Expanded Program for Immunization (EPI)

1. Epidemiological situation
2. Mass approach
3. Basic Health Service
The 7 immunizable diseases

1. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. Hepatitis B
Target Setting

 Infants 0-12 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old
Objectives of EPI

 To reduce morbidity and mortality rates among infants and children from six childhood
immunizable disease
Elements of EPI

 Target Setting

# of
Vaccine Content Form & Dosage Doses Route

Freeze dried
BCG (Bacillus Live Infant-
Calmette attenuated 0.05mlPreschool-
Guerin) bacteria 0.1ml 1 ID

DPT (Diphtheria DT-

Pertussis weakened
Tetanus) toxin liquid-0.5ml 3 IM
 P-killed
bacteria

OPV (Oral Polio weakened

Vaccine) virus liquid-2drops 3 Oral

Plasma
Hepatitis B derivative Liquid-0.5ml 3 IM

Weakened
Measles virus Freeze dried- 0.5ml 1 Subcutaneous

 Cold chain Logistic Management- Vaccine distribution through cold chain is designed to
ensure that the vaccines were maintained under proper environmental condition until the
time of administration.
 Information, Education and Communication (IEC)
 Assessment and evaluation of Over-all performance of the program
 Surveillance and research studies
Administration of vaccines

Schedule of Vaccines

Age at Interval
Vaccine 1st dose between dose Protection

BCG is given at the earliest possible age

protects against the possibility of TB
BCG At birth infection from the other family members

An early start with DPT reduces the

DPT 6 weeks 4 weeks chance of severe pertussis

The extent of protection against polio is

OPV 6weeks 4weeks increased the earlier OPV is given.

@birth,6th
week,14th
Hepa B @ birth week An early start of Hepatitis B reduces
 the chance of being infected and
becoming a carrier.

9m0s.- At least 85% of measles can be

Measles 11m0s. prevented by immunization at this age.

 6 months – earliest dose of measles given in case of outbreak

 9months-11months- regular schedule of measles vaccine
 15 months- latest dose of measles given
 4-5 years old- catch up dose
 Fully Immunized Child (FIC)– less than 12 months old child with complete immunizations of
DPT, OPV, BCG, Anti Hepatitis, Anti measles.
Tetanus Toxiod Immunization

Schedule for Women

% Duration of
Vaccine Minimum age interval protected Protection

TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

1year later/during next

TT4 pregnancy 99% 10 years

TT5 1 year later/third pregnancy 99% Lifetime

 There is no contraindication to immunization except when the child is immunosuppressed

or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after
a DPT or measles vaccine, report such to the doctor immediately.
 Malnutrition is not a contraindication for immunizing children rather; it is an indication for
immunization since common childhood diseases are often severe to malnourished
children.
Cold Chain under EPI

 Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to
the time it is given to child or pregnant woman.
 The allowable timeframes for the storage of vaccines at different levels are:
  6months- Regional Level
 3months- Provincial Level/District Level
 1month-main health centers-with ref.
 Not more than 5days- Health centers using transport boxes.
 Most sensitive to heat: Freezer (-15 to -25 degrees C)
 OPV
 Measles
 Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
 BCG
 DPT
 Hepa B
 TT
 Use those that will expire first, mark “X”/ exposure, 3rd- discard,
 Transport-use cold bags let it stand in room temperature for a while before storing DPT.
 Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
 FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are
utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines
expiry date are done to identify those near to expire vaccines.

Philippine Health Care Laws

REPUBLIC ACT – an act passed by the Congress of the Philippines, while the form of government
is Republican government.
 Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific
purposes.
 Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial
or agricultural establishment to furnish free emergency, medical and dental assistance to
his employees and laborers.
 Republic Act 1080 – Civil Service Eligibility
 Republic Act 1082 – Rural Health Unit Act
 Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
 Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid January 31
of each year
 Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
 Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in the
Philippines
 Republic Act 2644 – Philippine Midwifery Act
 Republic Act 3573 – Law on reporting of Communicable Diseases
 Republic Act 4073 – Liberalized treatment of Leprosy
 Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it can
operative
 Republic Act 5181 – Act prescribing permanent residence and reciprocity as qualifications
for any examination or registration for the practice of any profession in the Philippines
 Republic Act 5821 – The Pharmacy Act
 Republic Act 5901 – 40 hours work for hospital workers
 Republic Act 6111 – Medicare Act
 Republic Act 6365 – Established a National Policy on Population and created the
Commission on population
 Republic Act 6425 – Dangerous Drug Act of 1992
 Republic Act 6511 – Act to standardize the examination and registration fees charged by
the National Boards, and for other purposes.
 Republic Act 6675 – Generics Act of 1988
 Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
 Republic Act 6725 – Act strengthening the prohibition on discrimination against women
with respect to terms and condition of employment
 Republic Act 6727 – Wage Rationalization Act
 Republic Act 6758 – Standardized the salaries
 Republic Act 6809 – Majority age is 18 years old
 Republic Act 6972 – Day care center in every Barangay
 Republic Act 7160 – Local Government Code
 Republic Act 7164 – Philippine Nursing Act of 1991
 Republic Act 7170 – Law that govern organ donation
 Republic Act 7192 – Women in development nation building
 Republic Act 7277 – Magna Carta of Disabled Persons
 Republic Act 7305 – The Magna Carta of public Health Workers
 Republic Act 7392 – Philippine Midwifery Act of 1992
 Republic Act 7432 – Senior Citizen Act
 Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
 Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
 Republic Act 7624 – Drug Education Law
 Republic Act 7641 – New Retirement Law
 Republic Act 7658 – An act prohibiting the employment of children below 15 years of age
 Republic Act 7719 – National Blood Service Act of 1994
 Republic Act 7875 – National Health Insurance Act of 1995
 Republic Act 7876 – Senior Citizen Center of every Barangay
 Republic Act 7877 – Anti-sexual harassment Act of 1995
 Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
 Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
 Republic Act 8172 – Asin Law
 Republic Act 8187 – Paternity Leave Act of 1995
 Republic Act 8203 – Special Law on Counterfeit Drugs
 Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
 Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD 1146)
 Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment
 Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
 Republic Act 8424 – Personal tax Exemption
 Republic Act 8749 – The Philippine Clean Air Act of 1999
 Republic Act 8981 – PRC Modernization Act of 2000
 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
 Republic Act 9173 – Philippine Nursing Act of 2002
 Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This power of the President which allows
him/her to act as legislators was exercised during the Marshall Law period.
 Presidential Decree 46 – An act making it punishable for any public officials or employee,
whether of the national or local government, to receive directly or indirectly any gifts or
valuable things
 Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children
 Presidential Decree 69 – Limits the number of children to four (4) tax exemption purposes
 Presidential Decree 79 – Population Commission
 Presidential Decree 147 – Declares April and May as National Immunization Day
 Presidential Decree 148 – Regulation on Woman and Child Labor Law
 Presidential Decree 166 – Strengthened Family Planning program by promoting
participation of private sector in the formulation and implementation of program planning
policies.
 Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries
resulting from any form of violence.
 Presidential Decree 223 – Professional Regulation Commission
 Presidential Decree 442 – Labor Code Promotes and protects employees self-organization
and collective bargaining rights. Provision for a 10% right differential pay for hospital
workers.
 Presidential Decree 491 – Nutrition Program
 Presidential Decree 539 – Declaring last week of October every as Nurse’s Week. October
17, 1958
 Presidential Decree 541 – Allowing former Filipino professionals to practice their
respective professions in the Philippines so they can provide the latent and expertise
urgently needed by the homeland
 Presidential Decree 568 – Role of Public Health midwives has been expanded after the
implementation of the Restructed Health Care Delivery System (RHCDS)
 Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
 Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide
benefits to person covered by SSS and GSIS for immediate injury, illness and disability.
 Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
 Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms
of uncleanliness and for other purposes.
 Presidential Decree 851 – 13th Month pay
 Presidential Decree 856 – Code of Sanitation
 Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction
on family planning and responsible parenthood.
 Presidential Decree 996 – Provides for compulsory basic immunization for children and
infants below 8 years of age.
 Presidential Decree 1083 – Muslim Holidays
 Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take
Board Examination pending their naturalization.
 Presidential Decree 1519 – Gives medicare benefits to all government employees
regardless of status of appointment.
 Presidential Decree 1636 – requires compulsory membership in the SSS and self-employed
 Presidential Decree 4226 – Hospital Licensure Act
PROCLAMATION – an official declaration by the Chief Executive / Office of the President of the
Philippines on certain programs / projects / situation
 Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the
immunization program
 Proclamation No. 118 – Professional regulation Week is June 16 to 22
 Proclamation No. 499 – National AIDS Awareness Day
 Proclamation No. 539 – Nurse’s Week – Every third week of October
 Proclamation No. 1275 – Declaring the third week of October every year as “Midwifery
Week”
LETTER OF INSTRUCTION – An order issued by the President to serve as a guide to his/her
previous decree or order.
 LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions
and social work to prepare, plan and implement integration of family planning in their
curriculum to require their graduate to take the licensing examination.
 LOI 949 – Act on health and health related activities must be integrated with other
activities of the overall national development program. Primary Health Care (10-19-79)
 LOI 1000 – Government agencies should be given preference to members of the accredited
professional organization when hiring
EXECUTIVE ORDER – an order issued by the executive branch of the government in order to
implement a constructional mandate or a statutory provision.
 Executive Order 51 – The Milk Code
 Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and
Good Quality drugs to all
 Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the
right to Organize of government employee.
 Executive Order 203 – List of regular holidays and special holidays
 Executive Order 209 – The Family Code (amended by RA 6809)
 Executive Order 226 – Command responsibility
 Executive Order 503 – Provides for the rules and regulations implementing the transfer of
personnel, assets, liabilities and records of national agencies whose functions are to be
devoted to the local government units.
 Executive Order 857 – Compulsory Dollar Remittance Law
Other Important Information
 Administrative Order 114 – Revised/updated the roles and functions of the Municipal
Health Officers, Public Health Nurses and Rural Midwives
 ILO Convention 149 – Provides the improvement of life and work conditions of nursing
personnel.

Laws Affecting Public Health and Practice of CHN

R.A. 7160 – or the Local Government Code

 This involves the devolution of powers, functions and responsibilities to the local
government both rural & urban. The Code aims to transform local government units into
self-reliant communities and active partners in the attainment of national goals thru’ a
more responsive and accountable local government structure instituted thru’ a system of
decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD
(LHB) which is mandated to propose annual budgetary allocations for the operation and
maintenance of their own health facilities.
Composition of LHB

Provincial Level

1. Governor- chair
2. Provincial Health Officer – vice chairman
3. Chairman, Committee on Health of Sangguniang Panlalawigan
4. DOH representative
5. NGO representative
City and Municipal Level

1. Mayor – chair
2. MHO – vice chair
3. Chairman, Committee on Health of Sangguniang Bayan
4. DOH representative
5. NGO representative
Effective Local Health System Depends on:

1. The LGU’s financial capability

2. A dynamic and responsive political leadership
3. Community empowerment
R.A. 2382 – Philippine Medical Act.

 This act defines the practice of medicine in the country.

R.A. 1082 – Rural Health Act.

 It created the 1st 81 Rural Health Units.

  amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary inspectors
will live in the rural areas where they are assigned in order to raise the health conditions of
barrio people ,hence help decrease the high incidence of preventable diseases
R.A. 6425 – Dangerous Drugs Act

 It stipulates that the sale, administration, delivery, distribution and transportation of

prohibited drugs is punishable by law.
R.A. 9165 – the new Dangerous Drug Act of 2002

P.D. No. 651

 Requires that all health workers shall identify and encourage the registration of all births
within 30 days following delivery.
P.D. No. 996

 Requires the compulsory immunization of all children below 8 yrs. of age against the 6
childhood immunizable diseases.
P.D. No. 825

 Provides penalty for improper disposal of garbage.

R.A. 8749 – Clean Air Act of 2000

P.D. No. 856 – Code on Sanitation

 It provides for the control of all factors in man’s environment that affect health including
the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary
and recreation facilities, noise, pollution and control of nuisance
R.A 6758

 Standardizes the salary of government employees including the nursing personnel.

R.A. 6675 – Generics Act of 1988

 Which promotes, requires and ensures the production of an adequate supply, distribution,
use and acceptance of drugs and medicines identified by their generic name.
R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees

 It is the policy of the state to promote high standards of ethics in public office. Public
officials and employees shall at all times be accountable to the people and shall discharges
their duties with utmost responsibility, integrity, competence and loyalty, act with
patriotism and justice, lead modest lives uphold public interest over personal interest.

R.A. 7305 – Magna Carta for Public Health Workers

 This act aims: to promote and improve the social and economic well-being of health
workers, their living and working conditions and terms of employment; to develop their
skills and capabilities in order that they will be more responsive and better equipped to
 deliver health projects and programs; and to encourage those with proper qualifications
and excellent abilities to join and remain in government service.
R.A. 8423

 Created the Philippine Institute of Traditional and Alternative Health Care.

P.D. No. 965

 Requires applicants for marriage license to receive instructions on family planning and
responsible parenthood.
P.D. NO. 79

 Defines, objectives, duties and functions of POPCOM

RA 4073

 advocates home treatment for leprosy

Letter of Instruction No. 949

 legal basis of PHC dated OCT. 19, 1979

 promotes development of health programs on the community level
RA 3573

 requires reporting of all cases of communicable diseases and administration of prophylaxis

Ministry Circular No. 2 of 1986

 includes AIDS as notifiable disease

R.A. 7875 – National Health Insurance Act

R.A. 7432 – Senior Citizens Act

R. A. 7719 – National Blood Services Act

R.A. 8172 – Salt Iodization Act (ASIN LAW)

R.A. 7277- Magna Carta for PWD’s

 provides their rehabilitation, self development and self-reliance and integration into the
mainstream of society
A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding:

1. All newborns be breastfeed within 1 hr after birth

2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. Breastfeeding be continued up to 2 years and beyond
EO 51- Phil. Code of Marketing of Breast milk Substitutes

R.A. – 7600 – Rooming In and Breastfeeding Act of 1992

R.A. 8976- Food Fortification Law

R.A. 8980

 promulgates a comprehensive policy and a national system for ECCD

A.O. No. 2006- 0015

 defines the Implementing guidelines on Hepatitis B Immunization for Infants

R.A. 7846

 mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs
old
R.A. 2029

 mandates Liver Cancer and Hepatitis B Awareness Month Act (February)

A.O. No. 2006-0012

 specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code,
Relevant International Agreements, Penalizing Violations thereof and for other purposes

Garantisadong Pambata (GP)

Definition

 Garantisadong Pambata is a biannual week long delivery of a package of health services to

children between the ages of 0-59 months old with the purpose of reducing morbidity and
mortality among under fives through the promotion of positive Filipino values for proper
child growth and development.
Routine Health Services

Route of
Health Service Dosage Administration Target Population

12-59 months old,

200,000 IU or 1 nationwide9-12 months
capsule100,000 IU or old infants receiving AMV
Vitamin A capsule ½ cap or 3 drops Orally by drops nationwide

Ferrous Sulfate(25 mg.
Elemental Iron per ml; 30
ml. Bottle as taken home
medicine with instructions)
2-11 months old infants in
0.3ml(2-6 mos) once Mindanao area, including
a day evacuation centers in
Orally by drops armed conflict areas.
0.6ml(6- 11mos) once
a day

Routine Immunization-
BCG* 0.05ml Intradermal on Nationwide0-11 mos
right deltoid
-DPT* 0.5ml 0-11 mos
Intramuscularly
-OPV* 2 drops on anterior thigh 0-11 mos
Orally
-AMV* 0.5ml 9-11 mos
Subcutaneously
-Hepa B (if 0.5ml on deltoid 0-11 mos

available) Intramuscularly

Deworming drug(if 1 tablet as single

available) dose Orally 36-59 mos, nationwide

Weighing 0-59 mos, nationwide

 The child should not have received megadose of Vit. A above the recommended dosage
within the past 4 weeks except if the child has measles or signs and symptoms of Vit A.
deficiency.
 For any child between 12-23 months, who missed any of his routine immunization, the
health worker should give the child the necessary antigen to complete FIC and shall be
recorded as such.
Garantisadong Pambata

Sangkap Pinoy

 Vitamin A, Iron and Iodine

 Sources: green leafy and yellow vegetables, fruits, liver, seafoods, iodized salt, pan de bida
and other fortified foods.
 These micronutrients are not produced by the body, and must be taken in the food we eat;
essential in the normal process of growth and development:
1. Helps the body to regulate itself
 2. Necessary in energy metabolism
3. Vital in brain cell formation and mental development
4. Necessary in the body immune system to protect the body from severe infection.
5. Eating Sangkap Pinoy-rich foods can prevent and control:

 Protein Energy Malnutrition
 Vitamin A Deficiency
 Iron Deficiency Anemia
 Iodine Deficiency Disorder
Breastfeeding

 Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is recommended for
the first six months of life. At about six months, give carefully selected nutritious foods as
supplements.
 Breastfeeding provides physical and psychological benefits for children and mothers as
well as economic benefits for families and societies.
Benefits:

For infants
1. Provides a nutritional complete food for the young infant.
2. Strengthens the infant’s immune system, preventing many infections.
3. Safely rehydrates and provides essential nutrients to a sick child, especially to those
suffering from diarrheal diseases.
4. Reduces the infant’s exposure to infection.
For the Mother
1. Reduces a woman’s risk of excessive blood loss after birth
2. Provides a natural method of delaying pregnancies.
3. Reduces the risk of ovarian and breast cancers and osteoporosis.
For the Family and Community
1. Conserves funds that otherwise would be spent on breast milk substitute, supplies and fuel
to prepare them.
2. Saves medical costs to families and governments by preventing illnesses and by providing
immediate postpartum contraception.
Complimentary Feeding for Babies 6-11 Months Old

What are Complementary Foods?

1. foods introduced to the child at the age 6 months to supplement breastmilk
2. Given progressively until the child is used to three meals and in-between feedings at the
age of one year.
Why is there a Need to Give Complementary Foods?
1. breastmilk can be a single source of nourishment from birth up to six months of life.
2. The child’s demands for food increases as he grows older and breastmilk alone is not
enough to meet his increased nutritional needs for rapid growth and development
 3. Breastmilk should be supplemented with other foods so that the child can get additional
nutrients
4. Introduction of complementary foods will accustom him to new foods that will also
provide additional nutrients to make him grow well
5. Breastfeeding, however, should continue for as long as the mother is able and has milk
which could be as long as two years
How to Give Complementary Foods for Babies 6-11 Months Old?
1. Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed
beans, flaked fish/chicken/ground meat and oil.
2. Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and
number of feeding until the full recommended amount is consumed
3. Give bite-sized fruit separately
4. Give egg alone or combine with above food mixture

Health and Sanitation

Overview

 Environmental Sanitation is still a health problem in the country.

 Diarrheal diseases ranked second in the leading causes of morbidity among the general
population.
 Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis,
malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever
 DOH thru’ Environmental Health Services (EHS) unit is authorized to act on all issues and
concerns in environment and health including the very comprehensive Sanitation Code of
the Philippines (PD 856, 1978).
Water Supply Sanitation Program

EHS sets policies on:

 Approved types of water facilities

 Unapproved type of water facility
 Access to safe and potable drinking water
 Water quality and monitoring surveillance
 Waterworks/Water system and well construction
Approved type of water facilities

Level 1 (Point Source)

 a protected well or a developed spring with an outlet but without a distribution system
 indicated for rural areas
 serves 15-25 households; its outreach is not more than 250 m from the farthest user
 yields 40-140 L/ min
Level II (Communal Faucet or Stand Posts)
 With a source, reservoir, piped distribution network and communal faucets
 Located at not more than 25 m from the farthest house
 Delivers 40-80 L of water per capital per day to an average of 100 households
 Fit for rural areas where houses are densely clustered
Level III (Individual House Connections or Waterworks System)
 With a source, reservoir, piped distributor network and household taps
 Fit for densely populated urban communities
 Requires minimum treatment or disinfection
Environmental Sanitation

 The study of all factors in man’s physical environment, which may exercise a deleterious
effect on his health, well-being and survival.
Includes:

 Water sanitation
 Food sanitation
 Refuse and garbage disposal
 Excreta disposal
 Insect vector and rodent control
 Housing
 Air pollution
 Noise
 Radiological Protection
 Institutional sanitation
 Stream pollution
Proper Excreta and Sewage Disposal Program

EHS sets policies on approved types of toilet facilities:

Level I
 Non-water carriage toilet facility – no water necessary to wash the waste into receiving
space e.g. pit latrines, reed odorless earth closet.
 Toilet facilities requiring small amount of water to wash the waste into the receiving space
e.g. pour flush toilet & aqua privies
Level II
 On site toilet facilities of the water carriage type with water-sealed and flush type with
septic vault/tank disposal.
Level III
 Water carriage types of toilet facilities connected to septic tanks and/or to sewerage
system to treatment plant.
Food Sanitation Program

 sets policy and practical programs to prevent and control food-borne diseases to alleviate
the living conditions of the population
Hospital Waste Management Program

 Disposal of infectious, pathological and other wastes from hospital which combine them
with the municipal or domestic wastes pose health hazards to the people.
 Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent
transmission of nosocomial diseases
Program on Health Risk Minimization due to Environmental Pollution

1. Prevention of serious environmental hazards resulting from urban growth and

industrialization
2. Policies on health protection measures
3. Researches on effects of GLOBAL WARMING to health (depletion of the stratosphere
ozone layer which increases ultraviolet radiation, climate change and other conditions)
Nursing Responsibilities and Activities

 Health Education – IEC by conducting community assemblies and bench conferences.

 The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart
the need for an effective and efficient environmental sanitation in their places of work and
in school.
 Actively participate in the training component of the service like in Food Handler’s Class,
and attend training/workshops related to environmental health.
 Assist in the deworming activities for the school children and targeted groups.
 Effectively and efficiently coordinate programs/projects/activities with other government
and non-government agencies.
 Act as an advocate or facilitator to families in the community in matters of
program/projects/activities on environmental health in coordination with other members
of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors.
 Actively participate in environmental sanitation campaigns and projects in the community.
Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home
garden, parks drainage and other projects.
 Be a role model for others in the community to emulate terms of cleanliness in the home
and surrounding.

Integrated Management of Childhood Illnesses (IMCI)

Definition

 IMCI is an integrated approach to child health that focuses on the well-being of the whole
child.
 IMCI strategy is the main intervention proposed to achieve a significant reduction in the
number of deaths from communicable diseases in children under five
Goal

 By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of
the goal of reducing it by two thirds by 2015.
Aim

 To reduce death, illness and disability, and to promote improved growth and development
among children under 5 years of age.
 IMCI includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.
IMCI Objectives

 To reduce significantly global mortality and morbidity associated with the major causes of
disease in children
 To contribute to the healthy growth & development of children
IMCI Components of Strategy

 Improving case management skills of health workers

 § Improving the health systems to deliver IMCI
 Improving family and community practices
**For many sick children a single diagnosis may not be apparent or appropriate

Presenting complaint:
 Cough and/or fast breathing
 Lethargy/Unconsciousness
 Measles rash
 “Very sick” young infant
Possible course/ associated condition:
 Pneumonia, Severe anemia, P. falciparum malaria
 Cerebral malaria, meningitis, severe dehydration
 Pneumonia, Diarrhea, Ear infection
 Pneumonia, Meningitis, Sepsis
Five Disease Focus of IMCI:
 Acute Respiratory Infection
 Diarrhea
 Fever
 Malaria
 Measles
 Dengue Fever
 Ear Infection
 Malnutrition
The IMCI Case Management Process

 Assess and classify

 Identify appropriate treatment
 Treat/refer
 Counsel
 Follow-up
The Integrated Case Management Process

Check for General Danger Signs:

 A general danger sign is present if:
 The child is not able to drink or breastfeed
 The child vomits everything
 The child has had convulsions
 The child is lethargic or unconscious
Assess Main Symptoms

 Cough/DOB
 Diarrhea
 Fever
 Ear problems
Assess and Classify Cough of Difficulty of Breathing

 Respiratory infections can occur in any part of the respiratory tract such as the nose,
throat, larynx, trachea, air passages or lungs.
Assess and classify PNEUMONIA

 Cough or difficult breathing

 An infection of the lungs
 Both bacteria and viruses can cause pneumonia
 Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis
(generalized infection).
** A child with cough or difficult breathing is assessed for:

 How long the child has had cough or difficult breathing

 Fast breathing
 Chest indrawing
 Stridor in a calm child.
Remember:

 ** If the child is 2 months up to 12 months the child has fast breathing if you count 50
breaths per minute or more
 ** If the child is 12 months up to 5 years the child has fast breathing if you count 40
breaths per minute or more.
Color Coding

PINK GREEN
YELLOW
(URGENT REFERRAL) (Home management)
(Treatment at

OUTPATIENT
HEALTH FACILITY
 Pre-referral treatments
 Advise parents
 Refer child
REFERRAL FACILITY
 Emergency Triage and
Treatment ( ETAT)
 Diagnosis, Treatment
 Monitoring, follow-up
 Any general danger
sign or
 Chest indrawing or
 Stridor in calm child
 Fast breathing
outpatient health
facility)
OUTPATIENT HEALTH HOME
FACILITY
 Caretaker is counseled
 Treat local on:
infection  Home treatment/s
 Give oral drugs  Feeding and fluids
 Advise and teach  When to return
caretaker immediately
 Follow-up  Follow-up
 Give first dose of an
appropriate antibiotic
 Give Vitamin A
 Treat the child to prevent
low blood sugar
SEVERE PNEUMONIA  Refer urgently to the
OR VERY SEVERE hospital
DISEASE  Give paracetamol for
fever > 38.5oC
 Give an appropriate
antibiotic for 5 days
 Soothe the throat and
relieve cough with a safe
remedy
 Advise mother when to
return immediately
 Follow up in 2 days
PNEUMONIA  Give Paracetamol for
fever > 38.5oC
 If coughing more than
more than 30 days, refer
for assessment
 Soothe the throat and
relieve the cough with a
NO PNEUMONIA : safe remedy
COUGH OR COLD  Advise mother when to
return immediately
  Follow up in 5 days if not
improving

 No signs of
pneumonia or very
severe disease 

Assess and classify DIARRHEA

A child with diarrhea is assessed for:

 How long the child has had diarrhoea
 Blood in the stool to determine if the child has dysentery
 Signs of dehydration.
Classify DYSENTERY

 Child with diarrhea and blood in the stool

Two of the
following signs?
 Abnormally sleepy or
difficult to awaken
 Sunken eyes
 Not able to drink or
drinking poorly
 Skin pinch goes back
very slowly
 If child has no other severe
classification:
 Give fluid for severe
dehydration ( Plan C ) OR
 If child has another severe
classification :
 Refer URGENTLY to
hospital with mother
giving frequent sips of ORS
on the way
 Advise the mother to
continue breastfeeding
SEVERE  If child is 2 years or older and
DEHYDRATION there is cholera in your area,
give antibiotic for cholera

 Give fluid and food for some

dehydration ( Plan B )
 If child also has a severe
classification :
Two of the following signs  Refer URGENTLY to

: hospital with mother

giving frequent sips of ORS
 Restless, irritable on the way
 Sunken eyes  Advise mother when to
 Drinks eagerly, thirsty SOME return immediately
 Skin pinch goes back DEHYDRATION  Follow up in 5 days if not
slowly improving
  Home Care
 Give fluid and food to treat
diarrhea at home ( Plan A )
 Advise mother when to return
 Not enough signs to NO immediately
classify as some or DEHYDRATION  Follow up in 5 days if not
severe dehydration improving

 Treat dehydration before

SEVERE referral unless the child has
PERSISTENT another severe classification
DIARRHEA  Give Vitamin a
 Dehydration present  Refer to hospital

 Advise the mother on feeding a

child who has persistent
PERSISTENT diarrhea
DIARRHEA  Give Vitamin A
 No dehydration  Follow up in 5 days

 Treat for 5 days with an oral

antibiotic recommended for
Shigella in your area
DYSENTERY  Follow up in 2 days
 Blood in the stool  Give also referral treatment
Does the child have fever?

**Decide:
 Malaria Risk
 No Malaria Risk
 Measles
 Dengue
Malaria Risk

 Give first dose of quinine ( under

medical supervision or if a hospital is
not accessible within 4hrs )
VERY SEVERE  Give first dose of an appropriate
 Any general FEBRILE DISEASE / antibiotic
danger sign or MALARIA  Treat the child to prevent low blood
 Stiff neck sugar
  Give one dose of paracetamol in
health center for high fever (38.5oC)
or above
 Send a blood smear with the patient
 Refer URGENTLY to hospital

 Blood smear (
+)  Treat the child with an oral
If blood smear not antimalarial
done:  Give one dose of paracetamol in
health center for high fever (38.5oC)
 NO runny nose, or above
and  Advise mother when to return
 NO measles, immediately
and  Follow up in 2 days if fever persists
 NO other MALARIA  If fever is present everyday for more
causes of fever than 7 days, refer for assessment

 Give one dose of paracetamol in

health center for high fever (38.5oC)
 Blood smear ( – or above
), or  Advise mother when to return
 Runny nose, or immediately
 Measles, or FEVER : MALARIA  Follow up in 2 days if fever persists
Other causes of UNLIKELY  If fever is present everyday for more
fever than 7 days, refer for assessment
No Malaria Risk
 Give first dose of an appropriate
antibiotic
 Treat the child to prevent low blood
sugar
 Give one dose of paracetamol in
 Any general VERY SEVERE health center for high fever (38.5oC)
danger sign or FEBRILE DISEASE or above
 Stiff neck  Refer URGENTLY to hospital

 Give one dose of paracetamol in

health center for high fever (38.5oC)
or above
 No signs of very FEVER : NO  Advise mother when to return
severe febrile MALARIA immediately
disease  Follow up in 2 days if fever persists
  If fever is present everyday for more
than 7 days, refer for assessment
Measles

 Give Vitamin A
 Give first dose of an
appropriate antibiotic
 Clouding of  If clouding of the cornea or
cornea or pus draining from the eye,
 Deep or SEVERE COMPLICATED apply tetracycline eye
extensive mouth MEASLES ointment
ulcers  Refer URGENTLY to hospital

 Give Vitamin A
 If pus draining from the eye,
apply tetracycline eye
MEASLES WITH EYE OR ointment
 Pus draining MOUTH  If mouth ulcers, teach the
from the eye or COMPLICATIONS mother to treat with gentian
 Mouth ulcers violet

 Measles now or
within the last 3 MEASLES
months  Give Vitamin A
Dengue Fever

 Bleeding from nose

or gums or
 Bleeding in stools or
vomitus or
 Black stools or
vomitus or
 Skin petechiae or
 Cold clammy
extremities or
 Capillary refill more
than 3 seconds or
 Abdominal pain or
 Vomiting
 Tourniquet test ( + )
 If skin petechiae or
Tourniquet test,are the only
positive signs give ORS
 If any other signs are
positive, give fluids rapidly as
in Plan C
 Treat the child to prevent
SEVERE DENGUE low blood sugar
HEMORRHAGIC  DO NOT GIVE ASPIRIN
FEVER  Refer all children Urgently to
hospital
  DO NOT GIVE ASPIRIN
 Give one dose of
paracetamol in health center
for high fever (38.5oC) or
above
 Follow up in 2 days if fever
FEVER: DENGUE persists or child shows signs
 No signs of severe HEMORRHAGIC of bleeding
dengue hemorrhagic UNLIKELY  Advise mother when to
fever return immediately
Does the child have an ear problem?

 Give first dose of

appropriate
antibiotic
 Give paracetamol for
MASTOIDITIS pain
 Tender swelling behind the ear  Refer URGENTLY

 Give antibiotic for 5

days
 Give paracetamol for
 Pus seen draining from the ear pain
and discharge is reported for less ACUTE EAR  Dry the ear by
than 14 days or INFECTION wicking
 Ear pain  Follow up in 5 days

 Pus seen draining from the ear CHRONIC EAR  Dry the ear by
and discharge is reported for less INFECTION wicking
than 14 days  Follow up in 5 days

NO EAR
 No ear pain and no pus seen INFECTION  No additional
draining from the ear treatment
Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very Severe disease
COTRIMOXAZOLE AMOXYCILLIN
BID FOR 5 DAYS BID FOR 5 DAYS
 Adult Tablet Syrup
Age or Weight tablet Syrup

2 months up to 12 months ( 4 – < 9 kg ) 1/2 5 ml 1/2 5 ml

12 months up to 5 years ( 10 – 19kg ) 1 7.5 ml 1 10 ml

B. For Dysentery
AMOXYCILLIN
COTRIMOXAZOLE BID FOR 5 DAYS
BID FOR 5 DAYS

SYRUP 250MG/5ML
AGE OR WEIGHT TABLET SYRUP

2 – 4 months

( 4 – < 6kg ) ½ 1.25 ml ( ¼ tsp )

5 ml

4 – 12 months
½ 2.5 ml ( ½ tsp )
( 6 – < 10 kg ) 5 ml

1 – 5 years old
1 ( 1 tsp )
( 10 – 19 kg ) 7.5 ml

C. For Cholera
TETRACYCLINE COTRIMOXAZOLE
QID FOR 3 DAYS BID FOR 3 DAYS

AGE OR WEIGHT Capsule 250mg Tablet Syrup

 2 – 4 months ( 4 – < 6kg ) ¼ 1/2 5ml

4 – 12 months ( 6 – < 10 kg ) ½ 1/2 5 ml

1 – 5 years old ( 10 – 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

Primaqui
ne

Give
single Primaqui
dose in ne Sulfadoxine +
CHOLOROQUINE health Pyrimethami
center for Give daily ne
Give for 3 days P. for 14
Falciparu days for Give single
m P. Vivax dose

TABLET TABLET TABLET

AGE TABLET ( 150MG ) ( 15MG) ( 15MG) ( 15MG)

DAY DAY DAY

1 2 3

2months –

5months ½ ½ ½
¼

5 months –

12 months ½ ½ ½
1/2

12months – 1 1 ½
½ ¼ ¾
 3 years old

3 years old –

5 years old 1½ 1½ 1 3/4 1/2 1

GIVE VITAMIN A
AGE VITAMIN A CAPSULES 200,000 IU

6 months – 12 months 1/2

12 months – 5 years old 1

GIVE IRON
Iron Syrup
Iron/Folate Tablet FeSo4 150 mg/5ml
FeSo4 200mg + 250mcg (6mg elemental iron
AGE or WEIGHT Folate (60mg elemental iron) per ml )

2months-4months
(4 – <6kg ) 2.5 ml

4months – 12months
(6 – <10kg ) 4 ml

12months – 3
years (10 – <14kg) 1/2 5 ml

3years – 5 years ( 14
– 19kg ) 1/2 7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5oC OR MORE) OR EAR PAIN

AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )

2 months – 3 years ( 4 – <14kg ) ¼ 5 ml

 3 years up to 5 years (14 – 19 kg ) 1/2 10 ml

GIVE MEBENDAZOLE
 Give 500mg Mebendazole as a single dose in health center if :
 hookworm / whipworm are a problem in children in your area, and
 the child is 2 years of age or older, and
 the child has not had a dose in the previous 6 months

Maternal and Child Health Nursing Program

Philosophy

 Pregnancy, labor and delivery and puerperium are part of the continuum of the total life
cycle
 Personal, cultural and religious attitudes and beliefs influence the meaning of pregnancy
for individuals and make each experience unique
 MCN is FAMILY CENTERED- the father is as important as the mother
Goals

 To ensure that expectant mother and nursing mother maintain good health, learn the art
of child care, has a normal delivery and bear healthy children
 That every child lives and grows up in a family unit with love and security, in healthy
surroundings, receives adequate nourishment, health supervision and efficient medical
attention and is taught the elements of healthy living
Classification of pregnant women

 Normal – healthy pregnancy

 With mild complications- frequent home visits
 With serious or potentially serious complication – referred to most skilled source of
medical and hospital care
Home Based Mother’s Record (HBMR)

 Tool used when rendering prenatal care containing risk factors and danger signs
Risk Factors

 145 cm tall (4 ft & 9 inches)

 Below 18 yrs old, above 35 yrs old
 Have had 4 pregnancies
 With TB, goiter, heart disease, DM, bronchial asthma, severe anemia
 Last baby born was less than 2 years ago
 Previous cesarian section delivery
 History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies
born before EDD, stillbirth
 Weighs less than 45 kgs. or more than 80 kgs.
Danger Signs

1. any type of vaginal bleeding

2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. pallor
Prenatal Care

Schedule of Visits

 1st – as early as pregnancy, 1st trimester

 2nd – 2nd trimester
 3rd & subsequent visits – 3rd trimester
 More frequent visits for those at risk with complications
Tetanus Toxiod Immunization Schedule for Women

Minimum Age Percent

Vaccine Interval Protected Duration of Protection

As early as
possible during
TT1 pregnancy 0% None

Infants born to the mother will be

protected from neonatal tetanus. Gives
At least 4 weeks 3 years protection for the mother from
TT2 later 80% the tetanus.

Infants born to the mother will be

protected from neonatal tetanus.

At least 6 Gives 5 years protection for the

TT3 months later 90% mother.

At least 1 year Gives 10 years protection for the

TT4 later 99% mother

Gives lifetime protection for the

At least 1 year mothers. All Infants born to that
TT5 later 99% mother will be protected.
Dose: 0.5ml
Route: Intramuscular
Site: Right or Left Deltoid/Buttocks
Components of Prenatal Visits

 History – taking
 Determination of obstetrical score- G, P, TPAL, AOG, EDD
 U/A for Proteinuria, glycosuria and infxtn
 Dental exam
 Wt. Ht. BP taking
 Exam of conjunctiva and palms for pallor
 Abdominal exam – fundic ht, Leopold’s maneuver and FHT
 Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement
 Health teachings- nutrition, personal hygiene, common complaints
 Tetanus toxoid immunization
 Iron supplementation – from 5th mo. Of pregnancy – 2 mos. Postpartum
 In goiter endemic areas – iodized capsule once a year
 In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole
duration of pregnancy