ons 2. basic trust on people people & o on n their inmate inmate potentia potentials ls & capabil capabilitie ities s 3. from the peopl people e for the p people eople & w with ith tthe he pe people ople subj of CO= people 4. pe peop ople le want want to ch chan ange ge 5. selfself-wil willed led changes changes wi willll have have more meanin meaning g ___ then iimpos mposed ed chan changes ges – fear fear tactics tactics don’t don’t work work (imposed (imposed)) Context of CO: 22

 

Current situation- CO CO is class based. CO is given to the poor, deprived deprived & oppressed Goals of CO: -equal chance/ access for people CO in health: HSO (health sector organizing) establish communication based health programs - component of __ & health component - thrust is PHC

-

4. PRIMARY HEALTH CARE (PHC) - essential care based on scientifically scientifically sound & socially acceptable methods & technology made universally available available to ___. Families & communicates communicates at a cost they can afford at any given stage of  dev’t through their full participation towards towards self-reliance and self-determination. self-determination. PHC was declared in the ALMA ATA CONFEREN CONFERENCE CE in 1978, as a strategy to community health dev. It is a strategy aimed to provide essential HC that is C ommunity-based A ccessible P art and parcel of the total socio-economic dev effort of the nation A cceptable S ustainable at an affordable cost

Health Care System (HCS) vs. PHC Recipients- a few - many Providers- health professionals - brgy health workers Venue- hospitals - community

DOH framework: People’s empowerment & partnership is the key strategy to achieve the goal “Health for All Filipinos by the  Year 2000 and Health in the Hands of of the Peop People le by the year 2020”. WHAT DOES ESSENTIAL HC IN PHC MEAN? It stands for: E ducation of prevailing health problems L ocally-endemic dse prevention and control E xpanded program of immunization M aternal and child health and family planning E nvironmental sanitation and safe water supply N utrition and food supply T reatment of communicable and non-communicable dses/conditions S upply and proper use of essential drugs and herbal med D ental health promotion A ccess to and use of hospitals as centers of wellness M ental health promotion Pillars (major elements):  A. Multi-sectoral a approach pproach Intersectoral linkages Intrasectoral linkages B. Com Commun munity ity Partic Participa ipatio tion n Phases of CO in health: C. App Approp ropri riate ate Tec Techno hnolog logy y - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost. Criteria: F easible   A cceptable, Affordable C omplex E ffective S afe S cope- wise Ex. 23

 

Herbal Medicine 1. aromatic- has volatile volatile oil for tx of fever, cough, colds, colds, itchiness and gas pain. Luya, bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong, lagundi, ___ or o r petals of sampaguita, jasmine & rosal Luya- shd not be taken on an empty stomach Elixir- ______  Shake week after week—tx for TB Bawang crush 1 ear & drink it Tincture of bawang bawang 1:5  Add 5 tbsp. of gin; gin; 1 tbsp chopped bawang bawang Shake 10 mins for 1 week – good for superficial wounds Tanglad- lemon grass—for fever  Sambong—stomachache Suha/kalamansi- for fever, TSB 2. astringent-tasting- bitter- has tannin & pectin for diarrhea & wound A vocado leaves B ayabas leaves K amilo leaves D uhat leaves S aging leaves (saba cut into chips, let dry, pulverize then add to _____) 3. bitter-tastin b itter-tasting g a. skin problems--Acap p roblems--Acapulco, ulco, kalachuchi, malunggay, kakawati, inakabuhay b. depressantsto puttsitsirika hyper people to sleep--dapdap, dita, makabuhay, makahiya c. anti-cancer drug-d. aches & pains-- sambong, damong arya e. asthma- talampugay- can cause psychosis 4. seeds- fixed oils, anti-helmentics- niyug-niyogan (urine), patola, ipil-ipil, betel nut or bunga, balanyog, squash seeds, lanzones- do not throw peelings instead, burn it—good insect repellant 5. grass family- diuretics—kagon, tubo, tanglad, pandan, pugo-pugo, buto-butones, gatas-gatas, atajuo kahol, pansit-pansitan or ulasimang bato, stones- meis hairm, HPN- palay 10 Medicinal Plants: L agundi- asthma, cough, colds U lasimang bato- uric acid, HPN B awang- HPN B ayabas- Diarrhea  Y erba Buena- arthritis, toothache, swollen gums, cough & colds S ambong- cough and colds, renal stones A mpalaya- DM N iyug-nyogan- ascariasis T saang gubat- diarrhea A capulco- fungal infection, scabies RA 8423- utilization of medicinal plants as alternative for high cost medications. Policies: 1. the ind indica icatio tions/ ns/ use uses s of of plan plants ts 2. the the part part o off the the plan plantt to b be e used used 3. pre prepar parati ation of  a. deco decoct ctio ionn- la laga ga/b /boi oill b. poul poulti tice ce-- tapa tapall (m (may ay ad add d oil oil)) c. d. e. f.

infu infusi sion on-- ttea ea at at llea east st 24H 24H syrup- add sugar sugar and ffor or storag storagee- llasts asts for 3-5 days days oil oilss- bawan bawang, g, lu luya, ya, mans mansani anilya lya e extr xtract act oin ointmen tmentt- with wax 24

 

g. ti tinc nctu ture re al alco coho holl h. eli elixir b ba ased D. Support mechanism made available

TYPES OF PRIMARY HEALTH WORKERS VILLA LLAGE/ G GR RASSR ASSRO OOTS HEALTH LTH W WOR ORK KERS INTE INTER RMED MEDIATE LEV EVE EL EX

C H  A R  A C T E R I S T I

Tr Trai aine ned d com omm muni nitty Health worker; health auxillary volunteer;

General medical practiotioners

traditional birth attendant

Public health nurses Midwives  1st source of  professional Health care   Attend to health health problems beyond the competence of village health workers  Provide support to the frontline health workers in terms of supervision, training, referral services and supplies thru linkages with other sectors

  

Initial link, 1st contact of the community Work in liason with the local health service workers Provide elementary curative preventive health care measures

HEALTH LTH P PE ERSO SON NNEL OF OF FIRST LINE HOSPITALS Physicians with specialty area Nurses dentists  Establish close contact with the village and intermediate intermediat e level health workers to promote the continuity of acre from hosp to community to home.  Provide back-up health services for cases requiring hosp or dx facilities not available in HC

C S

Strategies/ programs to promote health of the vulnerable sectors of the population  Maternal Care Program

Strategies:  A. Provision of R Regular egular and Quality Maternal Care Services Services  Regular and quality pre-natal care - hx-taking, utilization of HBMR (Home-Based (Home-Based Mother’s Record) as a guide in the identification of risk factors - PE: weight, ht, BP-taking - Perform head to toe assessment, abd exam Tetanus toxoid immunization Fe supplementation: given from 5 th month of preg to 2 months postpartum (100-120 mg orally/day for  210 days) - Laboratory exam: heat-acetic acid test, benedict’s test - Oral/dental exam  Pre- natal counseling  Provision of safe, delivery care - all birth attendants shall ensure clean and safe deliveries at home or at the facilities ( RHUs/hospitals) - at-risk pregnancies and mothers must be immediately referred to the nearest institution - untrained TBAs who actively practice must be identified, trained, and supervised by a personnel of  the nearest BHS/RHU trained on maternal care. Major program policies: 1. Impr Improveme ovement nt of famil family y welfare welfare with main foc focus us on women’ women’s s health, sa safe fe motherhood motherhood & child child survival survival 2. fr free eedo dom m of choi choice ce 3. promo promotion tion of fa family mily solidar solidarity ity and responsi responsible ble pare parenthoo nthood d (except birth birth cont control) rol)

-

Causes

Possible Effects 25

 

Short interval of  pregnancies

MOM Bleeding, malnutrition, anemia, HPN Pregnant before 20 or >  Anemia, miscarriage, miscarriage, still birth, 30 yo prolonged labor  More Mor e tthan han 4 de deliv liveri eries es HP HPN, N, bleedi bleeding, ng, rup ruptur ture e of ute uterus rus.. cervical CA

BABY Pneumonia, bronchitis, diarrhea, measles, congenital deformities Low birth wt, fetal death, infant death, physical defects LB wt, respiratory distress

 FAMILY PLANNING PROGRAM

Family Planning Method: 1. 2. 3. 4.

spacing hor hormon mones es (pill (pills, s, inj inject ectabl ables) es) barri barrierer- IUD- condoms condoms (male/fem (male/female), ale), cer cervical vical cup, dia diaphrag phragm, m, sponge, sper spermici micides, des, dental dams dams sc scie ient ntif ific ic fami family ly pl plan anni ning ng - natural cervical mucus method - standard days method- urban poor women, red beads- start of mens 5. pe perm rman anen entt meth method od - tubal ligation- ok even if without consent of husband - vasectomy

 EPI

Goal of EPI- reduction of morbidity and mortality of immunizable dse Types and Schedule of Vaccines:  AT BIRTH BCG

1 ½ months

2 ½ months

3 ½ months

9-12 months

DPT1 OPV1 HEPB 1

DPT2 OPV1 HEPB 2

DPT3 OPV3 HEPB 3

MEASLES

BCG: infant – 0.05ml – ID School entrants – 0.1 ml ID (double dose) DPT: HepB TT

.5 ml, SQ – destroyed by freezing

Measles .5ml. SQ most sensitive to heat OPV – 2 gtts/PO Cold- all vaccines are sensitive to heat i.  j. k. l.

Koch’ Koch’s s phenomenonphenomenon- infl inflammat ammation ion of the the sit site e of in injecti jection on after after 2-4 days days warm c comple omplex x Deep abscess at sit sitee- incision and drai drainage nage Ind Indole olent nt ulc ulcera erati tionon- ulcer ulcer after after 12 wks Glan Glandu dula larr enl enlar arge geme ment nt-- abs absce cess ss

DPT- fever for a 2-3 dayweeks abscess will leave scar 12 wks after  - soreness at site within 3-4 days - abscess after a week or more- incision and drainage 26

 

convulsions Measles- fever 5-7 days after within 1-4 days - mild rashes Provision of quality postpartum care Proper schedule of follow-up must be followed: - 1st postpartum visit for home deliveries must be done within 24H after delivery - 2nd, done at least 1 week after delivery - 3rd, done 2-4 wks thereafter 

-

 Attendants must be aware of the early signs, sx, a and nd complications. They shd follow the the 3 CLEANS: CLEANS: CLEAN hands CLEAN surface CLEAN cord B. Improvement of the health personnel’s personnel’s capabilities capabilities on NB care, mi midwifery dwifery thru ttrainings. rainings. Trainings for  “hilots” must also be conducted C. Improveme Improvement nt on the qu qualit ality y of care at the Fir First st Ref Referral erral L Level evel  Orientation, training shd be done on the use of proper filling-up or HBMR card  Proper referrals/endorsements must be done for future if-ups D. Preventio Prevention n of unwanted unwanted pregnancies pregnancies thro through ugh family family planning planning services services E. Pre Preven ventio tion n and m mana anagem gement ent o off STDs. STDs. F. Pro Promot motion ion of app approp ropri riate ate hea health lth pr pract actic ices es G. Upgra Upgrade de re repor portin ting g servic services es H. Mobilize political political commitment commitment and community community involvement to provide support to basic HC delivery

Remember the principles   Even if the interval exceeded that of the expected interval, continue to give the doses of the vaccine. Immunization can still be given until the child reaches 6 yo If there has been a reported epidemic of measles, measles vaccine can be given as early e arly as six months BCG booster dose must be given to school entrants regardless of presence of BCG scar. There is no contraindication to immunization, EXCEPT when the child had convulsions upon giving the 1 st  dose of DPT. MALNUTRITION is not a contraindication, but RATHER AN INDICATION for immunization since common childhood disease are often severe to malnourished children. Cold Chain – a system used to maintain the potency of a vaccine from that of manufacturer to the time it is given to child or pregnant woman. Principles: 1. Storage- it should not exceed: - 6 months @ the regional level - 3 months @ the provincial/ district level - 1 month @ main health centers ( with refrigerators) - not more than 5 days @ health ctrs.( using transport boxes) Important points to remember: ♥  Arranging of stored stored vaccine according to: to: ≈ Type ≈ Expiration date Duration of storage # of times they have been brought out to the field The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE EXPIRE FIRST shd be distributed or used st 1 . ≈ ≈

♥

27

 

♥

It is a MUST to mark ampules/vials with an “X” mark each time they are carried to the field, bec if a VACCINE IS NOT USED on the 3 rd trip, it must already BE DISCARDED. II. Transport Use of cold dogs III. Handling Once opened or reconstituted, vaccines must be placed in a special cold pack during immunization sessions. Vaccine BCG DPT

Half life 4 hours

Polio Measles TT HepB

8 hours

TARGET SETTING: - Iinvolves the calculation of the eligible pop. - “ELIGIBLE POP” consists consists of any grp of people targeted for specific immunizations due to susceptibility to one or several of the EPI dses.  UNDER FIVES CARE PROGRAM

UFC Program (under five care program)  A package of child child health-related serv services ices focused on the 00-59 59 months old chil children dren to assure thei their  r  wellness and survival. A. Growth and Health Monitoring (GMC)  A standard tool used in health centers centers to record vital info rel to c child hild growth and dev, to assess signs of  malnutrition o Sallen “Ming Scale”, Bar and Detect type scales are a re being used  All NBs must must be enrolled for for UFCP o B. Oral Rehydration Therapy Di Diar arrh rhea ea

(Unu (Unusu sual al freq freque uenc ncy y of of bowe bowell mo move veme ment nts s mo more re than than 3x 3x/d /day ay)) (Marked change in the amount of stool) (Increase in stool liquidity)

3 Classifications of diarrhea: Mild- 5-10 unformed stools/24H Moderate- 10-15 unformed stools/24H Severe- >15 unformed stools/24H with associated s/sx Dehydration ♥ Mild-first sign: thirst, sunken fontanels and eyeballs, dry lips, is irritable but conscious, (-) skin fold test Tx: give ORS for 4-6H then reassess after 4-6H < 2 yo= ½ cup rice H2O/ H2O/ ___ or ½ glass of OR ORS S 2 years and above= 1 cup rice water or 1 glass of ORS ♥ ♥

Moderate- lethargic, normal blood glucose, (+) skin fold test- 10% weight loss Severe- comatose, almost (-) urine output, dry tear ducts, d ucts, (++) skin fold test-15% wt loss

DIARRHEA MANAGEMENT AT HOME 3 F’s ◊

Fluids Oresol Rehydration Therapy

◊ ◊

Frequent feeding Continue breastfeeding Wi With th childr children en ove overr 6 mos mos;; cereal cereals/ s/ starchy foods mixed with meat or fish

Fast Referral If child doesn’t get better in 3 days, or if  danger signs develop-refer patient Danger signs: 28

 

◊

Encourage/ensure inta intake ke of an any y frui fruitt  juices, “am”, “lugaw”, homemade soup

◊ ◊ ◊

and vegetables Mashed banana or any fresh fruit Feed the child at least 6x/day  After diarrhea episode, feed 1 extra meal/day for 2 weeks

◊ ◊ ◊ ◊ ◊ ◊ ◊ ◊

Fever  Sunken fontanel Sunken eyeball Frequent watery stools Repeated vomiting Blood in stool Poor intake of meals weakness

ORS: 1 pack 1 liter of water  Contains: Glucose for Na absorption NaCl for fluid retention NaHCO3 to serve as a buffer system KCL for smooth muscle contraction Home-made oresol: 1 L water 8 tsp of sugar OR 1 tsp salt

1 glass water  2 tsp sugar  1 pinch of salt

REMEMBER: Infant must be be given given ½ ¼--1½cup cupevery everyafter afterLBM LBM Child must  Adult must be given 1 or more c cups ups every after LBM Measures on diarrhea preventx ö breastfeed infants ö Provide appropriate supplemental feeding ö handwashing ö utilize clean and potable water  ö clean toilet and observe proper feces disposal ö immunize the child with measles * No antibiotics must be given to a diarrheic px except in infectious diarrhea like cholera. C. BreastfeedingUnique characteristics of Breast milk: B

F resh

R educed allegic reaction E conomical A lways available S afe/ maintains the stool soft T emperature always right

E bonding E motional asily established D igestible I mmunity N utritious G IT disorders are decreased

Difference of breast milk from formula milk: Breastmilk CHO CHON (LACTALBUMIN) fats Linoleic acid content (3x) Minerals

vs. > < = > <

Formula CHO CHON (CASEIN) fats Linoleic acid content minerals

* The high CHON and mineral content of cow’s milk may overwhelm the NB’s kidney, thus it still needs to be diluted. Casein is more di difficult fficult to digest. digest.

29

 

D. Imm Immun uniz izati ation on (se (see e EPI EPI)) E. Care o off Acute Acute Respirator Respiratory y Tract IInfec nfection tions s (CAR (CARI) I) Goal: identify and tx pneumonia Program:  Assessment: History: age, cough & duration, able to drink or stop feeding, fever, duration, convulsion PE: RR- one whole minute Fast breathing Less than 2 months—60/min 2 months- 1 year—50/min 1-5 years old—40/min Observe for: -chest in-drawing - stridor during inhalation - LOC - wheeze during exhalation - fever  - malnutrition Diagnosis ♥ Infants 2 mos to 5 yrs - very severe dse not able to drink, convulse, sleepy, stridor, severe malnutrition - pneumonia-chest in-drawing, nasal flaring, grunting, cyanosis tx: 1. refer refer urge urgentl ntly y to hospi hospital tal st

2.1 dose of antibiotics 3. tx of fever (TSB) and wheeze (nebulize) 4. anti-malarial Severe pneumonia- chest in-drawing, cyanosis, nasal flaring, grunting tx: same with very severe but anti-malarial is not given Not severe pneumonia- no chest in-drawing and fast breathing Tx: 1. home care- tsb, nutrition, steam inhalation 2.antibiotics- for 2 days & follow up after 2 days- if it improves, consume all meds finish the course of the treatment. treatment. If worse, refer. refer. ♥

Infants less than 2 mos 1. very sever severe e dse—stopped dse—stopped feedi feeding ng well, convulsio convulsions, ns, abnormally abnormally slee sleepy, py, stridor, stridor, wheeze, wheeze, severe malnutrition, fever of 38 °C or hypothermia (<35.5°C). Tx: refer  Keep warm Give first dose of antibiotic 2. Pneumonia—severe chest indrawing, fast breathing Tx: refer to hospital First dose antibiotics Keep warm 3. No pneumonia—assess for other problems, provide home care _____ with sore throat __________  Sore throat in children: very light tea with syrup

STANDARD ARI/PNEUMONIA ARI/PNEUMONIA Case Management (EO 110-E s. 1991)  Cotrimoxazole adult tabs Injectable penicillin should be regularly available in DOH facilities IM gentamycin IM chloramphenicol 

No DOH fund shall be used to regularly provide cough meds except only for the ff emergency conditions: - single ingredient cough suppressant for severe pertussis - single antihistamine for confirmed allergic conditions such as allergic rhinitis. 30

 

 

O2 and flow meters must be b e regularly available in all gov’t hospitals, with O2 delivered properly according to Standard ARI/ Pneumonia Case Management Children found to have severe pneumonia, very severe pneumonia, wheezing, otitis media, streptococcal sore throat shd be referred to Municipal Health Officer (MHO) or hospital physicians for proper  management according to the referral scheme.

STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS  COMMUNICABLE DISEASE PREVENTION AND CONTROL

Communicable Diseases

Chronic communicable Tuberculosis

vector-borne communicable diseases Malaria (MCP) Schistosomiasis Filariasis (FCP) H-fever (dengue)

Leprosy (LCP)

1. National Tuberculosis Control Program (NTBCP) “Tuberculosis is a highly infectious, infectious, chronic, respiratory respiratory disease caused by TB bacilli. It is one of the 10 leading causes of morbidity and mortality in the Philippines, which is also known as “Koch’s Dse”. Objective of the Program To control TB by reducing the annual risk of infection (prevalence and mortality rates) Key Policies: Prevention  BCG vaccination under the EPI program   Annual identification identification of at le least ast 45% of its pr prevalence evalence  Public health education re: PTB mode of transmission, methods of control, and impotance of early dx  Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive tx of contacts. Case finding  Direct sputum microscopy for identified TB symptomatics  X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam  Establishment of passive and active collection points for sputum samples of all identified TB symptomatics, as well as validation centers to ensure the standart & quality of sputum e exam. xam.  Case finding and treatment services shall be made available in the BHS/RHUs Treatment   All TB cases must must be treated for for free, on ambulatory ambulatory and domiciliary domiciliary (home) basis, except those with acute complications and emergencies.   All sputum positive positive and cavitary cases shall be given priority for shor shortt course chemotherapy or SCC for 6 mos.  Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all infiltrative but sputum negative. SR: isoniazid and streptomycin sulfate SCC: Combo pack, multi drug therapy PTB TREATMENT REGIMEN Categories: 6 SCC Patient will be: 2 months on

Rifampicin Isoniazid Pyrazinamide  

+ 4 months

Rifampicin Isoniazid 31

 

Indicated for patients who are: - (+) sputum smear  - Seriously ill - (-) sputum smear, (+) extensive lung lesion - (+) extrapulmonary cases 8 SCC Patient will be: Rifampicin Rifampicin 2 mos on Isoniazid Ethambutol

Isoniazid

Rifampicin + 4 months

Isoniazid

Pyrazinamide

+5 months

Ethambutol

Streptomycin Indicated for those with relapse: - failures - others 4 SCC Patient will be: Rifampicin 2 mos on Isoniazid Pyrazinamide Indicated for PTB minimal

+ 2 mos

Rifampicin Isoniazid

(-) sputum smear  2

Phas Phases es of Tr Trea eati ting ng a T TB B pati patien ent: t:

1. Intensive Phase

2 months

Rifampicin Isoniazid Pyrazinamide

Diagnostic: Sputum Exam If (+), proceed to Rifampicin 2. Mainte Maintenan nance ce P Phas hase e +4m mont onths hs o on n Isoniazid If still (+) TB colonies proceed to Rifampicin 3. Extensive Phase

up to 12 mos on Isoniazid

What is the purpose of SCC-MDT - prevent developing resistance against the tree drug combinations - shorten duration of treatment treatment usually treatment lasts lasts from 5-10 years. With SCC-M SCC-MDT, DT, tx can be reduced to a minimum of 6 mos - eradicate and completely prevent the relapse of the dse

Direct Observation Treatment of Short –Course Chemotherapy (DOTS) “Tutok-Gamutan” 2. Leprosy Control Program Leprosy is a chronic dse of the skin and peripheral nerves caused by Mycobacterium Leprae WHO CLASSIFICATION OF LEPROSY Paucibacillary (tuberculoid and indeterminate)- non-infectious Duration of treatment: 6-9 months Multibacillary (lepromatous and borderline)- infectious Duration of treatment: 24- 30 months 32

 

Objectives of the Program: - provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the prescribed period. - Identify all correctible deformities and institution of appropriate intervention - Reduce the stigma attached to the disease thru IEC - Formulate research proposals on topics associated with leprosy. Key Policies: - MDT as the core strategy for the National Leprosy Control Program - Procurement and supply of MDT Drugs, IEC, and training materials by CDCS - Health education - Supervision and control of leprosy control activities

Strategies: Prevention

-

health education BCG vaccination Case finding Validate old registered cases Early referral of suspected leprosy patients Epidemiologic investigation

Treatment

-

ambulatory domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment.

MDT Treatment Regimen Paucibacillary Supervised dose: Rifampicin 600mg Dapsone 100 mg Taken once/month in the clinic Self-administered Dapsone 100mg Taken OD, daily by the patient at home

Multibacillary Supervised dose: Rifampicin 600mg Lamprene 300mg taken once/mo in the clinic Self- administered dose Lamprene 50mg taken OD, daily at home

 

Leprosy patients must be taught ways to prevent secondary injury caused by burns and rough sharp objs Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-

 

up from time to time Provide mental and emotional support to the families of leprosy patients Refer patients as needed.

Rehabilitation:  Imbibe patient’s participation in occupational activities  Family and community health (PD 304) - non-segregation of leprosy patients - counseling and guidance

 LOCALLY-ENDEMIC DISEASE PREVENTION AND CONTROL

1. Malaria Control Program Malaria is a vector-borne disease caused by female Anopheles mosquito causing sx such as fever, sweating, intermittent chills, anemia, and splenomegaly 2 Major Strategies of the Program 1- Vector Control 33

 

Chemically treated mosquito nets Larva-eating fish Environmental clean-up of stagnant water   Anti- mosquito mosquito soap Chemoprophylaxis- chloroquine 1-2 weeks before entering an area then continuous until 4-6 weeks after  ≈ leaving the area 2- Detection and Early Treatment of Cases ≈ Early Recognition, Prevention, and Control of Malaria epidemics  identification of a patient patient with malaria as soon as he is exami examined. ned. This may be done thru: > Clinical >Microscopic - signs and sx - mass blood smear exam - history of visit to and endemis area In the event that an imminent epidemic occurs, the ff shd be done:  Mass blood smear collection  Immediate confirmation confirmation and follow-up of cases  Insecticide-treatment Insecticide-treat ment of mosquito nets 2. Schistosomiasis, H-fever, Filariasis Control Programs SCHISTOSOMIASIS CONTROL PROGRAM Schistosomiasis- a parasitic infection caused by blood flukes inhabiting the veins of their vertebral victims transmitted thru skin penetration causing diarrhea, ascites, hepatosplenomegaly

H-FEVER (DENGUE) Dengue- acute febrile infection of sudden onset, caused by  Aedes Aegypti, vector  mosquito

 Activities: Case Finding: surveillance of the dse Health educ- encourage use of  rubber boots for protection Environmental Sanitation-proper  disposal of feces Snail Eradication- use of moluscides

 Activities: Case Finding Early reporting of any known case or  outbreak

FILARIASIS CONTROL PROGRAM > a mosquito borne dse caused by a tissue nematode attacking the lymphatic system of  humans thereby causing elephantiasis, lymphedema and hydrocele > started in 1957 as an operational research of  malaria. Eradication S Service ervice Three Filaria Control were established and later on integrated with the Regional Health Officers    Activities: Case finding Early reporting of any known case of outbreak

 PREVENTION, CONTROL AND REHABILITATION OF NON-COMMUNICABLE DISEASES

1. Philippine Cancer Control Program  AO 89-A s. 1990 1990 Provided the Guidelines for the Philippine Cancer Control Program specifying its program policy, components, implementing guidelines and timetable. 6 Pillars: Public Information and Health Education Cancer Prevention and Early Detection Cancer Epidemiology and Research Cancer Treatment Cancer Pain Relief  In Cancer Nursing, the aim of management is to relieve physical, mental, and spiritual distress     

Vital Task of the nurse: To help the patient maintain his dignity and integrity

34

 

Cancer care is multidisciplinary. multidisciplinary. Who are to be prioritized for health supervision?  Newly diagnosed cases  Post-op cases/discharge  Indigent cases needing continuity of hospital care  Terminal cases 2. Smoking Control Program Health hazards of Smoking:  Lung Cancer   Cardiovascular diseases  COPD  Cancer of other body organs

Program Objective: To decrease the prevalence of smoking-related diseases and subsequent premature deaths Program Components:  Information and Education on Campaign and Social Mobilization  Policy Development and Legislation  Training of Counselors in Smoking Cessation Clinics for Specialty Hospitals  Resource Management and Monitoring Strategies:  National Anti-Smoking Campaign o World No Tobacco Day o National No Smoking Month Yosi Kadiri Campaign o 3. Renal Disease In “23 in ‘93” Preventive Cardiology and Nephrology  Enhance public awareness through health education regarding healthy lifestyles  Improve access to basic health services “Health for More in ‘94” “Buwan ng Buhay na Bato”  Requires urinalysis af ALL children entering grade 1 so as to detect childhood kidney infections which may lead to renal failure.  Encourage adult Filipino to undergo urinalysis once a year. 4. Cataract National Focus: Cataracts Screening Week at DOH Centers OPLAN: Sagip-Mata > eye surgery for cataract and squint operations for cross-eyed children  NUTRITION AND ADEQUATE FOOD SUPPLY

Goal: reduce M&M related to nutritional deficiencies The improvement of nutritional status, productivity and quality of life of the population through adoption of  desirable dietary practices and healthy lifestyle. Coverage: ____ energy ____, Vit A deficiency, Fe deficiency anemia, iodine deficiency disorder  Philippine Food and Nutrition Programs Directed to the provision of nutrition services to the DOH’s identified priority vulnerable groups: Infants, pre-schoolers, schoolers, women of child bearing age( also included are the pregnant and lactating mothers) and the elderly. Objectives: to decrease the morbidity and mortality rates secondary to Avitaminosis Avitaminosis and other nutritional deficiencies among the population mostly composed of infants and children.

35

 

1. Malnutrition Rehabilitation Program Targeted Food Task Force Nutrition R Re ehabilitation Wa Ward  Assistance Program Provision of food rations of  Every hospital must have a Nurse ward, bulgur wheat and green where an adequately trained nutritionist were peas assigned (RA 422) Target population: Pre-schoolers Pregnant women Lactating mothers

Akbayan sa sa K Ka alusugan ((A ASK Project)  Aimed to provide provide rice and corn soya blend supplemented with local foods. Target pop: 6 mos- 2 years Moderately and severely underweight Pre-schoolers not served by the DSWD and DA in Regions 2,8,9,10,11,12



2. Micronutrient Supplementation Program “23 in ‘93 Fortified Vitamin Rice

- a free enrichment e nrichment program aimed to prevent deficiencies in vitamin A (blindness); iron (anemia); iodine (goiter, mental retardation and delayed development) (1 cavan of rice + fistful processed, binilid enriched with essential micronutrients)

“Health for More in ‘94” “Buwan ng Kabataan, Pag-asa ng Bayan’ National Focus: National Micronutrient Micronutrient Day or  “Araw ng Sangkap Pinoy” -aimed to distribute vitamin A supplements, iodized oil for and seedlings of plants rich in Fe and other minerals.

3. Food Fortification Program Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or  seasoning. It involves:  Incorporation of Monosodium Glutamate (MSG) with vit A to reduce clinical signs of o f Xerophthalmia  The use of FIDEL of FIDEL salt in lieu with the National Salt Iodization Program F ortification for  I odine D efficiency EL imination 4. Nutrition Surveillanve System (operation timbang) - a system of keeping close watch on the state of nutrition and the causes of malnutrition within a locality, which involves periodic collection of data and analysis and dissemination of analyzed information. Tools utilized are anthropometric measurements: Weight for age Measures degree and presence of wasting or stunting Height for age Measures the presence of stunting < 90% of standard stunting or past chronic malnutrition Weight for height Determines the presence of muscle wasting Ideal body wt,: 135 Body mass index(BMI)= wt in kgs   Ht in meters If BMI is > 27.2 in men or 26.9 in women there is the need for wt, reduction Skin Fold Measurement Indicates amount of body fat with the use of fat-caliper  Sites: triceps, biceps, subscapular, suprailiac 36

 

MUAC Estimates lean body mass or skeletal muscle reserves Protein Energy Malnutrition Marasmus-- child lacks food rich in CHON & energy Marasmus  ____ usually < 1 year old old when malnutritionj malnutritionj starts - very thin, no fat - prominent ribs - very poor wt gain - loose and wrinkled skin - enlarged abdomen - anxious, always hungry tx:

food high in protein and energy content  frequency of feeding 

variety of food ___ 

Kwashiorkor - disease of older children when the next baby is born. This is usually ___ the child 1-3 years old - Very thin, fails to grow - swollen legs, feet, arms, and hands -Light colored, weak hair - doesn’t want to eat - Moon-shaped, unhappy face - dark spots on skin - Enlarged abd - skin sores and skin is peeling - Muscle wasting - apathetic Iron Deficiency Anemia- no enough hemoglobin in the RBC bec of lack of Fe Causes: low intake of Fe-rich foods esp. e sp. the more absorbable iron fr foods of animal origin Sources: Liver, internal organs, meat (pork and chicken) blood, fish and shellfish leafy vegetables alugbati, kangkong, saluyot, petchay, kamote tops, mustard (mustasa), dried beans, kadyos, monggo, abitsuelas Supplementation: FeSO4 iron supplement- drink drink fruit juice enhance Fe absorpt absorption ion Vitamin A DeficiencyConsequences: 1. blindness- night blindness due to Rhodopsin (visual purple) 2. nutritional blindness- due do destruction of cell of the cornea Causes: - low intake of Vitamin A rich food -low intake of ___ and protein - illnesses like measles, diarrhea, _____  Sources: -Breast milk -animal sources, whole milk, eggs, liver,meat -yellow/orange fruits (papaya, mango) - ___ plant sources yellow/orange veg (carrots & squash) - green leafy vegetables (malunggay, kangkong) - Vit. A capsule Iodine Deficiency Disorder- abnormalities __ get enough iodine. Abnormaliti Abnormalities es range from mild such as goiter, to serious as stillbirth, congenital abnormalities, abnormalities, growth and mental retardation& physical and motor abnormalities Consequences: fetus: abortion or miscarriages -congenital abnormalities - stillbirths Causes: Goitrogens and other environmental environmental factors Low intake of Iodine rich foods or low content of iodine in food. Supplementation:

37

 

 SUPPLY AND USE OF ESSENTIAL DRUGS

Essential drugs are medicinal preparations necessary to fill the basic health needs of the population. National Drug Formulary contains the list of essential drugs Generics Act of 1988 RA 6675 “Formally proclaims the state of promoting the use of generic terminology in the importation, manufacture, distributi distribution, on, marketing, promotion and advertising, labeling, prescribing and dispensing of  drugs.” “Reinforces the NDP with regards to the assurance of the high-quality and rational drug use.”

Dangerous Drugs Act RA 6425 “ The safe, administration and transportation of prohibited drugs is punishable by law.” 2 types of drugs: Prohibited Regulated LSD Benzodiazepines Eucaine Barbiturates Cocaine/ codeine Opiates

 ENVIRONMENTAL SANITATION

Environmental Sanitation is defined as the study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and survival. Goal: to eradicate and control environmental factors in dse transmission through the provision of basic services and facilities to all households. 1. Wat Water er S Supp upply ly S Sani anitat tation ion Progra Program m 3 typ types es of Appro Approved ved Water Water Su Suppl pply yF Faci acili litie ties s Level 1 Level II Point Source Communal Faucet system or stand posts  A protected well of a developed  A system composed of a source, a sprung with an outlet but reservoir, a piped distribution network and without a distribution system for  communal faucets, located at not more than rural areas where houses are 25 meters from the farthest house in rural thinly scattered. areas where houses are clustered densely. Water must pass the National Standards for Drinking Water set by the DOH.

Level III Waterworks system or individual house connections  A system with with a source, a reservoir, a piped distributor  network and household taps that is suited for densely populated urban areas.

2. Pro Proper per Excr Excreta eta a and nd Sewage Sewage D Disp isposal osal Syst System em 3 types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non- water carriage toilet facility: On site toilet facilities of the Water carriage types of  - Pit Latrines water carriage type with water  toilet facilities connected sealed and flushed type with to septic tanks and/or to - Reed Odorless Earth Closet septic vault/tank disposal sewerage system to - Bored-Hole facilities. treatment plant. - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space -pour flush -aqua privies Rural Areas- “blind drainage” type of wastewater collection and disposal facilities shall be emphasized until such time that sewer facilities and off-site treatment facilities are available. 3. Pro Proper per Solid Solid Waste Waste Manage Managemen mentt - refers to satisfactory methods of storage, collection and final disposal of solid wastes. Refuse 38

 

Garbage Rubbish

2 ways to Refuse Disposal Household -Burial > deposited in 1m x 1m deep pits covered with soil, located 25m away from water supply

Community -Sanitary landfill or controlled tipping > excavation of soil deposition of refuse and compacting with a solid cover of 2 feet

- open burning - animal feeding - composting - grinding and disposal sewer 

- Incineration

4. Foo Food d Sani Sanita tati tion on Pro Progr gram am Policies:  Food establishment are subject to inspection (approved of all food sources containers and transport vehicles)  Comply with sanitary permit requirement  Comply with updated health certificates for food handlers, helpers, cooks   All ambulant vendors must submi submitt a health cert to to det presence of intestinal intestinal parasit parasite e and bacterial infection. 3 points of contamination Place of production processing and source of supply   Transportation and storage  Retail and distribution points

5. Ho Hosp spit ital al Was Waste te Man Manag agem emen entt Goal: To prevent the risk of contraction contracting nosocomial infection from type disposal of infectious, pathological and other wastes from hospital 6. Progr Programs ams relat related ed to health health-risk -risk mi minimi nimizatio zation n secondar secondary y to environm environmental ental pol polluti lution on These include the following:   Anti-smoke Belching Belching campaign and A Air ir Pollution Pollution Campaign  Zero Solid Waste Management  Toxic, chemical and Hazardous Waste Management  Red tide Control and Monitoring  Integrated Pest Management and Sustainable Agriculture  Pasig River Rehabilitation Management 7. Edu Educat cation ion of p prev revail ailing ing heal health th pr probl oblems ems  Accepted activitiy activitiy at all levels of public health health used as a means of improving improving the health health of the people through techniques which may influence people’s thought motivation, judgement and action. Three aspects of Health education:  Information- provision of knowledge  Communication- exchange of information  Education- change in knowledge, attitudes, and skills Sequence of Steps in Health Education  Creating awareness  

Creating motivation Decision making action

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HIV/ STI PREVENTION AND CONTROL Operational Strategies:  Promotion of health/ health education  Disease detection Treatment program   Contact tracing  Clinical services 

Program components:  Case-finding  Case management  Training  Monitoring  Reporting system  Operations research

  MENTAL HEALTH

-

 A state ofofwell-being wlife ell-being where a person can realize hi his s or her own abi abilities, lities, to cope with with the normal stresses and work productively - The emotional adjustment the person achieve in which he can live with reasonable comfort, functioning, acceptably in the community where he/she lives - Involves the promotion of a healthy state of mind amont the whole pop through ♥ Developing positive outlook in life ♥ Strengthening coping mechanisms Vulnerable group to the dev of Mental Illness: ♥ Women ♥ Street children ♥ Victims of torture or violence ♥ Internal refugees ♥ Victims of armed conflicts ♥ Victims of natural and man-made disasters Components of Mental Health Program  A. Stress B. Drugs and Alco Alcohol hol Abus Abuse eR Rehabi ehabilitat litation ion C. Treatment Treatment and Rehabil Rehabilitat itation ion of Men Mentall tally-il y-illl Patients Patients D. Special Special Projec Projectt ffor or V Vulner ulnerable able Groups Groups Stresses in the environment of children such as times of disasters and natural calamities, disintegrati disintegration on of the values, structure and functions of the family and urbanization, migration, drugs, and physical and sexual abuse and poverty have direct effects on physical and mental health.

GOOD LUCK!

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