Chn Reviewer

 

CHN Community- a group of people with common char or inherent living together within a territory or geographical boundary. -place where people are found. Community as the client/patient in CHN ( client- well; patient- sick)

World views on Community: 1. Fam Family ily,, comm communi unity, ty, and soc socie iety ty Family- intrafamilial intrafamilial Community- intracommunity Interpersonal intrafamilial

Society- strong regional,parochial, - parochial -intrasocietal

2. 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 - degree of client wellness ranging from optimum wellness to death - 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- maint maintain ain a conti continuum nuum bal balance ance & purp purposeful oseful di directi rection on with envi envi - progress to a higher level of fxn to live to the fullest potential

1978- UNICEF & WHO- Alma Ata, R Russia ussia - global health situation - strategy/ approach: PHC - goal: HEALTH FOR A ALL LL BY 2000 (old) 1994- Riga - HEALTH FOR ALL BY 3000 AND BEYOND! 1979 – Alma Ata declaration - PHC as the thrust of MOH VISION of DOH- HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE PEOPLE BY 2020 MISSION- in partnership with the people, provide equity & accepts a ccepts quality health services to the marginalized. VISION & GOAL- same with DOH, PHC program 3. Age Agentnt-hos hostt envi mod modelel- (EPI (EPIDE DEMIO MIOLOG LOGIC) IC) - interplay of agt (causative etiologic factor)

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1. Hea Health lth bel belief ief mod model el –pr –preve eventi ntive ve - relationship bet. a person’s belief & his behavior in health ex. HIV infectn (commercial (commercial sex farers, sea workers, medical medical team Susceptibility, Susceptibilit y, possible MOT (mode of transmission)--- unprotected sex- occupational hazard Prevention: A bstinence   B e faithful C orrect, consistent, continuous use of condom D o not penetrate (SOP) HIV infected age groups Male Ma les s ag age e 40 40-4 -49 9 seaf seafar arer ers s rati ratio: o: 1: 5 anal anal sexsex- won on’t ’t ge gett preg pregna nant nt,, common in rural Vaginal: 1: 1000 Females 20-29 anal: 1: 200

2. Evol Evolutio utionary nary based based model- ilillness lness & death death serv serve e an evoluti evolutionary onary fxnfxn- survival survival of the fi fittes ttestt 3. Healt Health h promotion promotion model model-- dire directed cted at increase increase clients clients w well-b ell-being eing 4. WH WHO O de defini finiti 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 - it is a result of interplay of diff societal factors: -biological - Physical- heat, temp - Ecological- adaptation to envi - Political - Economic  AGENT (Etiologic)- virus, bacteria 1. bio infec infection tionss- fungi fungi,, prot protozoa, ozoa, helmi helminthes nthes,, ectoparasites 2. che chemic micalal- carcin carcinogen ogens, s, poi poison sons, s, all allerg ergens ens ex. GMO’s – carcinogen MSG- poison 3. me mech ch-- car car acci accide dent nts, s, etc etc 4. env enviro ironme nmenta ntal/ l/phy physic sicalal- hea heatst tstrok roke e 5. nut nutri ritiv tivee- exc excess ess or def defic icien iency cy 6. psy psych chol olog ogiica call

HOST Intrinsic factors and environmental factors 1. 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. prior prior immun immunolo ologic gic-- respon response se Extrinsic factors 1. nat natura urall bou bounda ndarie riess- physic physical al environmental, geography 2. bi biol olog ogiica call env envi 3. soc socioe ioecon conomi omic c envienvi- politic political al bounda boundary ry 2

 

- Social cultural - it is an outcome of many theories Descartes – dualism Multi Casual theory- holistic- General systems theory Community health- part of paramedical & medical iintervention/ ntervention/ approach concerned on the number of the whole whole population  Aims: 1. promotion of health 2. prev preven entx tx of illn illnes 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 of of population Sociology Epidemiology- study of dses

COMMUNITY HEALTH / PUBLIC HEALTH WINSLOW- sci and art of preventing dse, prolonging life, life, promoting health & efficiency efficiency through organized community effort - To enable each citizen to realize his birth right of health and longevity. - Major concepts: 1. heal health th pro promo motx tx 2. peopl people’s e’s participa participation tion towa towards rds selfself-reli reliance ance HANLON- most effective total dev & life of the indiv & his society PARDOM- applies holism in early years of life, young, adults, mid year & later  - prioritzes the survival of human being Nursing- assisting sick indiv to become healthy and healthy indiv 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 - the utilization of the nsg process in the diff levels of clientele- indiv, families, pop grps, and comm. concerned with a. pr prom omot otio ion no off hea healt lth h b. pr prev even enti tion on of ds dses es c. disa disabi bili lity ty a and nd rreh ehab ab Goal: to raise the level ot health of the citizenry citizenry by helping comm. & families families to cope with the discontinuities in & threats threats to health in such a way as to maximize their potential for high-level wellness. WHO CHN- 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 otiion o off he heal alth th 2. impr improvemen ovementt of the the con conditi ditions ons in the social social and ph physic ysical al env envii 3. reh rehab ab of of iilln llness ess asnd asnd disab disabili ility ty Jacobson- CHN is learned practice discipline with the ultimate goal of contributing, as individual individual and in collaboration with others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care. Freeman- 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 hea heallth 2. prev preven entx tx of illn illnes ess s 3. car care e of the sick sick at home home an and d re rehab hab Orem- self-care, autonomy - independent patient 3

 

Philosophy—Dr. Margaret Shetland Philosophy—Dr. - philo of CHN is based on the the WORTH AND DIGNITY DIGNITY of man Basic concepts of CHN 1. prim primary ary ffocus/ ocus/ emphasisemphasis- healt health h promo promo 7 dses prev preventx entx 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 practices practices -to -to ben benefit efit ( in indiv, div, ffam, am, speci special al pop, pop, com comm.) m.)

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iseneralist integrated and comprehensive 3. CHNCHN are genera g listss- ma matter tter of comm. comm. health health work work 4. all all ttyp ypes es and and lev level els s of HC Levels of HC: PHC- comm. SHC- regional, provincial, district, municipal, municipal, and local hosp (complicated sx) THC- sophisticated med ctr—heart ctr, QI, KI 5. Natu Nature re of CHN practice practice rrequir equires es knowledge knowledge o on n biologic biological, al, so social cial sciences sciences 6. Imp Impli licit cit iin n CHN iis s the nsg nsg pra practi ctice ce (ADP (ADPIE) IE) Basic principles of CHN: (adopted fr Gardner, Cobb & Jones) 1. The comm comm.. is the pati patient ent in CHN CHN,, the famil family y is the unit of care care and the 4 level levels s of clientele clientele are: a. indiv b. pop grp ( th those ose who share share common common char, char, dev sta stages ges and co common mmon exposure exposure tto o the pro problems blems ex ex.. Children, elderly) c. family d. comm. 2. In CHN CHN,, the client is considered as an ACTIV ACTIVE E partner NOT P PASSIVE ASSIVE recipient of care-participatory approach Client- active participant, full involvement recipient care 3. CHN pra practice ctice is affected affected by devt devts s in Health tech technolog nology, y, in partic particular, ular, ch changes anges in society, society, in general. general. 4. The goal of CH CHN N is achiev achieved ed throug through h multis multisector ectoral al effortsefforts- coordinat coordinated ed with other other sectors. sectors. 5. CHN is a par partt of health care care system an and d the large largerr human ser services vices sy system. stem.-- Nsg practice, practice, human human service service Nsg fxn 1. Ind Indepe epende ndentnt- w with ithout out supe superv rvisi ision on of M MD D 2. Coll Collabora aborative tive-- in collaboration collaboration wi with th other H team ( interdisci interdisciplina plinary, ry, intr intrasect asectoral) oral) Basic Concepts of CHN (fr DOH bk) 1. Prim Primary ary foc focus us is on hea health lth promotx. promotx. The com comm. m. H nurse nurse by the nature nature of her work work has th the e opport opportunity unity & responsibility for eval the health status of people & groups & relating them to practice. 2. CHN pr practic actice e is extended extended to benefi benefitt not only the indiv indiv but the whole whole family family and com communit munity. y. 3. Community health nurses are generali generalists sts in terms terms of their pract practice ice through life’s continuum- its its full range of health problems and needs. 4. Cont Contact act wit with h the clien clientt and/or fa family mily may may continue continue over a long per period iod of tim time e which inc includes ludes all ages ages and all types 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, ecology, clinical nsg, and community health organizations be utilized. 6. The dynami dynamic c process of assessing, assessing, planning, planning, implement implementing ing and intervening intervening,, provide peri periodic odic measur measurement ements s 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 ffocus/ ocus/ emphasis emphasis – healt health h promotio promotion n & dse dse prev preventx entx Primary goal: self reliance in health or o r enhanced capabilities of people Ultimate goal: raised the level of healthe of citizenry Philosophy of CHN- worth and dignity of man 2. CHN PracticePractice- to benefit benefit indi indiv, v, fam, fam, sp special ecial pop, comm. comm. 3. CHN are generalist generalistss- iintegr ntegrated ated and compr comprehensi ehensive ve 4. Al Alll ttyp ypes es and and le leve vels ls of HC - Primary HC- mgt at the level of comm. 4

 

Secondary HC- managed H problems regional, provincial, district, municipal & local hosps (for complicated pregnancies) - Tertiary HC- sophisticated medical centers, NCMH, Lung Ctr. Heart Ctr, Natu Nature re of CH CHN N practice practice requires requires k knowl nowledge edge on biologi biological, cal, soc social ial sciences sciences.. Impl Implicit icit in in CHN is the the nsg process process w w/c /c is an ind independe ependent nt nsg act action ion ADPIE ADPIE

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5. 6.

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 ba basis sis for CHN CHN practice practice CHN process  Assessment- data collectx collectx (fam, comm comm.) .) Data analysis- H problems Community dx with people (people’sofparticipatx)  Active and full involvement people people in decisx making. 2. Know Knowledge ledge and understan understanding ding of agency objecti objectives ves & policies policies facilitat facilitates es goal achiev achievement ement Planning: 1. pr prio iori riti tiza zati tion on 2. goal s se etting 3. obje bjectives 4. actions 5. eva evalua luati tion/ on/ out outcom come-e--cri criter teria ia --standard -measure outcome Criteria/ obj 3. Fa Fami mily ly iis s unit unit of of se serv rvic ice e 4. Res Respec pectt val values ues,, customs customs an and d beliefs beliefs of c clie lients nts Implementation- pt/ c ctt- comm. Focus of care: indiv, families, sp grps, comm..  Attitude: non-judgmental non-judgmental 5. Hea Health lth ed educ uc and co couns unseli elingng- vita vitall parts parts of CH CHN N 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 workin orking g rel with with healt health h team facili facilities ties goal goal achieveme achievement nt - nurse coordinator of health services 7. Peri Periodic odic and conta containing ining evalu evaluation ation is necess necessary ary 8. Con Contin tinuin uing g sta staff ff educeduc- up upgra grade de msg pract practice ice 9. In Indeg degen enou ous sa and nd ex exis isti ting ng  Appropriate technologytechnology- methods & tech tthat hat are: 1. scient scientifi ifical cally ly soundsound- exp experi erimen mentat tatio ion n 2. soci social ally ly ac acce cept ptab ablle 10. Indiv, famili families, es, & comm. must actively participate in decision making 11. super supervisi vision on of nsg service service by quali qualified fied perso personnel nnel 12. accurate recording/ reporting serve as eval & guide for fut future ure actions Who supervises the nurse in 1. CH Nsg pract practice ice-- RN RN s supe upervi rvisio sion n 2. Pro Projec ject/ t/ progr program am imple implemen mentat tation ion –MD –MD 3. Mg Mgt, t, & adm admin in con concer cerns ns-- Ma Mayo yor  r  a. MD b. RN super uperv viso sor  r  c. Major   d. All of them 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 5

 

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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 1. Plan Planner/ ner/ pro programm grammerer- identifi identifies es needs, priori priorities ties & prob problems lems if indiv, indiv, fams, fams, & comm. - formulates nsg component of H plans - In doctorless areas, she is responsible for the formulation of the municipal health plan - Provides technical assistance to rural health midwives in health matters like target setting. 2. Prov Provider ider of Nsg Nsg care- provides provides dir direct ect nsg care care to the sick, di disable sabled d in the homes, cl clinics inics,, schools, schools, or plac places es of 

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4. 5. 6.

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work - provide continuity of patient care Manag Manager/ er/ supervisor supervisor-- formulat formulates es care care plan for the: 4 Clientele: a. Requisitions, allocates, distributes materials (meds & medical supplies & records & reports equips b. Interprets and implements programs, policies, memoranda, & circulars c. Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on accomplishments Comm organizer- motivates motivates & enhance community participation participation in terms of planning, org, implementing implementing and evaluating H programs/ services. Coordinator of Health ServicesServices- coord with other health team & other other gov’t org (GOs & NGOs) to to other  health programs as envi sanitation health educ, dental health & mental health. Train Trainer/ er/ Heal Health th educat educator/ or/ couns counselorelor- con conducts ducts training training for R RHMs, HMs, BH BHWs, Ws, hilots hilots who aim towards towards H promo & illness prevention through dissemination of correct info; - educating people Resea Researcher rcher-- coordi coordinates nates w with ith govt govt & NGOs NGOs in the the implement implementation ation of of studi studies/ es/ researche researches s

- participates in the conduct of surveys studies & researches on Nsg and H related subjs. Responsibilities of CHN 1. Be a part iin n deliv delivering ering an ov overall erall healt health h plan; its its impl implement ementation ation & eval eval for comm. comm. 2. Prov Provide ide qualit quality y nsg services services to to 4 level levels s of clie clientele ntele 3. Maintain co coordination/ ordination/ linkages linkages of nsg servi service ce with o other ther health team member members s NGO/G NGO/GO O in the provi provision sion of PH PH services- multisectoral app 4. Condu Conduct ct research research relevant relevant to CHN services services to improv improve e provis provision ion of health ser servicevice- res research— earch—to to improv improve e HC 5. Prov Provide ide opportunit opportunities ies for profess professional ional gr growth owth and continui continuing ng educ for staff staff devt devt.. Sources of CHN standards: BON & PNA PNA

Multisectoral approach: - other sectors

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intersectoral own sector  linkages intrasectoral linkages comm. based referral network The CHN Process 1. Assessment –collection of data ( subjective: expressed by client or SO; objective: measurable- interview and observations,sensed, intrn) - analysis of data 7. Nsg Dx 8. Planning 9. Im Impl plem emen enta tati tion on 10. Evaluation- measurable outcome or objective 4 tools/ instruments for data collectx: 1. Nu Nurs rsin ing gh his isto tory ry – s sub ubjj 2 3.. P LaEb--OObbj j 4. Pro Proces cess s record recording ing-- obj ((ana analyz lyzed ed by R RN) N) Data analysis 6

 

Group 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 DEVELOPMENTAL Stages of Family Dev’t. Stage 1- Beginning family - marital & sexual adjustment, fxnal, communication, adjustment to roles, pre-natal p re-natal educ. Stage 2- Early childbearing

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changing parenting Stage 3- Families withroles, 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)

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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 - 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 - type & structure of family - dominant members in health - general family relationship  Assessment: Family - initial data base - 1st level assessment - 2nd level assessment Sociofactors - economic resources&&cultural expenses

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educ attainment ethnic background 7

 

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

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First Level Assessment 1. Healt Health h Threat- conditi conditions ons conducive conducive to dse, acci accidents dents or fail failure ure to reali realize ze one’s heal health th potential potential - healthy people - 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, disabi disability lity,, dev’tl lag) -ex. Dse/ illness- URTI, marasmus, scabies, edema  disabilities- blindness, polio, colorblindness, deafness  dev’tl problems like mental retardatx, gigantism, hormonal, dwarfism

3.

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

Second Level Assessment Family tasks that can’t be performed  recognition of the problem  decision on appropriate health action  care to affected family member   provision of healthy home environment en vironment  utilization of comm. resources for health care

Family Health Nursing Diagnosis - combination of health problems and health Ex. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit - problem prioritization 8

 

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 wt. = 1 pt. 3 B. 3 x 1 = 1 3

Modifiability Easily modifiable Partially modifiable Not modifiable

=2 =1 =0

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

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

=2 =1 =0

wt. = 2 pts.

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 h igher 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: indentify natrure 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) - infants & young children – dependent to caretakers - 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.

2.

Community Mental Heal Health th Nsg- a unique pr process ocess whi which ch includes an integrati integration on of concepts concepts fr nsg, 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 Occupational H Nsg- appl application ication of Nsg principles principles & procedures in conserving H of workers workers in all occupations. 9

 

 Aims: Healt Health h promotion & prevention prevention of dses & inj injuries uries From industrial to service 3.

Schoo Schooll Healt Health h Nsg- the app applicat lication ion of nsg the theories ories & principl principles es in the care of the the school pop Components: School H services- maintain school clinic, screening all children- visual, hearing, scoliosis Health instruction- health educ/ counselor direct & undirect u ndirect Healthful school living- health monitor  - mental health- substance abuse, sexual H - environmental health- food sanitation, water supply, safe environment, safe toilet - school comm. linkage- comm. organizer   ASSESSMENT OF COMMUNITY  ASSESSMENT COMMUNITY HEA HEALTH LTH NEEDS Community Dx- descriptive research - profile general picture of comm. - process by which the people in the conn & H team assess the comm. H problems & needs as bases for H programs devt. -  A learning process for the comm. to identify identify their own H pr problems oblems & needs -  A profile that deposits deposits the H proble problems ms & potentials of the 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

Site selection- locatx of 1 st criteria poor community- bec. Vulnerable to dse- H problem free from other agency 2. Pre Prepar parati ation on if the com commun munity ity 3. St State atemen mentt of o objbj- depend dependent ent o off com comm. m. dx 4. Ident Identify ify methods methods & instr instruments uments for data colle collectio ction n  A. Method of survey- questi questionnaire onnaire - census (100%) most ideal, enumeratx of data conducted 6 mos. - Sample survey- most practical study study representative of a comm. Size matters in terms of validity validity 1.

B. Inte Interv rvie iew w metho method d - instrument- interview guide/ schedule C. Re Reco cord rds s rrev evie iew w - instrument: checklist D. Ocu Ocula larr insp inspect ection ion// obse observa rvatio tion n - instrument: checklist E. Partic Participa ipant nt observ observati ation on 5. Fin Finali alize ze s samp ampli ling ng d desi esign gn & method methods s  A. Probability- equal chances- random- ( simple, stratified, stratified, cluster) B. Non- pr probabi obability lity-- everyo everyone ne wil willl not have eq equal ual chances/ chances/ no nott equal 6. Ma Make ke a ti time meta tabl ble e

Implementation Phase 1. Da Data ta coll collec ecti tion on 2. Dat Data a org organi anizat zation ion// collat collation ion 3. Data Pres Presentat entation ion (narr (narrativ ative, e, tubula tubular, r, g graphic raphical) al) 4. Da Datta Ana Anallysi sis s 5. Ide Identi ntific ficati ation on of health health pro proble blems ms 6. Pri Priori oritiz tizati ation on of health health pro proble blems ms 7. De Deve velo lopm pmen entt of a heal health th p pla lan n 8. Valid Validation ation and feedba feedbackck- presentati presentation on of results results 10

 

Evaluation Phase 1. Pr Proc oces ess s eval evalua uati tion on 2. Pr Prod oduc uctt eval evalua uati tion on Statistics- science- collection, organization, analysis, interpretation of numerical data. Biostatistics- refers to the application of statistical method to the life science like biology, medicine.  A. Demography- study of p pop op size, composition & spatial distribution distribution as affected by births, births, deaths and migration. migration. Phenomenon of variation - 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 data:ant- value 1. ofConst Constantvalue rem remains ains th the e same from from perso person n to perso person, n, tim time e to time time,, plac place e to place Ex. Minutes/ hour, speed 2. Vari Variab able le-- ex ex.. Te Temp mper erat atur ure e 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 - can be measured e. temp - discrete- whole number or integral values - continuous- fractions, decimals, can attain any decimal Sources of Demographic Data: 1. Survey a.

CenTypes: sus 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 rec recor ords ds - RA 3753 ( Civil Registry Law) registration of births, deaths to local registrars (city health officer or municipal treasurer) - Problem: under registration & de facto registration Unreported birth- unreported death 2.

Weekl Weekly y reports repor ts fr field field health heal th pers personnel onnel R RA A 3573 ( Law on reporting reporting of no notifi tifiable able dse) dse) report to provincial & duty health office - midwife reports – under supervision of the nurse - report within 24H –measles or polio - report within a week- tetanus neonatorum, severe & acute diarrhea, HIV - Problems: under reporting- crisis oriented, concept in health, sx, dx, syndromic approach.

3. Popul Population ation census census-- shd have interv interval, al, ac accurat curate e estimatio estimation n 4. Ind Indiv. iv. Heal Health th re recor cords/ ds/ ffami amily ly rrecor ecords ds - birth cert., school clinic records, employment records, health ctr records, hosp records, health facility logbooks, death cert 5. Publ ublica cattions ons Demography- study of pop size, composition & spatial distribution as affected by births, deaths and migration.

Components: Population Size: 5. Na Natu tura rall incr increa ease se (N (NI) I) NI= birth – deaths 11

 

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 tributi bution on – per percen centt in te terms rms of of age grp grp 2. me medi dian an age age – middl middle e mo most st a age ge MA 20yo 50%= 50%= 20yo 20yo MA younger  3. Dependency ratio= number of dependent (0-14) +65 100 indiv in the prod age ( 15-64 yo) 4. sex rratio atio – number number of of mal males es for every 100 fe female males s Males x 100 Females = SR = 100 (M-F) SR > 100 ( M) SR < 100 ( F) 5. popul population ation p pyrami yramidd- double double bar grap graph h depict depicting ing the a age ge & sex structu structure re of the p pop op 6. Publ Public ic he heal alth th-- SR= SR= 105 105 (birth) SR = age SR

= poor countries

SR = rural communities 0-1 vulnerable age for boys 0-6 7. other other ch char aract actest estic ics: s: - occupational groups - economic grps - educ attainment - ethnic grps- visayan %, bicolano %

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

shows shows the propo proportion rtion of people people livi living ng in urban compa compared red to rural areas

Crowding Index- no. of household members ex. 20 = 4/rm Room for sleeping 4 - indicates the ease by whi which ch a CD can be transmitted fr 1 host to another susceptible susceptible host

3. Population Density-

-

no. of indiv or Square km

indiv 2 Km

determines congestion of the place

Vital Statistics- direct health indicator  - 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  12

 

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 are 1000 How to read: there 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 p op 2. General Fertility Rate (GFR) - true fertility f ertility rate – specific segments of pop that is fertile GFR= ________Birth___________ ________Birth___________ x 1000 Pop of women (15 to 44 yo) Ex. GRF=32 There are 32 births iin n every woman in 15-44 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 2. Specific Mortality Rate- can apply to any pop grp 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: IMR= D Death eath 0 -1 -1 year x 1000 Births



Neonatal Mortality Rate:



Post Neonatal Mortality Rate:

NMR= deaths 0-28 days x 1000 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 30= (ANS) 2_+x10 1000 10=00 1 100 000 0 = 10 200 100 13

 



Maternal Mortality Rate (MMR) MMR= death of women r/t pregnancy, delivery, & puerperium x 1000 Births Ex. IMR = 30 There are 30 infant deaths in every 1000 births 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. 0.1 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 k kill iller er ( TB, heart dse, di diarrhe arrhea) a) Death due to TB x 100

PMR

total deaths = 30%

TB --In every 100 deaths, 30 are due to TB



Case Fatality Rate (CFR) How is survival rate, how strong is killing power, prognosis CFR= death due to part cause x 100 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) - rank as a killer  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) Rank as a common dise 14

 

PR = TB

old and new case of TB x 100,000 total pop

Ex. PR = old & new case of TB x 100,000 TB Ex. PR = 326 TB There are 326 cases of TB out o ut of 100,000 population. 

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

Epidemiology- study of distribution distribution of dse or physiologic ph ysiologic condition among human pop & the factors affecting such distribution. -- 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- envi envi 2. transmission of CD – common vehicle, source- serial- transfer- propagated fr host to host 3. Incubation prd- fr every of pathogens up to appearance of the 1st s/sx 4. Herb ImmunityImmunity- % of immu immune ne poppop- so some me iindiv ndiv are iimmune mmune Dengue- aedes – daytime C  Arthropod malaria – anopheles- nighttime nighttime L E A Neem tree Types of Immunity 1. Passive- quick to come, quick to go Natural- in water, breast feeding  Artificial- serum globulin, ant antiserum, iserum, antitoxi antitoxin n 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- exposure, susceptibility or response to agents. - influenced by intrinsic characteristic - genetic/ family, human behavior, prior immunologic experience - age, sex, ethnic grp, physiologic status Some identified increase risk grps. - mothers, infants, and young children - school children, old people, contacts - people far fr medical assistance - people in areas with endemic dse - people at certain times  Attack Rate- incidence of illness 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. 15

 

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 p roportion 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) Case control study

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

Prospective Cohort (future)

Independent variable (cause) Dependent (effect) National Health Situation Health Indices I. Basic Health Indicators Nutrition Disease Patterns Leading causes 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. 4. 5. 6. 7.

2001-1999 diarrhea br bro onch nchitis pneumonia influenza HPN TB dses dses of the hear heartt

1. 2. 3. 4. 5. 6. 7.

10 Leading Causes of Morbidity 1998 diarrhea pneumonia bron onc chitis influenza HPN TB malaria

1. 2. 3. 4. 5. 6. 7.

1997 diarrhea pneumonia bronchi hittis influenza TB malaria dses dses of the the he hear artt 16

 

8. malaria 9. measles 10. var varice icella lla

8. measles 9. varicella 10. 10. deng dengue ue

8. ds dses es of the he hear artt 9. dengue 10. var varice icell lla a

10 Leading causes of Death 1998 1. dses dses of the hear heartt 2. ds dse e of th the e vas vascu cula larr s sys yste tem m 3. pneumonia

1. dse ses so off tthe he hear heartt 2. ds dses es of va vasc scul ular ar sy syst stem em 3. pneumonia

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

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

ma mali lign gnan antt neop neopla lasm sm accidents TB COPD DM ot oth her pes pesp dse nep nephri hritis tis

1995

ma mali lign gnan antt neop neopllas asm m TB accidents COPD DM othe otherr resp respir irat ator ory yd dse se nep nephri hritis tis

II. Other indicators  A. Infant Mortality 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 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. Normal del delivery ivery and other complications complications r/t pregnancy occurri occurring ng in tthe he course of labor, delivery, and and puerperium 2. HPN compl complicati icating ng pregnancy pregnancy,, chi childbir ldbirth th and and puer puerperiu perium m 3. Post Post part partum um he hemor morrh rhag age e 4. Pre Pregna gnancy ncy wi with th abor abortiv tive e outc outcome ome 5. He Hemo morr rrhag hage e r/ r/tt preg pregna nanc ncy y Life expectancy at birth—life span either: age specific 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 of the people. people. It is large, complex, complex, multi-l multi-level evel and multi-disci multi-disciplinary.” plinary.” FOUR QUESTIONS: 17

 

Who are served?—only a few bec only a few f ew can afford Who provides the services? –health professionals Where are the services given? – hospitals- access physical inaccessibility inaccessibility-- financial What is the focus of care? – curative   Participation 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 p roper division of labor & proper coordination of operations among the government agency jurisdictions. 3. Ensure a minimum level of o f implementation nationwide 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  - Municipal health officer- mayor  -  Assist ____ - municipal municipal

-

Provincial health officer  Health Promotionno threats, no risk- approach behavior  Health Prevention- identified health problem- avoidance behavior  Private Sector  - composed of both commercial and business orgs, non- business orgs NGOs  Assumes the ff roles: roles: - Policy and Legislative Advocates - Organizers, Human Rights Advocates - Research and Documentation - Health Resource Dev Personnel - Relief and Disaster Mgt - Networking THE NATIONAL HEALTH PLAN National Health PlanPlan- a long-term directional plan for heal health. th. This is the blueprint defining the countr country’s y’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-productiv e 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 segments of society   Address specific health health problems of the the population  Upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective 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” 18

 

“23 IN 1993” -- 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”—activities ‘94”—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” - 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” - emphasizing on improvements in health care delivery by maximizing people’s participation in health “ Sentrong Sigla Movement” - pertains to development & implementation of standards to provide quality health services to the people. Strategies and Methodologies - 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, armed-conflict, 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 1. Health Pr Promotionomotion- consists consists of activities directed tow towards ards increasing the level of well-being well-being & actualizing tthe he health potentials of indiv, families, communities, societies - Goals: Goals: wellness level – no ri risk sk fact factor, or, n no o threat threats s Differences with Dse Prevention: not dse/ dysfunction or health problem specific approach _____ behavior not “avoidance behavior” risk to expand positive potential for healthful prevention thwarts the occurrence of pathogens with ____ __ health & well-being. Levels of Health Promotion 1. Indi ndiv wel welllnes ness 2. fa fami mily ly welln ellnes ess s 3. comm commun unit ity y we well llne ness ss 4. envi enviro ronm nmen enta tall w wel elln lnes ess s 5. soci societ etal al we well llne ness ss Methods of health promotion: 1. health educ 2. goo ood d nu nutritx 3. per person sonali ality ty devdev- groo groomin ming g and h hygi ygiene ene 4. provi provision sion of adequat adequate e housing, housing, recr recreatio eation, n, and amenable amenable w workin orking g condition condition HEALTH PROMOTION AND DISEASE PREVENTION IN THE CONTEXT OF A PATHOGENESIS Health promo Healthy person-----------time------------person-----------time---------------------------- healthy person (pathway of health) No risks, no threats, no problems

Pathway of dse---recovery Permanent

s/sx-self-medication 19

 

Death

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

-

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= pregnancies= 3 (4 kids- wit with h risks, >4 increase ri risk) sk) 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 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 theshealth the 1. sou source rces of raw rawoffoodfoo d-ff: w with ithout out pest pestici icides des no double dead meat 2. fo food od han andl dler ers s 3. env envir iron onme ment ntal al sa sani nita 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 fo forr H2O water Needs Nee ds tr trans anspla plant nt Ci Ciste stern rn fl flush ush w with ith s sewa ewage ge sy syste stem m No ttrrans anspl plan antt -c -ciist ster ern n ffllush with s sep epti tic c tta ank

No water   Fly Flying ing s sauc aucerer-pai paill sys system tem (buc (bucket ket llatr atrine ine)) 1. PIT- pri privy vy> >a ant ntiipolo polo,, bor bore h hol ole, e, com ompo post st,, ttw win > ventilate 1 improved pit- less smell > reed odorless earth ea rth closet (ROEC) 2. overhung latrine (batalan) – bangin 3. cat-hole latrine

Consider culture of the peoplePublic toilet- disadvantage- pay, maintenance -very old, young 20

 

-typhoon & night – dangerous 4. Refuse Management- solid and semi-solid waste excluding human excretal Garbage- fruit peelings, left over food- biodegradable Rubbish- broken glass, plastic- non-biodegradable  Acceptance refuse 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 sterilization 7. Good living & working condition 8. Health educ Health promotion best source of prevention p revention Secondary prevention- early dse prompt intervention to halt pathological process to shorten duration, severity & return to normal fxn at earliest possible time. 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 c counse ounseling ling-- risk risk app appraisa raisall for dse p prevent revention ion - risk situation, risk behavior  b. ELISA I c. Po Post st test test cou couns nsel elin ing g - behavioral modification- IMPT - uniqueness of indiv - risk factor: increase probability of dse d. ELISA II e. Wester Western n bloc block k testtest- ((-)) or (+) (+) res result ult w with ith post post counseli counseling ng - Ochar  Characteristics of an ideal screening test: 1. Sensi Sensitivi tivityty- true true posit positive ive rate rate or stren strength gth of as associa sociation tion bet presence presence of 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 21

 

 Awareness ability ability to identify or ____ personal concerns & troubles troubles to bigger contex contextt

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 p roblems will grp together & relate to one another, *identifies a common problem Interest articulation- people recognized problems & ___ diff ways; crying, crying, wailing, swearing due to a problem. problem. People recognizes the the prob & expresses it 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 o obje bject ctive ive c condi onditio tions ns 2. basi basic c trust on peop people le & on ttheir heir iinmat nmate e potentials potentials & capab capabilit ilities ies 3. from from th the e people people for for the the people people & with with the the pe peopl ople e subj of CO= people 4. people want to change self-willed ed changes will have more more meaning ___ ___ then imposed changes – fe fear ar tactics don’t w work ork (imposed) 5. self-will Context of CO: - Current situation- CO is class class based. CO is given to the poor, 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 sound & socially acceptable methods & technology made universally available to ___. Families & communicates communicates at a cost they they can afford at any given stage of dev’t through through their  full participation towards self-reliance and self-determinati self-determination. on. PHC was declared in the ALMA ATA CONFERENC CONFERENCE E 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 the People by the year 2020”. WHAT DOES ESSENTIAL HC IN PHC MEAN? 22

 

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 h erbal 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 Parti Particip cipati ation on 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 Ex.

S cope- wise

Herbal Medicine 1. aromatic- has volatile volatile oil for tx of fever, cough, colds, itchiness itchiness and gas pain. Luya, bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong, lagundi, ___ or 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 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-tasting a. skin problems--Acapul p roblems--Acapulco, co, kalachuchi, malunggay, kakawati, inakabuhay b. depressants- to put hyper people to sleep--dapdap, dita, makabuhay, makahiya c. anti-cancer drug-- tsitsirika 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 23

 

5. grass family- diuretics—kagon, tubo, tanglad, pandan, pugo-pugo, buto-butones, gatas-gatas, atajuo kahol, pansitpansitan 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 indica indicatio tions/ ns/ use uses so off p plan lants ts 2. th the e part part o off the the plan plantt to b be e us used ed 3. prep prepar arat atiion of  a. deco decoct ctio ionn- laga laga/b /boi oill b. poul poulti tice ce-- tapa tapall (m (may ay ad add d oi oil) l) c. infu infusi sion on-- ttea ea a att llea east st 24H 24H d. syrup syrup-- add sugar and fo forr storagestorage- lasts for 3-5 days days e. oin oil oilsba wang, luya, ya, mansani anilya lya e extr xtract act f. oi nstmen tmbawan entt- wg, it ith hlu w wax ax mans g. ti tinc nctu ture re alco alcoho holl h. elixir ba based D. Support mechanism made available

TYPES OF PRIMARY HEALTH WORKERS VILLAGE/ GR GRASSROOTS HE HEALTH WO WORKERS INTERMEDIATE LE LEVEL EX

Tra Trained co communit nity Health worker; health auxillary volunteer; traditional birth attendant

General medical practiotioners Public health nurses Midwives

HEALTH PERSONNEL O OF F FIRST LINE HOSPITALS Physicians with specialty area Nurses dentists

24

 

C H  A R  A C T E R I S

 Initial link, 1st contact of the community

 1st source of professional

 Establish close contact



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

with the village and intermediate 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

Work in liason with the local health service workers Provide elementary curative preventive health care measures



T I 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 M Maternal aternal Care Services Services  Regular and quality pre-natal care - hx-taking, utilization of HBMR (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 5th 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 family we welfare lfare wi with th main focus on wom women’s en’s health, health, safe motherho motherhood od & child survi survival val 2. fr free eedo dom m of of c cho hoic ice e 3. promo promotion tion of fam family ily solidari solidarity ty and responsibl responsible e parenth parenthood ood (exc (except ept birth birth control) control)

-

Causes Short interval of  pregnancies Pregnant before 20 or > 30 yo More Mo re tha than n 4 del deliv iver erie ies s

Possible Effects MOM Bleeding, malnutrition, anemia, HPN  Anemia, miscarriage, miscarriage, still birt birth, h, prolonged labor  HP HPN, N, ble bleedi eding ng,, ru rupt ptur ure e of u ute teru rus. s. 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. spacing 2. hor hormon mones es (pills (pills,, iinje nject ctabl ables) es) 25

 

3. barri barrierer- IUD- condoms condoms (male/femal (male/female), e), cervical cervical cup, diaphr diaphragm, agm, spong sponge, e, spermic spermicides, ides, dental dental dams 4. sc scie ient ntif ific ic fami family ly plan planni 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.

Koch’s phenomenon- inflammation of the site of injection after 2-4 days warm complex  j. Deep abscess at site- incision and drainage k. Indole Indolent nt ulc ulcera erati tionon- ulcer ulcer after after 12 wk wks s l. Glan Glandu dula larr e enl nlar arge geme ment nt-- abs absce cess ss 2-3 weeks abscess will leave scar 12 wks after  DPT- fever for a day - soreness at site within 3-4 days - abscess after a week or more- incision and drainage - 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 early signs, sx, and compl complications. ications. They shd follow th the e 3 CLEANS: CLEAN hands CLEAN surface CLEAN cord B. Improvement of the health personnel’s personnel’s capabilities capabilities on on NB care, midwifery midwifery thr thru u training trainings. s. Trainings for for “hilots” “hilots” must also be conducted C. Improveme Improvement nt on the qu quality ality o off care at the the First First Refer Referral ral Lev Level el 26

 

 

D. E. F. G. H.

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 Preventio Prevention n of unwanted unwanted pregn pregnancies ancies tthroug hrough h family pl plannin anning g servi services ces Pre Preven ventio tion n and manag manageme ement nt of S STDs TDs.. Pro Promot motion ion of appro appropri priate ate healt health h practic practices es Upgrad Upgrade e repor reportin ting g servi services ces Mobilize p political olitical commitment commitment and community involvement involvement to provide support to basic HC delivery delivery

Remember the principles   Even if the interval exceeded that of the expected interval, continue to give the doses of o f 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 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 1st  dose of  DPT. MALNUTRITION MALNUTRI TION 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: ≈ 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 FIRST shd be distributed or used 1st. ♥ 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 3rd 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 Polio Measles TT HepB

Half life 4 hours

8 hours

TARGET SETTING: - Iinvolves the calculation of the eligible e ligible pop. - “ELIGIBLE POP” 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 health-related health-related servi services ces focused on the 0-59 mont months hs old children to assure their wellness and survival. 27

 

 A. Growth and Health Health Monitoring (GMC)  A standard tool used used in health centers to record vital info rel to child growth growth and dev, to assess signs of  malnutrition Sallen “Ming Scale”, Bar and Detect type scales are being used o o  All NBs must be enrolled for UFCP UFCP B. Oral Rehydration Therapy Di Diar arrh rhea ea

(Unu (Unusu sual al freq freque uenc ncy y of of b bow owel el move moveme ment nts s mo morre ttha han n 3x/d 3x/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 ORS 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, (++) skin fold test-15% wt loss

Management for Moderate and Severe: IVF Y

N Assess if can drink

ORS

Y

N NGT

NGT

Y

N

Intravenous fluids, no IV ___ if child child can still drink. If the child can still drink, gi give ve ORS then refer for IV. If child can’t drink dehydrate NGT yes and refer IVF. No NGT refer IVF. IVF. DIARRHEA MANAGEMENT AT HOME 3 F’s ◊

◊

Fluids Oresol Rehydration Therapy Encourage/ensure in inta take ke of an any y fr frui uitt  juices, “am”, “lugaw”,

◊ ◊

◊ ◊

Frequent feeding Continue breastfeeding With Wit h childr children en ove overr 6 mos mos;; cereal cereals/ s/

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

starchy foods mixed with meat or fish and vegetables Mashed banana or any fresh fruit Feed the child at least 6x/day

Danger signs: ◊ Fever  Sunken fontanel ◊ ◊ Sunken eyeball 28

 

homemade soup

◊

 After diarrhea episode, feed 1 extra meal/day for 2 weeks

◊ ◊ ◊ ◊ ◊

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 given ¼- ½ cup every after LBM Child must be given ½ -1 cup every after LBM  Adult must be given 1 or more cups ever every y after LBM

Measures on diarrhea preventx -breastfeed infants - Provide appropriate supplemental feeding - handwashing - utilize clean and potable water  - clean toilet and observe proper feces disposal - 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 R educed allegic reaction E conomical A lways available S afe/ maintains the stool soft T emperature always right

F resh E motional bonding E 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 difficult to digest. D. Imm Immuni unizat zation ion (se (see e EPI) EPI) 29

 

E. Care of Acute Acute R Respir espirator atory y Tract Tract Inf Infectio ections ns (C (CARI) ARI) 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. refe referr urgent urgently ly to to hospit hospital al 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 the treatment. If worse, refer. ♥

Infants less than 2 mos 1. very sev severe ere dse—stopped dse—stopped feed feeding ing wel well, l, convulsions convulsions,, 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 on ly 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 regularly available in all gov’t hospitals, with O2 delivered properly according to Standard ARI/ Pneumonia Case Management otitis titis media, streptococcal sore  Children found to have severe pneumonia, very severe pneumonia, wheezing, o 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 disease 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 least 45% 45% of its prevalence  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 exam.  Case finding and treatment services shall be made available in the BHS/RHUs Treatment   All TB cases must must be treated for free, on ambulatory an and d domiciliary (home) basis, except those w with ith acute complications and emergencies.   All sputum positive positive and cavitary cases cases shall be given priority priority for short course 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: Rifampicin Isoniazid Pyrazinamide   Indicated for patients who are: - (+) sputum smear 

2 months on

Rifampicin + 4 months Isoniazid

31

 

-

Seriously ill (-) sputum smear, (+) extensive lung lesion (+) extrapulmonary cases

8 SCC Patient will be: Rifampicin Isoniazid Pyrazinamide Streptomycin

2 mos on

Rifampicin Isoniazid Ethambutol

+ 4 months

+5 months

Rifampicin Isoniazid Ethambutol

Indicated for those with relapse: - failures - others

4 SCC Patient will be: Rifampicin 2 mos on Isoniazid Pyrazinamide Indicated for PTB minimal (-) sputum smear  2

+ 2 mos

Rifampicin Isoniazid

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

1. Intensive Phase

2 months

Diagnostic: Sputum Exam If (+), proceed to

Rifampicin Isoniazid Pyrazinamide 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 usually usually treatment lasts from 5-10 years. With SCC-MDT, tx can 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 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 32

 

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

Multibacillary

SupervisReidfadmopsiec:in 600mg

SupervisReidfadmopsiec:in 600mg

Dapsone 100 mg Taken once/month in the clinic

Lamprene 300mg taken once/mo in the clinic

Self-administered Dapsone 100mg Taken OD, daily by the patient at home

Self- administered dose Lamprene 50mg taken OD, daily at home



Leprosy patients must be taught ways to prevent secondary injury caused by burns b urns 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 Chemically treated mosquito nets Larva-eating fish Environmental clean-up of stagnant water   Anti- mosquito mosquito soap 33

 

≈

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 with with malaria as soon as he is examined. This may be done thru:

> Clinical - signs and sx - history of visit to and endemis area

>Microscopic - mass blood smear exam

In the event that an imminent epidemic occurs, the ff shd be done:  Mass blood smear collection  Immediate confirmation and follow-up of cases  Insecticide-treatment 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

 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

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

 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 Serv Service ice Three Filaria Co Control ntrol were established and later on integrated with the Regional Health Officers    Activities:  Activiti es: 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 o f 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 d deficiency eficiency 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 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 and other nutritional deficiencies among the population mostly composed of infants and children.

35

 

1. Malnutrition Rehabilitation Program Targeted Food Task Force Nutrition Rehabilitation War Ward Akbayan sa Kalusugan (ASK Project)  Assistance Program Program Provision of food rations of  Every hospital must have a Nurse ward, where an  Aimed to provide provide rice and corn soya bulgur wheat and green adequately trained nutritionist were assigned (RA blend supplemented with local foods. peas 422) Target pop: Target population: 6 mos- 2 years Pre-schoolers Moderately and severely underweight Pregnant women Pre-schoolers not served by the Lactating mothers DSWD and DA in Regions 2,8,9,10,11,12 

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

- a free enrichment program aimed to prevent deficiencies in vitamin  A (blindness); iron iron (anemia); iodine 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 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 anthropo anthropometric metric 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 2 6.9 in women there is the need for wt, reduction Skin Fold Measurement Indicates amount of body fat with the use of fat-caliper  MUAC

Sites: triceps, biceps, subscapular, suprailiac

Estimates lean body mass or skeletal muscle reserves Protein Energy Malnutrition 36

 

Marasmus-- child lacks food rich in CHON & energy Marasmus  ____ usually < 1 year 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  1-3 years old - disease of older children when the next baby is born. This is usually ___ the child - 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. 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 fruit fruit juice enhance Fe absorption 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 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. Abnormalities range from mild such as goiter, to serious as stillbirth, congenital abnormalities, growth and mental retardation& physical and motor abnormalities Consequences: fetus: abortion or miscarriages -congenital abnormalities - stillbirths Causes: Goitrogens and other environment environmental al factors Low intake of Iodine rich foods or low content of iodine in food. Supplementation:

 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

Dangerous Drugs Act RA 6425

“Formally proclaims the state of promoting the use of generic terminology in the importation, manufacture, distribution, marketing, promotion and advertising, labeling, prescribing and dispensing of drugs.” “Reinforces the NDP with regards to the assurance of the high-quality h igh-quality and

“ The safe, administration and transportation of prohibited drugs is punishable by law.” 2 types of drugs: 37

 

rational drug use.”

Prohibited Regulated LSD Benzodiazepines Eucaine Barbiturates Cocaine/ codeine Opiates

 ENVIRONMENTAL SANITATION

Environmental Environm ental 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. Wate Waterr Supp Supply ly Sanit Sanitati ation on P Prog rogram ram 3 typ types es of Approv Approved ed Water Water Su Suppl pply yF Faci acili litie ties s Level 1 Level II Point Source Communal Faucet system or stand posts  A system composed of a source, a reserv reservoir, oir, a  A protected well well of a developed sprung with an outlet but without a piped distribution network and communal distribution system for rural areas faucets, located at not more than 25 meters where houses are thinly scattered. from the farthest house in rural 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 Excre Excreta ta and Sew Sewage age Di Dispos sposal al Sy Syste stem m 3 types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non- water carriage toilet facility: On site toilet facilities of the water  Water carriage types of  - Pit Latrines carriage type with water sealed and toilet facilities connected to flushed type with septic vault/tank septic tanks and/or to - Reed Odorless Earth Closet disposal facilities. sewerage system to - Bored-Hole 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 f acilities 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 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 - open burning - animal feeding - composting - grinding and disposal sewer 

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

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4. Food Food 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 vendors must submit a healt health h cert to det presence of intestinal parasite parasite and bacterial infection. infection. 3 points of contamination  Place of production processing and source of supply  Transportation and storage  Retail and distribution points

5. Ho Hospi spita tall 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 h ospital 6. Progr Programs ams relat related ed to health-risk health-risk minimiz minimization ation secondary secondary to envi environme ronmental ntal poll pollution ution These include the following: f ollowing:   Anti-smoke Belching Belching campaign and Air Pollution Campaign Campaign  Zero Solid Waste Management W aste Management  Toxic, chemical and Hazardous Waste  Red tide Control and Monitoring  Integrated Pest Management and Sustainable Agriculture  Pasig River Rehabilitation Management 7. Edu Educat cation ion o off prevai prevailin ling g health health pr probl oblems ems  Accepted activitiy activitiy at all levels o off public health used as a means of improv improving ing the health of the 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 

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 of well-being well-being where a person can can realize his or her own abilities, tto o cope with the normal normal stresses of  life and work productively 39

 

The emotional adjustment the person achieve in which he can live with reasonable comfort, functioning, acceptably in the community where he/she h e/she lives - Involves the promotion of a healthy state of mind amont the whole pop through ♥ Developing positive outlook in life ♥ Strengthening coping mechanisms

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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. Drug Drugs s and and Alcoh Alcohol ol A Abuse buse Rehab Rehabilit ilitation ation C. Treatment Treatment and and Rehabi Rehabilita litation tion of Mental Mentally-i ly-illll Patients Patients D. Special Special Project Project for Vulnerabl Vulnerable eG Groups roups Stresses in the environment of children such as times of disasters and natural calamities, disintegration 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.

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