Raiders Child Health

DELIVERING CHILD HEALTH SERVICES AS ONE:
The RA eRS Approach

VINCENT J. SUMERGIDO, RN, CRN
Senior Health Program Officer
OUTLINE
Expanded Program on Immunization Law
Vaccine Preventable Diseases & Vaccines
Routine Immunization Schedules
Cold Chain Management
Preparing for Immunization
Conduct of Catch-up Immunization
Recording/Reporting
OUTLINE
Micronutrient Supplementation Guideline
VAC Supplementation Schedule
Deworming Drugs
Deworming Schedule
OVERVIEW / RATIONALE
GOAL
Reduce Under-
Five Mortality by
two-thirds
between 1990 and
2015
CURRENT SITUATION
34 34
30 31
25 24
22 23 26.7 U5MR
19
IMR
NDHS NDHS FHS NDHS MDG/PDP

2003 2008 2011 2013 Target
2015
Situational Analysis: Only NCR, CAR, and 4a was able to attain both U5MR and IMR
MDG target
60 55
52
49
50 IMR
43
37 39
40 34 32 35
31 33
30
30 25 26 23
U5MR Target:
22 21 26.7/1,000 LB
20 36 37
32 33 IMR Target:
26 27 25 26
21 25
19/ 1,000 LB
10 16 16 23 20 23 19 19
0
NCR
CA R
Region 1
Region 3
Region 4B
Region 5
Region 6
Region 8
Region 9
Region 10
Region 11
Region 12
ARMM
Region 2
Region 7
CARAGA
Region 4A
Color Coding:
High child mortality are recorded in rural Target attained
Below Natl. Ave. but
regions, NDHS 2013 Above Target
Above Natl Ave.
Mortality Differentials
40 37 36 Presence of disparities in
32
30 23 health outcomes among
16 the social strata
20 12 13
10
0 Other confounders also
Infant Mortality NCR / ARMM College / No Highest
Rate (Phils.) education Quintile / include higher risk of
Lowest
mortality among:
Distribution of Child Deaths by Period born to mothers aged
of Life 40-49 years old;
60%
53% with high parity of seven
50% 47% (7) and above; and,
born after short birth
40%
0 - 28 days 1- 59 months intervals
(1 mos. to <5 years old)
ESSENTIAL PACKAGE FOR CHILD SURVIVAL
Support of
RaIDeRS
EXPANDED PROGRAM ON
IMMUNIZATION
REPUBLIC ACT 10152
An act providing for MANDATORY BASIC IMMUNIZATON
services for infants and children, repealing for the purpose
PresidenCal Decree No 996, as amended
The act shall be known as Mandatory Infants and Children
ImmunizaCon Act of 2011
The mandatory basic immunizaCon shall be given for FREE at

any government hospital or health center to infants and
children up to ve (5) years of age
EXPANDED PROGRAM ON
IMMUNIZATION
PROGRAM GOALS
Maintenance of Polio Eradication
Elimination of Measles
Elimination of Maternal and Neonatal Tetanus
Control of Diphtheria,Pertusis, Hepatitis B

infection, Tuberculous Meningitis and other
disseminated forms of TB
Maintenance of at least 95% FIC coverage

EXPANDED PROGRAM ON
IMMUNIZATION
WHAT IS FIC (Fully Immunized Child)

A child before reaching 1 year old should receive all of the
following:
1 dose of BCG
3 doses of DPT
3 doses of OPV
3 doses of Hep B
1 dose of AMV
WHAT IS HERD IMMUNITY? SCENARIO 1
Immunized Susceptible Contagious Vaccinated but get the disease
Low population immunity

Chance for contagious to meet susceptible is high
Disease spreads fast. Transmission is sustained.
Outbreaks are frequent
WHAT IS HERD IMMUNITY?: SCENARIO 2
Immunized Susceptible Contagious
High population immunity
Above a certain threshold of population immunity (95% for

measles), chance for contagious to come into contact with
susceptible is low
Disease spread is limited. Outbreaks are small. This population has
Herd immunity
EPI TARGET DISEASES
PoliomyeliCs Mumps
Measles Rubella
Diphtheria Rotavirus
Pertussis (whooping cough) Congenital Rubella
Tetanus Syndrome
Disseminated Tuberculosis Pneumococcal Disease
(TB) Human Papillomavirus
HepaCCs B InfecCon
EPI VACCINES
BCG (Bacillus of Calmette Guerin)
Type of Vaccines Live ASenuated
No. of doses One (1) dose only
Schedule At birth (before 1 year of age)
Dose 0.05mL
InjecCon Site Upper Arm
InjecCon Type Intradermal
Side Eects Local reacCon
Storage +2 to +8 C
EPI VACCINES (BCG)
BCG is freeze-dried.
Before you can use BCG, you must reconsCtute the
dry vaccine with an accompanying diluent.
Maximum of 6 hours only aêr reconsCtuCon
BCG is damaged most easily by sunlight.
EPI VACCINES
Hepatitis B (birth-dose)
Type of Vaccines InacCvated vaccine
Schedule Within 24Hours
Dose 0.5mL
InjecCon Site Outer-mid thigh
InjecCon Type Intramuscular
Side Eects Local soreness
Storage +2 to +8 C
EPI VACCINES (HEPATITIS B)
Gold Standard: WITHIN 24 Hours
If not given within 24 hours, given immediately aêr
24 hours before 2 weeks of age.
EPI VACCINES
Pentavalent Hib
Type of Vaccines Inactivated vaccine
Component D, P, T, HepaB, H. Influenza type B
No. of doses Three (3) doses (one month apart)
Schedule 6, 10, 14 weeks
Dose 0.5mL
Injection Site Outer-mid thigh
Injection Type Intramuscular
Side Effects Local reaction, fever
Storage +2 to +8 C
EPI VACCINES (PENTAHIB)
Shake the vial before aspiraCon of the vaccine.
Do not massage injecCon site.
Apply pressure to the site.
Instruct mothers for side eects management:
FEVER: Increase uids; Paracetamol; TSB
LOCAL REACTION: Cold Compress
EPI VACCINES
Oral Polio Vaccine
Type of Vaccines Live Attenuated Vaccine
Dose 2 drops
Injection Site -------
Injection Type Oral
Side Effects Usually none
Storage -15 to -25 C
EPI VACCINES (OPV)
Oral polio vaccine (OPV) is damaged very quickly by
heat.
If the child has diarrhea, give the dose now, unCl
compleCon of the series. Then give an extra dose
one month aêr the last dose in the series.
EPI VACCINES
Pneumococcal Conjugate Vaccine
Type of Vaccines Inactivated vaccine
Dose 0.5mL
Injection Site Outer-mid thigh
Injection Type Intramuscular
Side Effects Local reaction, fever
Storage +2 to +8 C
Can start giving vaccines around July-August once stocks arrive
EPI VACCINES
Measles
Schedule 9 months
Dose 0.5mL
InjecCon Type Subcutaneous
Side Eects Local reacCon, fever, rash
Storage +2 to +8 C
EPI VACCINES (MEASLES)
Measles is freeze-dried.
You must reconsCtute the dry vaccine with an accompanying
diluent.
Maximum of 6 hours only aêr reconsCtuCon
Management of side eects:
Fever (develops 5-12days a_er, lasts for 2 days) Increase
OFI
Rash (develops 5-12days a_er, lasts for 2 days) No acCon
needed
Soreness (may occur in 24H) resolves within 2-3 days
EPI VACCINES
Measles-Mumps-Rubella (MMR)
Schedule 12-15 months
Dose 0.5mL
InjecCon Type Subcutaneous
Side Eects Local reacCon, fever, rash
Storage +2 to +8 C
6 10 14 9 12
Vaccine Birth
weeks weeks weeks months months
BCG
EPI VACCINES
HEPA B Included in Included in Included in
Penta Penta Penta
OPV 1
PENTA 1 Right Thigh
PCV 1 Left Thigh
OPV 2
PENTA 2 Right Thigh
PCV 2 Left Thigh
OPV3
PENTA3 Right Thigh
PCV3 Left Thigh

Separated by
2.5cm apart
IPV Left Thigh
MEASLES
MMR
BEFORE USING THE VACCINES:
ALWAYS Check the following:
If this is the right vaccine that you need
The dose that you should give and site of
administraCon
The vaccine is stored in the right place at the right
temperature
The vaccine is not expired:
1) Look for expiry date
2) Color change in the vaccine vial monitor (VVM)
Different stages of VVM colour change
BCG, Measles, MMR are discarded 6 hours aêr

reconsCtuCon
PentaHib, IPV, HepaCCs-B, Tetanus Toxoid, & OPV

are under the MulCdose Vial Policy
Conditions for MDVP
C proper Cold Chain is maintained at all times
A Aseptic /sterile technique has been used to withdraw all doses
V Vaccine Vial Monitor (VVM) has not reached the discard point
E Expiry date has not passed
S septum/vial has not been submerged in water
D Date of opening is indicated
IDENTIFY DEFAULTERS
What is a defaulter?
All children who have not received their vaccines at the
recommended age and schedule are considered as DEFAULTER

Who are our target age groups in defaulter tracking?
All under ve (5) year old children. They should complete their
primary series before they turn ve years old

How to look for defaulters?
TCL Tracking
House to House (TSiSMIS)
Defaulter Tracking Form
Province:
Municipality: IDENTIFY DEFAULTERS Target
(Eligible
Population)
Month: Barangay: : Date:
VACCINE NOT GIVEN Exclusive Breastfeeding Vita
REM
NBS min
AGE DATE ARK
AMV done A
NAME (0-11 HEP OPV OPV OPV PEN PEN PEN VACCINE S/
BCG PCV1 PCV2 PCV3 (MC Yes/ given
mos) B 1 2 3 TA 1 TA 2 TA 3 GIVEN REA
V1) No Yes/
SON
1 2 3 4 5 6 No

PREPARING FOR IMMUNIZATION
A. Prepare all the necessary equipment and supplies for
immunizaCon
1. IdenCfy the number of children to be vaccinated.
2. Calculate the needed vials of vaccine/diluents:
BCG No. of Children to be vaccinated x 2.5 20
HepaB - No. of Children to be vaccinated x 1.1 10
PentaHib (single dose vial) - No. of Children to be vaccinated x 1.1
OPV - No. of Children to be vaccinated x 1.67 20
Measles - No. of Children to be vaccinated x 2 10
MMR - No. of Children to be vaccinated x 1.1 5
immunizaCon
Calculate the needed vials of vaccine:
PCV (single dose vial) Total Number of Children to be vaccinated x
1.1

Calculate the number of needed syringes
AD Syringe Total Number of Children to be vaccinated x 1.1
Mixing Syringe Total Number of Vials for reconsCtuCon x 1.1
(BCG,Measles,MMR)
immunizaCon
Secure availability of vaccine carriers
Adequate number of condiAoned ice packs
Foam slit
Secure Individual Treatment Records (ITR) or Recording Forms
Secure Epinephrine Kits
Have available Thermometers, Stethoscope
Safety Collector Boxes
B. Pack vaccines properly into a vaccine carrier
Place vaccines/diluents in a plasCc container to
prevent wejng
Ensure condiConed icepacks are adequate
Pack accordingly based on the manufacturers
guide
How to condition icepacks:
CONDUCT OF IMMUNIZATION
Set-up the vaccine carrier
C. PosiCon the child properly
D. Administer the vaccine properly
Correct Vaccine
Correct Dose
Correct Site
Correct Technique

DISPOSE USED Syringes in the Safety Collector Box

E. Give proper instrucCons to mothers during
vaccinaCon
Inform about the side eects and their management
Assess why the child missed the immunizaCon session
Correct misconcepCon
Set the date of the next injecCon schedule
If you see other signs/symptoms, refer IMMEDIATELY
to the Health Center
Signs / Symptoms to Watch out
DANGER SIGNS:
Convulsions
Less than 6 months of age
6months & up: more than 1 episode during the
present illness lasCng more than 15mins
Vomits everything
Lethargic
unable to Drink or breasoeed
Cough / Diculty Breathing
Diarrhea
Fever
Ear Problem
Anemia
MalnutriCon

Umbilicus is red or draining with pus
Skin pustules
Low body temperature (less than
35.5)

CORRECT MISCONCEPTION
Remember: VACCINES ARE ONE OF THE MOST SAFEST
PUBLIC HEALTH COMMODITY
There are not much contraindicaCon to vaccinaCon.
All infants should be immunized EXCEPT for these situaCons:
Anaphylaxis/Severe allergic reacCon to a previous dose.
Persons known to have an allergy to a component of a vaccine
Do not give BCG to a person exhibiCng signs & symptoms of
AIDS
F. Record date during immunizaCon
For less than 1 year of age:
Record the date and the type of vaccine given in the ECCD
Card and your Recording Form. Reect these informaCon
in the ITR & TCL later. (This will be used by the Midwives
for her rouAne reporAng)

Indicate in the Catch-up immunizaCon forms the name of
vaccine, Lot No, expiraCon date, VVM status.

F. Record date during immunizaCon
For less 1 year of age to less than 5 years old:
Record the date and the type of vaccine given in the ECCD
Card and your Recording Form. Reect these informaCon
in the ITR.
Indicate also in the Catch-up immunizaCon forms the name
of vaccine, Lot No, expiraCon date, VVM status.

ANAPHYLAXIS MANAGEMENT
PRIORITIZATION OF AREAS TO RAID
How will we prioriCze areas to Raid?

Use the Reaching Every Barangay Strategy
This strategy will idenCfy highly populated areas with
poor service coverage where resources will be
focused
Surrogate Indicator: Number of unimmunized for
MCV2
Gather Data Analyze problems
REB Analysis Highest

Unimmunized
Doses of Vaccines
Unimmunized for MCV2
Administered
Target (No.)
Total Pop Administered
Municipality of: Pop
Pototan Prioritize area
MCV2 MCV2 Priority 1,2,3
a b c d e f
Barangay A 1,500 41
Barangay B 3,500 95
Barangay C 1,750 47
Barangay D 2,800 76
STEP 1: Gather Data

Doses of Vaccines Unimmunized
Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Municipality of: Total Pop x (get from TCL) (c d) Prioritize area
Pototan 2.7%
a b c d e f
Barangay A 1,500 41
Barangay B 3,500 95
Barangay C 1,750 47
Barangay D 2,800 76
STEP 1: Gather Data

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay A 1,500 41 30
Barangay B 3,500 95 80
Barangay C 1,750 47 35
Barangay D 2,800 76 65
STEP 2: Calculate for the Number of Unimmunized MCV2

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay A 1,500 41 30
Barangay B 3,500 95 80
Barangay C 1,750 47 35
Barangay D 2,800 76 65
STEP 2: Calculate for the Number of Unimmunized MCV2

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay A 1,500 41 30 11
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
STEP 3: Arrange in order from Highest to lowest unimmunized

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay A 1,500 41 30 11
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
STEP 3: Arrange in order from Highest to lowest unimmunized

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
Barangay A 1,500 41 30 11
STEP 4: IdenCfy the Brgys where 75% of unimmunized are found

Unimmunized
Administered (No.)
Target Pop for MCV2
Administered

Total Pop
Pototan 2.7%
a b c d e f
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
Barangay A 1,500 41 30 11
Unimmunized
Target Pop Administered (No.)
for MCV2
Administered
Total Pop
Total Pop x
Municipality of: Prioritize area
2.7% (get f rom T CL) (c d)
Pototan
a b c d e f
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
Barangay A 1,500 41 30 11
A. Sum up: 15 + 12 + 11 +11 = 49

B. Get 75%: 49 x 75% = 37
C. Start adding the highest unimmunized to get
total of 37
Unimmunized
Target Pop Administered (No.)
for MCV2
Administered
Total Pop
Total Pop x
Municipality of: Prioritize area
2.7% (get f rom T CL) (c d)
Pototan
a b c d e f
Barangay B 3,500 95 80 15
Barangay C 1,750 47 35 12
Barangay D 2,800 76 65 11
Barangay A 1,500 41 30 11
A. Sum up: 15 + 12 + 11 +11 = 49

B. Get 75%: 49 x 75% = 37
C. Start adding the highest unimmunized to get
total of 37
Barangay B, C, D are now the PRIORITY Barangays to

Raid.

These are the barangays wherein when we focus our
resources, will PULL-UP the over all accomplishments
of the Municipality.

VITAMIN A
SUPPLEMENTATION
CHILD HEALTH
CAMPAIGNS
ROUTINE SUPPLEMENTATION
Vitamin A is crucial for Child Survival

Reduces the risk from mortality by 23-34%
Reduces deaths due to Measles by about 50%
Reduces deaths due to diarrhea by about 40%
It plays an important role in promoCng and
maintaining good vision
Promotes healthy lining of eyes, respiratory, urinary,
intesCnal tracts
INFANTS: 0-11 MONTH OLD
6-11 month old infants need regular iron and Vit. A
supplementaCon for rapid growth and development
CHILDREN 12-59 MONTH OLD (1-<5 YEAR OLD)

Regular iron supplementaCon to 12-23 month old
because of high prevalence of anemia and increased
daily requirement
Two doses Vit. A a year for children 12-59 months

SIDE EFFECTS AND
CONTRAINDICATIONS:
Usually no side eects if given according to
recommended dose
If child complains of loss of appeCte, vomiCng,
headache, nausea, these are temporary and
disappear within 24 hours
PrecauCons:
Always ask the last dose of Vit.A given to avoid
overdose
Never give Vit.A supplement to pregnant women
except if with xerophthalmia
EXCLUSIVE
BREAST
FEEDING
INFANTS: 0-11 MONTH OLD
6-11 month old infants need regular iron and Vit. A
supplementaCon for rapid growth and development
CHILDREN 12-59 MONTH OLD (1-<5 YEAR OLD)

Regular iron supplementaCon to 12-23 month old
because of high prevalence of anemia and increased
daily requirement
Two doses Vit. A a year for children 12-59 months

EXCLUSIVE BREASTFEEDING
Exclusive breastfeeding means that an infant
receives only breastmilk with no additional
foods or liquids, not even water.
Exclusively breastfeed their babies for at least
the first six (6) months of the baby
Breastfeeding reduces the risk of uterine
bleeding after delivery, and helps return the
uterus to its pre-pregnant size
DEWORMING
WHY DEWORM?
STH infections impair healthy nutrition
Crompton et al. 2002
Untreated STH-infected children have higher levels

of stunting,5 lower body-mass index, anemia, and
undernourishment
Dantzer 2001, Stoltzfus 2004, de Leon and Lumampao 2005) Stoltzfus et al. 199. 7
Children 1-5 years old suer the greatest morbidity

when infected. Deworming is intended as curaNve
care to ensure child survival.
WHY DEWORM?
Under 5 year old children:

Deworm every 6 months
starCng 1 year of age
CONTRAINDICATION TO DEWORM
Fever
Abdominal Pain
Diarrhea
Sever MalnutriCon
Infant care
Child
"ALONE WE CAN DO SO LITTLE,TOGETHER
WE CAN DO SO MUCH."

Raiders Child Health

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DELIVERING CHILD HEALTH SERVICES AS ONE:

The RA eRS Approach

NDHS NDHS FHS NDHS MDG/PDP

The mandatory basic immunizaCon shall be given for FREE at

Elimination of Maternal and Neonatal Tetanus

Control of Diphtheria,Pertusis, Hepatitis B

Maintenance of at least 95% FIC coverage

Low population immunity

High population immunity

Above a certain threshold of population immunity (95% for

PCV 1 Left Thigh

PCV 2 Left Thigh

PCV3 Left Thigh

BCG, Measles, MMR are discarded 6 hours a^er

PentaHib, IPV, HepaCCs-B, Tetanus Toxoid, & OPV

How will we prioriCze areas to Raid?

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

REB Analysis Highest

MCV2 MCV2 Priority 1,2,3

A. Sum up: 15 + 12 + 11 +11 = 49

A. Sum up: 15 + 12 + 11 +11 = 49

Barangay B, C, D are now the PRIORITY Barangays to

Vitamin A is crucial for Child Survival

CHILDREN 12-59 MONTH OLD (1-<5 YEAR OLD)

CHILDREN 12-59 MONTH OLD (1-<5 YEAR OLD)

Untreated STH-infected children have higher levels

Children 1-5 years old suer the greatest morbidity

Under 5 year old children:

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