Community Health Nursing

COMMUNITY HEALTH NURSING

Community Health Nursing
 … direct, goal-oriented, and adaptable to the needs
Key Concepts:
of the individual, the family, and community during
health and illness - ANA (1973)
 Community  Client
 … an area of human services directed toward
 Health  Goal
developing and enhancing the health capabilities of
 Nursing  Means
people – either singly, as individuals, or collectively as
groups and communities. – Ruth Freeman & Janet
Community
Heinrich (1981)
 Group of people sharing common geographic
location, institution where they are organized into
Public Health
population aggregate concept (age group), common
 Philosophy—health and longevity as birthright
values or interest
 Objectives:
o Prevent disease
Levels of Clientele
o Prolong life
 Individual
o Promote health and efficiency
 Family – focus of care (CHN)
 Through: organized community effort
 Community – group of families; CHN directs its services
 “The application for science in the context of politics to
to the community because the client is the community
remove inequalities in health and deliver the best
 Population Groups – common health needs
health for the greatest number” – WHO
Health
Public Health Nursing
 Complete state of physical, mental and social well-
 Public health + Nursing + Social Assistance
being and not merely the absence of disease or
infirmity (WHO)
1. Promotion of health
 Soundness and wholeness of human structures and
2. Improvement of the physical & social environment
bodily and mental functions (Orem)
3. Rehabilitation
 Dynamic fluctuating from patterns of death or OLOF
4. Prevention of illness and disability
(Optimum level of functioning) (Dunn)
- WHO Expert Committee on
o Modern concept of health
Nursing
 Right of every individual
o Art. 25 Sec 1 of Universal Declaration of human
Community health nursing focuses on the community. (Freeman
Rights: Health is a basic right of every individual
& Heinrich)
 Setting: Natural environments of people
 General Philosophy of CHN
 Home  PHN
o Community health nursing is based on the worth
School  SHN
and dignity of man. – Margaret Shetland
Workplace CHN
----------------------------------
 Health as a Right
3 fields of CHN Practice
o Art. 25, Sec. 1 (Universal Declaration of Human
Rights)
Health Care Delivery System
 Everyone has the right to a standard of
 Primary
living adequate for the health and
o Prevention
wellbeing of himself and of his family
o Management of prevalent conditions
 Dual responsibility of the government and
o Out-patient services
the individuals
o Providers:
o Art. 2, Sec. 15
 Barangay Health Station
 The state shall protect and promote the
 Rural Health Units
right to health of the people and instill
 Secondary
health consciousness among them.
o Hospitalization
o Art. 13, Sec. 11
o Providers:
 The state shall adopt an integrated and
 Provincial Hospitals
comprehensive approach to health
 District Hospitals
development
 DOH
 Tertiary

o Rehabilitation
Nursing – Means
o Specialized care
 “Assisting an individual, sick or well, in the performance
o Highly trained personnel
of those activities contributing to health or its recovery
o Highly departmentalized
(or to peaceful death) that he would perform if he
o Sophisticated equipment
head the necessary strength, will, or knowledge, and to
o Providers:
do this in such a way as to help him gain
 Regional Hospital
independence as rapidly as possible.” - Virginia
 National Hospitals
Henderson (1964)
 DOH national office
 Art - skills
 Medical Centers
 Science – involves a process in taking care of the
 University Hospital
patients; systematic
 RITM

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 Community Health Nursing
Two-way Referral System
 Communication among facilities
 Competent care
 Efficiency of health care delivery
o Least possible cost
o Maximize resources
RA 7160 - Devolution Code Local Government Code
 Aim: to transform local government units into:
o Self-reliant communities
o Active partnership with the people
o Responsive government representatives
o Accountable government representatives
o Decentralization system of health decision
making
1. Accessible – to the people in the catchment of
the barangay
2. Available
3. Appropriate – to the needs of the people
4. Affordable
 Acceptable – does not conflict their values and
beliefs in the locality year 2020.
 PHN Cornerstones/Pillars
o Active Community Participation
o Intra and inter-sectoral linkages
 within and between the community
o Use of appropriate technology
 Focus on indigenous resources available
in the community (eg. Herbal medicines)
o Support mechanisms made available
 Provided by the DoH

DOH  Primary Health Workers

o Village/BHWs—trained community health works,
Chair: health Secretary (Janet Garin) health auxiliary volunteers, traditional birth
attendants, healers (Grassroots Levels)
o Intermediate Level—Professional group
Provincial Health Board  Primary
Chair: Governor; Vice-Chair: Provincial health Officer; o Rural Health Midwife (1:5,000)
Members: Chairman, NGO, DOH  Secondary
o Public Health Nurse (1:20,000) –
WHO 1:10,000
Municipal Health Board o Dentists (1:50,000)
o Rural Sanitary Inspector (1:20,000)
Chair: Mayor; Vice-Chair: Municipal Health Officer;  Tertiary
Members: Chairman, NGO, DOH Representative o Municipal Health Officer -
Physician (1:20,000)

Traditional Alternative Medicine Act (RA 8423)

Department Of Health
 National hospitals/DOH, national office, Medical  Respiratory
Centers  Cough/Cold
Lagundi Sambong  Diuretic
 Rheumatis
 Chair: Health Secretary  Asthma
 Lowers uric acid
Ulasimang Bato Ampalaya  Diabetes
Provincial Health Board in the blood
Bawang - after  Hypertension
 Regular hospitals/RHO meals  Toothache
Niyog-niyogan  Anti-helminthic
 Provincial Hospital/PHO  Abdominal
 District Hospital Bayabas  Anti-septic Tsaang Gubat pain
 Diarrhea
 Chair: governor
 Menstrual pain  Skin infections
 Vice chair: PHO Yerba Buena  Bites Akapulko  Fungal
 Members: Chairman, NGO, DOH  Bleeding infection

Municipal Health Board Things to remember:

 RHU/BHS
 Chair: Mayor
 Vice Chair: MHO
 Members: Chairman, NGO, DOH representative
DOH: standards, training and funding
LGU: policies, implementation
Primary Health Care (PHC)
 Legal Basis—LOI 949
o October 1979 by Ferdinand Marcos, one (1) year
after the First International Conference on
Primary Health Care in Alma Ata (Russia)
sponsored by WHO & UNICEF
 Goal - Health for all Filipinos & Health in the Hands of
the People by the
 Mission - To strengthen the health care system by
increasing opportunities and supporting the conditions
wherein people will manage their own health care
 Essential health care made universally:
o Boiling—Remove cover
o One kind of plant for each type of symptom – may alter
the therapeutic effect of other herbs
o No insecticides
o Use clay pot and plant part advocated
o Stop in case of untoward reactions; seek consultation if
signs and symptoms not relieved after 2–3 doses
o Herbal medicines may be prepared by decoction (boil
part), infusion (tea), or poultice (topical).
o Hard parts—Decoction – Bark, stem, roots
o Soft parts—Infusion/ Poultice – Leaves, flowers
Health Promotion
 Is the process of enabling people to increase control
over, and to improve their health
 A behavior motivated by the desire to increase well-
being and actualize human health potential. It is an
approach to wellness
 Ottawa Charter

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
o Output of the first international conference on
health promotion, meeting in Ottawa this 21st
day of November, 1986
o A call for action to achieve health for all by the
year 2000 and beyond
1. Building healthy public policies –
Breastfeeding Law, Rooming-in
2. Create a supportive environment
3. Strengthen community action
4. Develop personal skills
5. Reorient health services
 Prerequisites for Health
o Advocate
o Enable the community of health education
o Mediate – facilitate decision making process
Millennium Development Goals
 The 3 day summit held on 6–8 September, 200 @ NY
was the largest ever gathering of world leader
 They agreed to achieve a set of concrete, measurable
 The millennium development goals are the world’s
time-bound and quantified targets
Goal 1: Eradicate extreme poverty and hunger
 Reduce by half the proportion of people living on less
than a dollar a day
o Proportion of population below $1/day
o Poverty gap ratio
o Share of poorest quintile in national
consumption
Goal 2: Achieve Universal Primary Education
 Ensure that all boys and girls complete a full course of
primary schooling
o Net enrollment ratio in primary education
o Proportion of pupils starting grade 1 who reach
lest grade of primary
o Literacy rate of 15–24 year–olds, women and
men
Goal 3: Promote Gender Equality and Empower Women
 Eliminate gender disparity in primary and secondary
education preferable by 2005, and at all levels by 2015
o Ratios of girls to boys in primary, secondary and
tertiary education
o Share of women in wage employment in the
non-agricultural sector
o Proportion of seats held by women in national
parliament
Goal 4: Reduce Child Mortality
 Reduce y 2/3 the mortality rate among children under
5 o
o Under 5 mortality rate
o Infant mortality rate
o Proportion of 1 year old children immunized
against measles
Goal 5: Improve Maternal Health
 Reduce by ¾ the maternal mortality ratio
o Maternal mortality ratio
o Proportion of births attended by skilled health
personnel
 Achieve by 2015, universal access to reproductive
health
Goal 6: Combat HIV/AIDS, malaria, and other diseases
University of Santo Tomas – College of Nursing / JSV
 Halt and begin to reverse the spread of HIV/AIDS
 Achieve by 2010, universal access to treatment for
HIV/AIDS for all those who need it
 Halt and begin to reverse the incidence
Goal 7: Ensure environmental sustainability
 Integrate the principles of sustainable development
into country politics and programs; reverse loss of
environmental resources
 NGPs – 1.5 billion trees
Goal 8: A global partnership for development
 Develop an open, rule-based, predictable, non-
discriminatory trading and financial system
Department of Health
 Vision - Leader, staunch advocate and model in
promoting health for all in the Philippines
 Mission - guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor, and to lead
the quest for excellence in health
 History
o Spanish Era - “Medicos Titulares”
o Japanese Era – services were interrupted
o American – services resumed
 Standards – same for all facilities; developed by DOH
 Policies – institutional; developed by RHUs
FOURmula One for Health as Implementation Framework
 Goals:
o Better health outcomes
o More responsive health system
o Equitable health care financing
 Four Thrusts:
o Financing (increased, better and sustained)
o Regulation (assured quality & affordability)
o Service Delivery (access & availability)
o Good Governance (improves performance)
Sentrong Sigla Movement
 Goal - Quality Health
 Objective - Better and more effective collaboration
between the DoH and LGUs
 DOH - Technical and financial assistance
 LGUs - Developers of health systems and implementer
 Pillars
o Quality assurance – ongoing process of
improving health care services
Grants and technical assistance
o Awards – Sentrong Sigla Movement seal
o Health promotion – health education
Aquino Health Agenda
 Achieving universal health care (UHC) for all Filipinos
 Kalusugan Pangkalahatan (KP)
 AO No. 2010-0036
 Objective:
o To achieve universal healthcare
 Community Health Nursing
Obstacles Thrust Strategy oEndemic – persistently present
oEpidemic – sudden increase
 Enrollment of poor families  Point source – one sourse
is NHIP (RA 7857)  Propagated - spread
o Deployment of CHTs and
Rapid expansion o Vector-borne
The DOH and LGU RNs to serve poor
budgets, and the
in NHIP enrollment
families
o Human
and benefit o Pandemic – present worldwide
NHIP not able to o Procurement of budget
delivery using o RA 3573 – report presence of infectious diseases
adequately provide for medicines and
national subsidies
financial risk supplies of DOH-retained  Weekly monitoring – measles, polio,
for the poorest
protection for poor hospitals for the neonatal tetanus, rabies, AIDs
families
implementation of the  Eradicate – measles, polio, neonatal
“no balance billing”
tetanus, rabies, AIDs
policy
o Cash subsidy of Php 2400
 Community Organizer
to poor families
Home Visit
 Professional face to face contact made by the nurse to
Improved access
Poor households the family
to quality
have inadequate
hospitals and  LGU health facilities and
 Purpose:
access to quality o To provide necessary health care activities
health care DOH retained hospitals shall
outpatient and o To further attain an objective of the agency
facilities through be upgraded using Health
inpatient care from
accelerated Facilities Enhancement
health care facilities
upgrading of Fund (HFEP)  Principles in Planning for a Home Visit:
public health 1. Have a purpose or objective
facilities
2. Make use of all available information
3. Focus on essential needs of the individual and
Failure of the  Procurement and family but prioritize needs recognized by the
financing and distribution of medicines family
health care delivery Attainment of the and supplies to RHUs for 4Ps 4. Should involve the individual and family
systems to address health-related beneficiaries 5. Flexible and practical
the needs of poor MDGs by o Focusing efforts and
Filipinos, it is applying resources in areas with:
unlikely that the additional effort  Highest Bag Technique
Philippines will meet and resources in concentration of  Equipment - Public Health Bag
its MDG localities peer  Opened 3 times
commitments by  Women with o Hand washing
2015 unmet need for FP o Gather materials
o Return items

Roles of Public Health Nurse  Principles

 Health Care Provider – provides direct care 1. Minimize & Prevent spread of infection
 Health Educator – process of changing undesirable  All articles from the family are considered
knowledge, skills and attitude as contaminated
o Phases:  Well to Sick
 Unfreezing  Hold the lining on the outside
 Changing  Clean technique
 Refreezing 2. Save time & effort of nurse
o Elements: 3. Effectiveness of car—not overshadow
 Information 4. Performed in variety of ways—do not spread
 Communication – teaching strategy infection
 Education – change in knowledge, skills Types of Problems in the Community
and attitude
 Leader/Manager
o Planning – budgeting, mission, vision
Family Community
o Organizing – members of health team – duties Wellness Condition Health Status
and responsibilities Health Resources
Directing – members of the health team Health Deficit
o (facilities, manpower)
o Controlling – ensuring that all resources are Health Related
available
Health Threat (political, environmental,
 Advocate – promotion of health and prevention of
diseases social, economical)
 Counselor Foreseeable Crisis or
 Researcher Stress
o 5 Phases
 Conceptual Evaluation of Nursing Care
 Design and Planning  Effectiveness - Measures attainment of objectives
 Empirical  Efficiency - Cost, time, and resources
 Analytic  Appropriateness - the ability of the intervention to solve
 Dissemination the problem
 Epidemiologist  Adequacy - Comprehensiveness or the number of
o Sporadic – on and off solutions to solve the problems

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
 Without co-existing disease
Department of Health Programs  No history of complications/abnormalities in present
 Public Health Problems and previous pregnancies and deliveries
 Tulong-Sulong Sa Kalusugan  Imminent delivery - no choice but to deliver the baby
o Developed to achieve empowered, insured, at Home
satisfied and healthy families
Maternal Health Program CMMNC Framework
 No woman should die giving life  The center is the pregnant women
 Every woman has a right to a safe pregnancy and  Transportation/ Communication
childbirth o Ambulance
 Provide care and support
 Three Delays Model o Partner/spouse
o Family members
o Accompany the mother in the hospital
 Key Elements
o Organized mothers, families, communities and
barangay with maternal and newborn health
plans and programs
o Supportive barangay captains

Perinatal Care
Prenatal/ Antenatal visits
 Home-based mother’s records
 Encourage all women to deliver in the health facility

NUMBER OF WHO/UNICEF/DOH CPG

PHN 2007 BOOK
VISITS 2005/2006
 Paradigm Shift
Before the 4th month of
First 1st Trimester
pregnancy
Identifies high rish Second
Between 6th to 7th
2nd Trimester
Risk pregnancies month of pregnancy
Third 8th month of pregnancy 3rd Trimester
Approach For referral during
Fourth 9th month of pregnancy
After 8th month;
the prenatal period every 2 weeks

Pre-natal Check-up
Considers  Age
 LMP
EmOC all pregannt women to
 Family history
be at risk of  Fundic Height
Approach complications at  Leopold’s Manuever
childbirth  Blood Pressure
 Tetamus ToxoidImmunization
 Laboratory Tests
o CBC – Anemia
Basic Emergency Obstetric Care (Bemoc) Services
o Glucose Tolerance Test – 24 to 28th week AOG
 Are upgraded enhanced BHS, RHU, lying-in clinics or
– if with hx of DM
birthing homes, District and Community hospitals that
o Blood Typing – ABO Rh Incompatibility
provide
o UA – Proteinuria, UTI, STIs
 6 Basic Obstetric Functions
o Administer Parenteral antibiotics
Leopold’s Maneuver
o Parenteral Uterotonic drugs (Oxytocin)
 Void first
o Parenteral Anticonvulsants
 Position: supine or dorsal recumbent
o Manual Removal of Placenta
 Palm not fingertips
o Removal of Retained Placental Products
 Provide privacy
o Perform assisted vaginal delivery
1. 1st Maneuver (Upper pole)
Comprehensive Emergency Obstetric Care (CEmoc) Services
 Fundal grip – find out what is occupying the
 Are end-referral facilities capable of managing
uterus
complicated deliveries and newborn emergencies
 Fetal presentation
 It should be able to perform 6 basic OB functions as
2. 2nd Maneuver (sides of maternal abdomen)
well as to provide
 Umbilical grip
o CS services
 Fetal back
o Blood banking and transfusion services
3. 3rd Maneuver (Lower pole)
Domiciliary Obstetrical Service: Qualifications
 Paulick grip
 Full term
 Assess for fetal engagement
 Not a primigravida with less than 5 pregnancies

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
 Floating or engaged school age w/ 200 mg iodine
 Primi: 2 weeks before labor (engagement) Women 15 – 45 Iodized oil capsule
 Multi: during labor 1 cap for 1 year
yrs old w/ 200 mg iodine
Iodized oil capsule
4. 4th Maneuver (presenting part evaluation) Adult males 1 cap for 1 year
w/ 200 mg iodine
 Pelvic grip
 Fetal position Postnatal Visits
 Fetal attitude WHO/UNICEF/DOH CPG
Tetanus Toxoids Number of Visits PHN 2007 BOOK
2005/2006
 Mother - Artificial Active First 24 to 48 hrs after
 Baby – Natural Passive First Within 3-5 days
delivery
6 weeks after
Schedule of Tetanus Toxoid as per AO # 15 Second 6 weeks after delivery
delivery

Duration of % Protection of  Uterus will return to pre-pregnancy state after 6 weeks

Dose Schedule
Protection the Mother Post-Partum Care
1st Anytime At any point Immediate  Breast
2nd After 1 month 3 yrs. 80%  Uterus
After 6  Bowel
3rd 5 yrs. 95%
months  Bladder
4th After 1 year 10 yrs. 99%  Lochia – rubra, serosa, alba
5th After 1 year Lifetime 99%  Episiotomy
 Mother is protected after 1 dose  Skin
 Baby is protected after 2 doses  Homan’s Sign
 IM – 0.5 mL – deltoid  Emotions

Micronutrient Supplementation Family Planning Program

 Iron Deficiency – can cause neural tube defects  Reproductive Health Program (Responsible Parenthood
 Anemia – presence of pallor, N = 11g/dl Program)
 Ideal: Prior to marriage
 Four Pillars:
Iron Supplementation o Responsible Parenthood
 They can have as many child as they want
Targets Preparations Dose/ Duration provided that they can support their needs
1 tab OD for 6  PD 965
Tab containing 60 months o mandates all couples prior to
Pregnant Women mg el with 400 mcg or marriage must attend family planning
Folic Acid 2 tabs/day if 2nd seminar
or 3rd trimester o done at the local municipal office
Tab containing 60 o Child Spacing – at least 3 to 5 years interval
1 tab OD for 3 Respect for life – anti-abortion
Lactating Women mg el with 400 mcg o
mos or 90 days Informed Choice
Folic Acid o
 The right of every couple to be
Vitamin A Supplementation knowledgeable of the different family
 Plant sources: Carotene planning methods, its advantages and
 Animal sources: Retinol disadvantages
 Vit A Deficiency – can cause congenital problems  All health care workers must inform them of
 Do not give Vit. A if woman is taking multivitamins its contraindications
 2nd trimester – teratogenic  Before they can teach, must attend a
 Blue – 100,000 IU training seminar (PD 791)

Targets Preparations Dose/Duration  Family Planning Priorities

1 cap/tab 2x/wk o Couples in the reproductive age: 20 to 44 years
10,000 IU o 3 or more children
Pregnant Women (4th mo. until
(Colorless) o Close interval pregnancies
delivery)
Postpartum 200,000 IU 1 cap 1x (within 4 o (+) chronic disease
Women (Red) wks after delivery)
 Family Planning Counseling
Iodine Supplementation o Greet – warmly and politely
 Iodine deficiency – can cause congenital o Ask – about him/herself
hypothyroidism or cretinism o Tell – health center and the services provided
 Sources: seafood o Help – make the decision that is best for him/her
 Avoid goitrogenic foods – cabbage, broccoli, potato, o Explain – relevant information about the signs,
peanuts, cauliflower - inhibit the absorption of iodine in diagnosis, treatment
the body o Return – schedule a return visit

Targets Preparations Dose/Duration Early Childhood Care and Development (ECCD)

 RA 8980
Children of Iodized oil capsule 1 cap for 1 year
o Refers to the full range of health, nutrition, early

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
education and social services programs that
provide for the basic holistic needs of young
children from birth to 6 years of age, to promote
their optimum growth and development
 Center-based Programs
o Day-care Service (RA 6972)
o Public and Private Pre-schools
o Kindergarten
o Community or school-based early childhood
o Child-minding centers
o Health centers and stations
 Home-based Programs
o Neighborhood-based play groups
 Supervised by the barangay captain
o Family day care programs
 Supervised by the public schools
o Parent education
o Home visiting Programs
Essential Intrapartal Newborn Care – Unang Yakap
 DOH Administrative Order 2009 – 0025
 Four Core Steps in EINC
o Immediate and thorough drying
 2 towels
o Early skin to skin contact
 To prevent hyperthermia
o Properly timed clamping and cutting of the cord
 To prevent intraventricular hemorrhages
and anemia
o Non-separation of the newborn and the mother
thru initiation of early breastfeeding
 Within 90 minutes after birth
Newborn Screening
 RA 9288—Newborn Screening Act of 2004
 Detect congenital metabolic disorder that may lead to
mental retardation or even death if left untreated
 6 diseases:
o Congenital Adrenal Hyperplasia
o Congenital Hypothyroidism
o PKU
o Galactosemia
o G6PD
o Maple Syrup Purine Disease
 April 2014  Can now detect 28 diseases  1,600 pesos
(rate) and can now be charged to Phil Health
 1cc of blood  in the blood filter  dry for 4 hours 
within 24 hours  send to Newborn screening facility
(UP-PGH; National Institute of Health)
 Initial results after 7 working days  negative (no
problem)  if positive  confirmatory test  positive
again  refer to specialist for management
 Recommended: Get specimen after 48 – 72 hours after
birth  because PKU cannot be detected as early as
24 hours
 Advocacy: education of the mother about the benefits
of Newborn Screening Test (as early as pregnancy
stage) and ask to prepare said amount
Universal Newborn Hearing Screening Program
 RA 9709
o Universal Newborn Hearing Screening and
University of Santo Tomas – College of Nursing / JSV
Intervention Act of 2009
o Early detection of congenital hearing loss and
referral for early interventions for infants (under 3
months of age)
o Newborn Hearing Screening Reference Center at
the National Institute of Health
o BAAH Test – to detect initially whether the child
has hearing loss
 Say the phrase “BAAH”  child will respond through
nodding
 Mobile Application
o On any healthcare practitioner who delivers, or
assists in the delivery of a baby in the Philippines
the obligation to inform the parents or legal
guardian of the newborn of the availability,
nature and benefits of hearing loss screening
among newborns or infants THREE (3) MONTHS
AND BELOW.
Breastfeeding Campaign
 The first step to raising a bright child
Breastfeeding “Tsek”
 Tama Sapat EKsklusibo
 Launched on Feb. 23, 2011
 Target: new and expectant mothers in urban areas:
 Aim:
o Encourages mothers to exclusively breastfeed
their babies from birth up to 6 months
o Establish a supportive community, as well as to
promote public consciousness on the health
benefits of breastfeeding in lowering the risk of
diarrhea, pneumonia and chronic illnesses.
Promoting Breastfeeding
 RA 7600
o Rooming in and Breastfeeding Act of 1992
o Breastfeeding week: August 1-7
 EO 51
o Milk Code
o Avoid formula milk
o Do not give incentives who use formula milk
 RA 10028
o Expanded Breastfeeding Promotion Act of the
Philippines
o Promotes that each facilities (if they have female
employees) should have a breastfeeding station
o Must include refrigerators
 AO 2006 – 0012
o Revised Implementing Rules and regulations in
the EO 51
 AO 2005-0014
o National Policies on Infant
Breastfeeding Practices:
 Exclusive Breastfeeding Practices
o Allows ORS, drops, syrups (vitamins, minerals,
medicines)
 Predominant Breastfeeding
o May also have water and water-based drinks,
fruit juice, ritual fluids and ORS – drops or syrups
such as vitamins, minerals and medicines
 Complementary Feeding
o Interval of 1 week to check for food allergies
o Giving the infant foods and liquids along with
breast milk
 Community Health Nursing
o When breast milk is no longer sufficient to  Carrier o Attenuated –
nutritional requirements  Sick of the BCG, OPV,
 Bottle feeding disease AMV, Rotavirus
o Child is given food or drink (including breast milk) o Killed – P. HBV
from a bottle with a nipple  Weakened toxins
 Breast milk  Prepared by
 Early Initiation of breastfeeding (IgA) Laboratories
Initiating breastfeeding of the newborn after birth Passive
o  Placenta
within 90 minutes of life in accordance to the (IgG)
essential newborn care protocol

Positions  Launched by DOH, WHO, & UNICEF last July 1976

 Cradle Hold/Madonna/Cross chest  Objective - reduce morbidity and mortality among
o NSD infants and children caused by the 6 childhood
o Father is beside mother immunizable diseases
 Football hold/clutch position
o SGA, twins  PD No. 996 (Sept. 16, 1976)
 Side lying position o Providing for compulsory basic immunization for
o Delivered via CS infants and children below 8
 Kangaroo Position o 6 vaccines
o Promotes nutrition and warmth  RA 10152
o Inclusion of new vaccines
How to get baby “latch on” o Mandatory Infants and Children Health
1. The mother holds her breast in a C-hold position Immunization Act of 2011
o To anchor the breast o 11 vaccines
2. Stimulate the baby’s rooting reflex  RA 7846 (Dec. 30, 1994)
o Striking the cheek of the child o Hep. B immunization
o Stimulate the sucking reflex using the nipple o 7 vaccines
3. When the baby’s mouth opens wide, put the nipple  PP No. 6 (April 3, 1996)
and as much of the areola as possible into his mouth o Implementing a United Nations goal on Universal
o Chin and breast must be in contact Child Immunization by 1990
 Wednesday—Immunization day
How to make baby let go of the breast without hurting the  (2001-2020) Decade of Vaccines – envision a world of
mother which all individuals and communities enjoy lives free
1. Press down on the breast near his mouth from vaccine-preventable diseases (WHO)
2. Pull down on his chin and insert a small finger in the
corner of his mouth. This will break his seal on the nipple Principles of EPI
3. Then remove him from the breast  Epidemiological Situation
o Schedules are drawn on the basis of occurrence
*Swollen nipple – withhold feeding on the affected side; advice and characteristic feature of the disease
warm compress o Applicable to children below 8
*Inverted nipple – nipple rolling or nipple stretching exercise  o Goal is to complete vaccines before 1 year
press the base of the nipple (“Fully Immunized Child”)
o If achieved after 1 year—“Completely
Signs that the baby has latched on properly to the breast: Immunized”
1. The baby’s mouth is widely open
2. The baby and the mother are into tummy-to-tummy Antigen Route Site
position BCG (Bacillus
3. Much of the areola is inside the baby’s mouth Calmette- ID R deltoid
4. The mother does not feel nipple pain Guerin)
5. Baby is relaxed and happy Anterolateral
Hep B vaccine IM
thigh
DPT-HepB-Hib
Breastfeeding Campaign (Pentavalent IM
Anterolateral
 Storage of breast milk thigh
vaccine)
o If at room temp – 8 hours Oral Polio
ORAL Mouth
o If refrigerated – 24 hours Vaccine
o If frozen – 1 month Attenuated Outer part of
SUBCUTANEOUS
 Galactogen Measles Vaccine the upper arm
o Malunggay (mammolactin) MMR – measles-
Outer part of
o Soups, Broths, Shellfish mumps-rubella, SUBCUTANEOUS
the upper arm
AMV2
 Breastfeeding should be fed on demand – at least 8x a
Rotavirus
day vaccine
ORAL Mouth
 No coffee, alcohol, drugs, smoking  Mass approach
o If taken coffee, withhold feeding after 24 hours  Integrated to the health services of the unit
Expanded Program on Immunization Elements of EPI
 Target setting—all children before 1 year old
Natural Artificial  Cold chain logistics
Active  Exposure  Antigens o PHN—Cold chain officer

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 Community Health Nursing
o Vaccines must be stored in a cold place o With persistent fever
 Freezer (–15–25ºC) - OPV & Measles o Management—I/D
 Refrigerator Compartment (2–8ºC) - BCG &
DPT  Hepatitis B Vaccine
o BCG—Light sensitive o 3 doses, 2 types (Plasma derived and
o Measles/MMR—Heat sensitive recombinant Hep B surface antigen)
 Information, Education, and Communication (IEC) o Target age:
 Assessment and evaluation of the program overall  HBV 1
performance o At birth (Health Facility)
o Target: 95% every month o For more than 7 days (home)
 Surveillance, studies and research  HBV 2 & HBV
o 3—6 weeks
o 14 weeks
Supplementary Immunization Activities (SIAs)
 “Catch up” or “speed up” campaigns for the new  Pentavelent
vaccine to rapidly increase immunity in older age o 6, 10, 14 weeks
groups that are outside of the immunization schedule o 0.5 m, IM, Vastus Lateralis
 Intended to reduce or interrupt transmission of the o Effects:
targeted disease with the goal of elimination or  No fever
eradication  Local tenderness  Do not massage; apply
Contraindications cold compress
1. History of seizures/convulsions for DPT 1
o If convulsions last for 3 days—DT  Pentavalent
o If convulsions > 3 days—Do not give succeeding o DPT, Hib, Hep. B
doses o 3 doses, 4 weeks or 1 month interval
2. Clinical AIDS—Infant BCG o Target age—6, 10, 14
3. Immunosuppression o 0.5 mL, IM, vastus lateralis (upper outer thigh)
Not Contraindications o Reduces chance of acquiring pneumonia and
1. Fever up to 28.5ºC meningitis
2. Simple or mild acute respiratory infection o Effects:
3. Simple diarrhea without dehydration  Fever  Antipyretic every 4º
4. Malnutrition (it is indication for immunization)  Local tenderness  do not massage site

Schedule for Immunization  OPV

Antigen Age Dose o Against Poliomyelitis
BCG (Bacillus o Pathognomonic—Tightening and spasms of
At birth 0.05ml
Calmette-Guerin) Hamstring
Hep B vaccine At birth 0.5ml o 3 doses, 4 weeks/1 month
DPT-HepB-Hib
o Target population—same as above, eligibility until
(Pentavalent 6,10, 14 weeks 0.5ml
vaccine)
Grade 6 (12 years)
Oral Polio Vaccine 6,10,14 weeks 2 drops o 2–3 drops, oral route
Attenuated o Color—clear pink or pale orange liquid
9 months 0.5ml o Keep Philippines Polio Free
Measles Vaccine
MMR – measles- o Effects:
mumps-rubella, 12-15 months 0.5ml  Vomiting—if after 30 minutes, do not re-
AMV2 administer
6-15 weeks (1st  Do not feed child for 30 minutes
dose)
Rotavirus vaccine 1.5ml
10-32 weeks (2nd
dose)  Rotavirus
o 2 doses, 8 weeks interval
 Infant BCG o Target age: 6 and 14 weeks
o 0–11 months or 0_1 years o 1.5 mL, PO
o At birth o 1st – 6 to 15 weeks
o 0.05 mL (dose)—ID, right upper deltoid o 2nd – not more than 32 weeks
o Freeze dried then reconstituted with diluent o Reduces chance of acquiring diarrhea
 School Entrance BCG o Effects:
o When the child enters Grade 1 with or without  Soft stool
scar in the right arm then still go on with the  Dispose diapers – virus is there
vaccination except if he is repeating grade 1  Wash cloth diapers separately
o 0.1 mL OPV  Rotarix  Pentavalent
o Effects
 Wheal lasts for 30 minutes to 1 hour
 Inflammatory response lasts from 2 weeks -
12 weeks  Scar  Measles
o Administer warm compress on the o 9–11 months
site of injection o In cases of epidemics—can be given at 6 months
 Fever  Antipyretic every 4º o 0.5 mL, subcutaneous, any arm (outer part of the
 SQ Abscess - Marble-like mass present on upper arm, preferably left)
the site of injection o Fever and measles rash lasting for 1–3 days within

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 Community Health Nursing
2 weeks after immunization (modified measles)  3 doses—Hepa, OPV, DPT, Penta
o Vitamin A is given with measles—100,000 IU (Blue)  2 doses—Rota
– boost immune system  1 dose – BCG, AMV, MMR
o At least 85% can be prevent by immunization at  IM—Penta, Hepa B
this age  Orem—OPV, Rota
o Freeze dried then reconstituted with diluent water  0.5—MMR, AMV, Penta, Hepa
o Effects:  1.5 rota
 Fever – Antipyretic every 4º  UE—BCG MMR, OPV, Rota
 Rashes within 2 weeks and lasts for 3 days –  LE—Hepa, Penta
subside naturally  Fever—Penta, Measles, MMR, BCG
 1 Mo—Penta, OPV
 Measles, Mumps, Rubella (MMR)  Freezer—OPV, Measles
o 12–15 months  Diluted—BCG, AMV, MMR
o Mumps - enlargement front and below the ear  SQ—AMV, MMR
o 0.5 mL, SC, any arm (deltoid)  Rashes—AMV, MMR
o Vitamin A is given with MMR, 200,000 IU (red)  Local Tenderness—Hepa, Penta
o Freeze dried then reconstituted with diluent water  All IM—LE with local tenderness
 All not IM—UE
 BGC, AMV, MMR  All Vaccines are 0.5, except for BCG, Rota
o Diluted – cold temperature
o Must be consumed within 4 to 6 hrs Nutrition Program
 Goal: Improve quality of life through better nutrition,
Ensuring Potency improved health and increased productivity

Nutritional Programs
 Nutritional assessment
 Micronutrient supplementation
 Food fortification
 Maternal and child health service packages
 Nutrition information communication, education
 Home, school and community food production
 Food assistance
 Livelihood assistance
 Check expiration date  Treatment of conditions associated with malnutrition
 Vaccine Vial Monitor (VVM)—Square should be lighter
than the circle Legislations Affecting the Philippine Nutrition Program
 Shake – discard if with residual  PD No. 491 - declared July as the Nutrition Month and
 Place refrigerator at least 3 ft. away from the window creation of National Nutrition Council
 LOI 441 - Integration of Nutrition Education in the school
Maximum Storage and Transport Period curriculum
 Regional Health Office—6 months
 Provincial/District Health Office—3 months Common Intestinal Parasites
 Rural Health Unit—1 month
 Maximum transport period (With cold packs) — 5 days  Ascaris (giant roundworm)
 For determining the amount of vaccines to be o Nutritional competition
requested—3 to 2.7% o Source: Soil, fecal-oral
 FEFO: First expiry, first out o Vomit worms
 Ancylostomiasis/Hookworm
Discarding Unused Biologicals o Blood sucker
 VVM – vaccine vial monitor o Heavy infestation is seen as severe anemia
 Discard unused portion of BCG and AMV 6 hours after o Enters the human body by skin penetration, abd.
reconstitution or at the end of the immunization session Pain
whichever comes first  Enterobius (pinworm)
 If square is lighter than circle: may use the vaccine o Habitat is the rectum
 If square is darker than circle: discard o Major symptom is pruritis ani
 Shake the vial o Highly contagious
o Mixture between the solid and liquid content – o Source: fingernails
may use  Taenia saginata/ solium (tapeworm)
o The longest intestinal parasite (average adult
Contraindications length is about 15 to 25 meters)
 General: Any serious condition that needs
hospitalization
 Specific: Deworming
o DPT 2 and 3: a history of seizures within 3 days  Anti-helminthic drugs every 6 months
after DPT  Together with vitamin A
o Attenuated vaccines: immune deficiency  Albendazole/Mebendazole
 Done 2x a year
Other Considerations:

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Albendazole Mebendazole  1” TSF is normal
Age
400 mg/tab 500mg/tab
- Biochemical or Lab exams
12-23 months ½ 1
- Clinical Exams
24-59 months 1 1 - Dietary History
- Health History
Mebendazole/ Albendazole
 Given every 6 months Macronutrient Deficiencies
 Start giving at 1 year old 1. Kwashiorkor
o Qualitative Deficiency
Nutritional Methods of Assessment o Manifestations:
 A – anthropometry  Edema
 B – biochemical or lab exams  Ascites
 C – clinical exam  Irritable
 D – dietary history  Alternating black or black hair – Flag Sign –
 H – health history discoloration of hair
- Anthropometry  Skin desquamation
 Weight for age  Normal weight – edema
 Height for age 2. Marasmus
 Body mass index o Quantitative Deficiency
 Mid upper arm circumference o Protein, Carbohydrates, Fats
o Manifestations:
 Muscle Wasting
1. Weight for age  Normal hair and skin
 Under 5 - Operation Timbang  Skin and bones
 Not used when patient has edema  Weight between 2nd to 3rd degree
 Used in diagnosis of: malnutrition
o Acute (current) malnutrition
 Overweight – obesity
Point of
 Underweight – wasting Kwashiorkor Marasmus
difference
Afr. “The
Gomez classification of nutritional status sickness of the
Formula for computation of % of IBW Etymology older child Gr. “Wasting”
when the next
𝑎𝑐𝑡𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 baby is born”
× 100
𝑒𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 Condition that
Severe
results from
 >110 % = overweight energy
 91-110 %= normal severe CHON
Definition deficiency =
 76-90 % = 1° under nutrition (mild) – education deficiency =
quantitative
 61-75 % = 2° under nutrition (moderate) – qualitative def.
def. condition
education condition
 ≤60 % = 3° under nutrition (severe) – Various age
hospitalization Weaning age:
Age/group group even
toddler
infant
2. Height for age
3. Body mass index Starvation
 Normal 18-24 Improper (famine,
Health history weaning; extreme
4. Mid Upper Arm Circumference diarrhea poverty, child
 Only for children under 5 years old (1-4 years abuse)
old) Present but may Present and is
 Rapid screening for malnutrition Wasting
not be obvious very obvious
 Procedure:
a. Determine midpoint between acromion Wasting – skin
Edema; ascites
and olecranon Major feature and bones
pedal
b. Measure circumference at midpoint appearance
c. Interpretation: Abnormal =
o ≥13 cm = normal nutritional status 2nd or 3rd
o <13 cm = acute under nutrition Weight May be normal
degree
(wasting) malnutrition
5. Skin Fold Thickness
Facial Old man
Moon facies
 Thickness of SQ tissue appearance facies
o Femoral, Abdominal, Appetite for
Poor Very good
Triceps food
 Adults – to diagnose Acute Malnutrition Mental
 Harpenden Caliper Irritable Apathetic
outlook

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Sparse;
Hair changes depigmentation Absent Iodine Deficiency Disorder (IDA)
“flag sign:  Susceptible population - Pregnant women
 Most serious effect - mental retardation (cretinism) in
Flaky paint; the baby if the mother does not have enough supple
Skin changes Absent
dermatosis of Iodine during pregnancy
Micronutrient  200mg capsule once a year
 a substance found in very small amounts in the body (<  Other Signs of Cretinism
0.005% of body weight o Growth stunting
 Major Micronutrient Deficiency in the Philippines o Pasty Skin
o Vitamin A deficiency o Protruding Abdomen
o Iron deficiency anemia  Foods rich in Iodine: sea foods
o Iodine deficiency disorders o Iodine in vegetables and fruits depends on the
soil on which they are grown
Vitamin A Deficiency (VAD) o Goitrogens – substances that interfere with
 Xerophthalmia - Night Blindness iodine use; found in cabbage, turnips, mustard,
 Susceptible population: 1-4 year; usually occurs red skin of peanuts, cauliflower, broccoli, Brussels
together with PEM sprouts, cassava
 Retinol à  Rods  Color/Peripheral/Night
Vision Fortification - Addition of a nutrient to food during processing
 Deficiency: irreversible blindness  Sangkap Pinoy seal - placed on label fortified foods
 Foods rich in vitamin A
o Richest: liver, egg yolk and milk; contain retinol  RA 8976 - Philippine Food Fortification Act of 2000
o Best (considering socio-economic status of o This provides for mandatory fortification of the
family): dark green leafy vegetables, yellow fruits following products:
and vegetables; contain carotene  Rice with iron
 Wheat flour with Vit. A and Iron
 Signs of Vitamin A deficiency  Refined Sugar with Vit. A
o Night blindness  Cooking Oil with Vit. A
o Photophobia  RA 8172 - “Asin” Law
o Conjunctival xerosis  EO 382 - November 7 declared National Food
o Bitot’s spot Fortification Day
o Corneal opacity o Yellow—Vitamin A
o Keratomalacia - can cause irreversible blindess o Green—Iron
o Purple—Iodine
 Supplementation – administration of a concentrated
source of a nutrient 4P’s—Pangtawid Pamilyang Pilipino Program/Conditional Cash
o Garantisadong pambata (GP) - ASAP/Araw ng Transfer Program (CCT)
Sangkap Pinoy/Child Health Week  Rights-based and social development program of the
o A.O. 36, s2010 - Expanded Garantisadong national government to reduce poverty by providing
Pambata (GP) conditional cash grants to improve their health,
nutrition and education particularly of children aged 0–
 VAD Prevention 14 to extremely poor households.
o 6 - 11 Months - 100,000 IU for 1 dose
o 12 - 83 months - 200,000 IU every 6 months  Includes
o P6,000/year or P5,000/month household for
 VAD Treatment health and nutrition expenses
o 6 - 11 months - 100, 000 IU immediately upon o P3,000 for 1 school year for 10 months or
treatment P300/month/child for educational expenses.
o 12 - 59 months - 200,000 IU 1 cap given next day Maximum of 3 children
& 1 cap o A household with 2 qualified children received a
 2 weeks after subsidy ofP1,200/month to P2,400 during the
 then after 6 months school year or P15,000annualy as long as they
comply with the conditionality
Iron Deficiency Anemia o The cash grants shall be received by the most
 Susceptible population: pregnant women and infants responsible person, the mother through Land
 Foods rich in Fe Bank cash card
o Liver and other internal organs o The beneficiaries shall be provided their cash
o Egg yolk grants though an alternative payment scheme
o Dark green leafy vegetables such as over the counter transaction from the
 Major sign of IDA: Palmar Pallor (Color of the palm nearest Land Bank branch in cases where
darker than the color of the skin) payment though cash card is not feasible
 Management:
o 150mg/5mL = 14 days Cash Grants Php/Month Php/Year
o Below 4 months—2.5 mL
4–12 months—4 mL
Php Php 6 000 (12
o Health
o 1–3 yrs.—5ml 500/household months)
o 3–5 yrs.—10 mL
o Taken once a day for 3 months

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Php 3 000 (10 Dose)
Php 300/child X 3
months) X
Education (max) = Php 900  Yellow - Some/Disease Condition
3(max) = 9 000
for 3 children o Management - RHU + Pharma (3 days)
for 3 children
o Follow-up - 2 days
Php 1 400 Php 15 000  If after 2 days, the child gets better -
continue antibiotic
Program Conditions: Health  If after 2 days, the child doesn’t improve -
 Pregnant women must avail pre and post-natal care change to 2nd line antibiotic
and be attended by a trained health professional  If after 2 days, the child gets worse – refer
 0–5 years old children must receive regular preventive
health checkups and vaccines  Green - No Classification
 6–14 year old children must receive deworming pills o Management - Home
twice a year o Follow-up - 5 days

Program Conditions: Education Assessment of Malnutrition – IMCI

 3–5 year old children must attend day care or
preschool classes at least 85% of the time  Look and Feel
 6–14 years old children must enroll in elementary or high o Visible severe wasting
school and must attend at least 85% of the time o Edema of both feet
o Weight for age
Program Conditions: Family Development o MUAC—for children 6 months or more
 Parents must attend family development sessions

Convergence Strategy  Classification

1. Sustainable Livelihood Program (SLP) Signs Classify Treat
o Established and manage their own micro- Any one of the ff:
enterprise through skills training and non-  Treat to prevent
 Severe wasting
low blood sugar
collateral, interest-free loan of Php 10,000  Edema both
SEVERE  Give vitamin A
2. Guaranteed Employment feet
MALNUTRITION  Refer urgently to
 Less than
hospital or RHU if
115mm
Systems not available
1. Compliance Verification System (CVS) – check  Vitamin A
compliance of beneficiaries on conditionalities of Very low wt. for age VERY LOW WEIGHT
 Follow up: 30 days
health, education and parenting/responsible  If the child < 2 y/o,
parenthood as basis for payment of grants assess the child’s
2. Grievance Redress System (GRS) – instrument used for feeding and
facilitating due process in resolving complaints and counsel the
grievances of household beneficiaries and the mother on
feeding
community
according to the
3. Beneficiary Update System (BUS) – get information that Not very low wt. for feeding
has bearing on cash payments and continued eligibility NOT VERY LOW
age and no other recommendations
WEIGHT
of household beneficiaries. signs of malnutrition and care for
development (if
Integrated Management for Childhood Illnesses feeding is a
Basic Steps in IMCI problem, follow-
up in 5 days)
 Assess
 Advise the mother
a. Child’s problem – interview the mother when to return
b. Check for general danger signs immediately.
 Ask
o Able to drink or breastfeed? o Prevent hypoglycemia
o Vomit everything?
o Had convulsions?  If can feed, feed
 Look  If cannot fed, but can swallow – 30 mL
o Abnormally sleepy or difficult to Sugar water (200 mL + 4 tbsp.)
awaken
c. Then ask for main symptoms  If cannot swallow - NGT with 30 to 50 mL
sugar water or milk
 Classify
o Severe (Pink)  Unconscious – IVF – slow IV
o Some/Disease (Yellow) o D5W – 1 mL/kg body weight
o No (Green) o D10W – 5 mL/kg body weight
 Treat
 Follow-up
Management of Anemia
Color Codes - Classification and Management  Look
o Palmar Pallor - Severe or some?
 Pink – Severe Classification
o Management - Referral to hospital + Pharma (1st Signs Classify Treat

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Any one of the ff:
SEVERE ANEMIA
 Refer urgently to hospital or  Intramuscular Antibiotic for children being referred
 Severe Pallor RHU if not available
 Feeding and counseling
urgently
the mother o Gentamicin (7.5 mg/kg)
 Iron o Benzyl penicillin (50 000 units/kg)
Some pallor ANEMIA  Mebendazole/albendazole
if 1 y/o and above, if no
 Pneumonia
dose in the past 6 months o Amoxicillin – 1st line BID
 Follow up: 14 days o Clotrimoxazole – 2nd line BID
 Feeding and counseling  Soothe throat of child
No pallor NO ANEMIA mother
 Follow up: 5 days o Calamansi
o Breastmilk
Control of Acute Respiratory Infections o Don’t give: codeine, cough syrup, nasal syrup
 Assess  IMCI: 3 weeks for TB
o Main Symptoms - cough/difficulty breathing  Not taking any antibiotic but have cough for 30 days:
o Ask how long: acute (pneumonia), chronic TB
(asthma)  Not IMCI: 2 weeks for TB
 Look and Listen: child must be calm  Oral Antibiotic
o Stridor o First line: Amoxicillin for 3 days, BID
o Chest indrawing
o Count RR/min Amount of ATB
o Wheeze Age 100 mg/5ml
 If with chest indrawing, fast breathing and wheeze AMOXICILLIN
o Trial of rapid acting bronchodilator for 3x 15 – 2 months – 6 months 1.5 ml
20 mins apart. 6 months – 12 months 2.5 ml
 1st choice – Inhaler 12 months to 3y/o
3.5ml; 5ml
 2nd choice – Oral salbutamol 3y/o to 5y/o
 Very severe pneumonia or severe pneumonia
o Any general danger sign  If 250/5ml
o Chest in-drawing or o Less than 2 months = 2.5 ml
o Stridor (noisy inspiration) in a calm child o 2-12 months = 5 ml
o 12 months to 5 years = 10 ml
 Pneumonia
o Fast breathing Control of Diarrheal Diseases (CDD)
Dysentery/ Shigelosis
Age Respiratory Rate
 EA: Shigella disentiriae
Below 2 months 60/min and above  Source: Feces
 2-3 times of loose watery stools (diarrhea for children)
2-12 months 50/min and above  MOT: contaminated food, water and by hand to
12 months – 5 years 40/min and above mouth transfer of contaminated materials
 IP: 1 day
 Sx: Bloody mucoid stool
 Damage mucosa lining  becomes necrotic  fibrin
 No pneumonia: Cough or Cold
 Treatment Cholera
 EA: Vibrio el tor (rod-shaped)/ coma (roung-shaped)
Classify Treat  Source: Vomitus, feces
 1st dose of antibiotic  Mot: Contaminated food and water
 Treat to prevent low blood
 IP: Few hours to 5 days
sugar
 Vitamin A
 POC: 7 to 14 days
SEVERE PNEUMONIA  Refer urgently to the  Sx: Rice watery stool
hospital
 If chest indrwaing and Assessment:
wheeze, give  Main symptoms—Diarrhea
bronchodilator o Ask
 Give ATB for 3 days  How long?
 If cough for more than 3
 Blood in stools?
weeks, refer for assessment
PNEUMONIA for TB or asthma o Dysentery
 Soothe the throat with safe o Cholera
remedy o Look and feel
 Follow up: 2 days  Abnormally sleepy or difficult to
 Soothe the throat awaken
 If cough is 30 days, refer for  Restless and irritable
NO PNEUMONIA
assessment
 Sunken eyes
 Follow up: 5 days
 Not able to drink
 Pinch the skin (skin turgor)
Classify:
 Note: if wheezing, give inhaled rapid bronchodilator or
 Severe dehydration - 2 of the following signs
oral salbutamol for 5 days.
o Abnormally sleepy or difficult to awaken
o Sunken eyes• Not able to drink or drinking

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poorly 1. Give IVF immediately - LRS or NSS
o Skin pinch goes back very slowly (>2 secs)
Then give 70ml/kg
Age First 30 ml/kg in:
 Some dehydration - 2 of the following symptoms in:
o Restless, irritable Infants under 1 y/o 1 hour 5 hours
o Sunken eyes Children 1 y/o and
o Drinks eagerly, thirsty 30 minutes 2 ½ hours
above
o Skin pinch goes back slowly
2. If no health facility, use NGT
 No dehydration 3. Or if the child can drink, give ORS by mouth
o Not enough signs 4. If any of the above steps not possible, bring
child immediately to the hospital for IVF or NGT
Classification of Chronic Diarrhea treatment
 If lasts for 14 days or more 5. Give antibiotic if 2 years older or cholera
o Severe persistent diarrhea epidemic
 Dehydration present
o Persistent diarrhea *If the age of the child is 2 y/o and above or there is cholera
 No dehydration epidemic, administer 1st dose of antibiotic as prophylaxis
o Blood in stool - Dysentery
o Rice water stool – Cholera  Severe Persistent Diarrhea (less than 2 months and with
* If the child is less than 2 mos w/ diarrhea lasting for 14 days or chronic diarrhea)
more = SEVERE PERSISTENT DIARRHEA o Treat dehydration
o Give Vitamin A if not given last 30 days
Management o Refer to hospital
 Plan A - No dehydration (XZB5)
o 4 rules  Persistent Diarrhea
1. Give extra fluid and food (soup, rice o Advise feeding
water, or buko juice or ORS) every o Give Vitamin A if not given last 30 days
after loose stool o Give Zinc supplements for 14 days
o Below 2 yrs. = 50–100 mL o Follow-up - 5 days
o 2–5 yrs. = 100–200 mL o Advise when to return
2. Zinc Supplements for 14 days
o 2 - 6 months = 10 mg/day  Antibiotics
o 6 months - 5 yrs. = 20 o Dysentery - Ciprofloxacin for 3 days, BID (15
mg/day mg/kgBW)
3. Continue breastfeeding o Cholera - Tetracycline (250mg) or Erythromycin
4. Follow-up in 5 days if not improving (250mg) BID for 3 days

 Plan B - Some Dehydration  Vitamin A – Severe malnutrition, Very low weight,

1. Give reformulate ORS within the first 4º
 Amount of ORS = weight in kg x 75
mL/kg BW
 Homemade Oresol
o 1L water + 1 tsp. salt + 4 tsp.
sugar
o 1 glass of water + 1 pinch of
salt + 1 tsp. of sugar
 For under 6 months—give 100–200
mL in the first 4º
1. Advise mother to continue breastfeeding
2. After 4º - continue feeding and give zinc
 If mother must leave before
treatment - explain 4 rules of home
mgt
3. Follow-up - 5 days if not improving
severe dehydration, pneumonia, severe persistent
diarrhea, persistent diarrhea
 IV fluids – D5W & D10W (prevent low blood sugar), PLRS
and PNSS (Severe DHN)
 ORS – 1 L water + 1tsp NaCL + 4 tsp. sugar
 Sugar water – 200 mL H20 + 4 tsp sugar
 Follow-up
o Antibiotics – 2 days
o Bronchodilator (Salbutamol) – 2 days
o Very low weight - 30 days
o Anemia – 14 days
o No DHN, Anemia, Pneumonia, not very low
weight – 5 days
 Soothe throat – Calamansi except codeine, cough
syrup and decongestant

Amount (ml) in 4
Age Weight
hours Prevention and Management of Abortion Complications (PMAC)
Below 4 months <6kg 200-450 Abortion
4-12 months 6- <10kg 450-800  As a public health issue
12 months – 2  As a human rights issue
10- < 12kg 800-960  As a resource issue
years
2-5 years 12 to <19 kg 960 - 1600

* Weight – better parameter

* ORS is taken at the RHU – 4 hours Adolescent (10-19 y/o) Health Program
* After ORS – Plan A at home Adolescent Health Issues
 Plan C - Severe Dehydration 1. Early pregnancy & childbirth – 30% of births
2. HIV

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 Community Health Nursing
3. Malnutrition 3. Feelings of sadness and loss
4. Mental Health 4. Ensuring financial security
5. Tobacco use 5. Decrease in mobility
6. Harmful use of alcohol – starts at 13 – 15 y/o 6. Increase reliance on others
7. Violence Gerotrancendence Theory
8. Injuries  Gero (greek) “old age”, transcendence (latin) “to
Factors Affecting Adolescent Health Issues climb over”
1. Lack of Like Skills  Human aging includes a potential to mature into a new
2. Lack of Access to health services outlook and understanding life
3. Lack of Safe and Supportive environment  “Redefinition of the self and of relationships to others”

Characteristics of Adolescent-friendly Health Services (WHO) Elderly Population

Adolescent  RA 9257 – Expanded Senior Citizen Act of 2003
 Accessible  RA 7432 – An Act to Maximize the Contribution of Senior
 Acceptable Citizens to Nation Building, Grant Benefits and Special
 Appropriate Privileges and for other purposes
 Equitable  Proc. 470 – 1st week of October every year as “Elderly
 Effective Filipino Week”

Required Quality of Adolescent Health Service Provision Elderly Health Services

 Facility 1. Management of Illness
o Available resources 2. Counseling substance abuse, sexuality and
o Appealing and respectful Reproductive Tract Infections (RTI)
 Provider 3. Nutrition and Diet Counseling
o Non-judgmental and considerate 4. Mental Health
o Appropriate delivery 5. Family planning and Responsible Sexual Behavior
6. Dental Care
 Community 7. Screening And Management Of Lifestyle Related And
o Support the provision of service Other Degenerative Diseases
 Adolescent o Men—Accidents And Injuries, Liver Diseases,
o Awareness of available service BPH, Prostate Malignancies
o Able and willing to obtain service o Women—Goiter, Malignancies (Breast), DM
8. Screening And Management Of Chronic Debilitating
Adolescent Health Services And Infectious Diseases
1. Management of Illness 9. Post Productive Care
2. Counseling substance abuse, sexuality and
Reproductive Tract Infections (RTI) Facilities for the Elderly
3. Nutrition and Diet Counseling  National Center for Geriatric Health (Manila)
4. Mental Health  Golden acres Home for the Aged (Gov’t)
5. Family Planning and Responsible Sexual Behavior  Mountain Crest Residential Care (Cavite)
6. Dental Care  Kanlungan ni Maria
 Blessed Family Home Care Facility (QC)
Adult Men and Women Health Program
1. Management of Illness Violence Against Women and Children (VAWC)
2. Counseling Substance Abuse, Sexuality and  Women and children considered as the vulnerable
Reproductive Tract Infections (RTI) groups in the population
3. Nutrition and Diet Counseling  RA 9262 - Anti-Violence Against Women And Their
4. Mental Health Children Act Of 2004
5. Family Planning and Responsible Sexual Behavior  RA 9231 – Special Protection of Children against Child
6. Dental Care Abuse, Exploitation, and Discrimination Act
7. Screening and Management of Lifestyle Related and
other Degenerative Diseases Non-Communicable Disease
o Men - Accidents And Injuries, Liver Diseases, BPH,  Mortality = Lifestyle Related/Chronic
Prostate Malignancies 1. Cardiovascular Diseases
o Women - Goiter, Malignancies (Breast), DM 2. Cancer
3. Chronic Obstructive Pulmonary Disease
Elderly Health Program 4. Diabetes Mellitus
 6.8% of the 92.1 population (2010)
 Ageing index = 20.3% (2010) or  Risk Factors of Disease
60 y/o & above: 15 y/o = 1:5 1. Smoking
 Life Expectancy: 2. Physical inactivity
o Males = 64.10 y/o 3. Unhealthy diet
o Females = 70.10 y/o 4. Excessive alcohol drinking
 Mortality = CVD, Cancer
 Morbidity = Influenza, Pneumonia, TB (Infectious)
Strategies for the Control & Prevention of Non-Communicable
Challenges of an Elderly 1. Promote Physical Activity & Exercise
1. Maintaining health and fitness  Physical Activity = body movement that results in
2. Maintaining social networks and activities expenditure of energy (occupational, leisure-

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 Community Health Nursing
time, routine daily activities)
 Exercise = planes, structured, repetitive aimed at
improving or maintaining physical fitness
(performed activities with vigor & alertness
without undue fatigue)
 Moderate intensity for 30 mins. for days
2. Promote Proper Nutrition (ABC)
 Aim for physical fitness (Ideal body weight)
 Build healthy nutrition-related practices –
variety of foods, breastfeed, monitoring,
eat vegetables, milk, avoid salty foods, clean
and safe foods.
 Choose food sensibly
3. Promote Smoke Free Environment
 Five A’s – Quitting Smoking
o Ask = smoking status
o Advise = to stop smoking, can cause
death
o Assess = willingness to quit
o Assist = quitting
o Arrange follow up = monitor progress
 RA 10352 - Excise tax on alcohol and tobacco
for 5 years for the Universal Health Care
program of the government
4. Stress Management Techniques – 12s
1. Spirituality
2. Self-Awareness
3. Scheduling Activities
4. Siesta
5. Stretching
6. Sensation Techniques – Massage, Spa
7. Sports
8. Socials
9. Sounds and Songs
10. Speak to me
11. Stress Debriefing
12. Smile
Programs for NCDC
 EO 958 – “National Healthy Lifestyle Advocacy
Campaign” 2005 – 2015 as decade of healthy lifestyle
 Wellness Programs – mag “HL Tayo”
 Wellness Center – BP screening, Ht & Wt measurements,
smoking cessations classes, and aerobics class services
What is Information and Communication Technology (ICT)?
 A diverse set of technological tools and resources used
to communicate, create, disseminate, store and
manage information. (Blurton, 2002)
 Example technologies:
o Computers
o Internet
o Television
o Mobile Phones
What is eHealth?
 eHealth is the use of ICT for health. (WHO, 2012)
eHealth in the Philippines
 Kalusugan Pangkalahatan and ICT
o Also known as KP, one of its aims is to attain
efficiency by using ICT in all aspects of health
care
o The DOH recognizes the valuable purpose of
ICT for health and has drafted its National
eHealth Strategic Frameworks for 2010-2016
University of Santo Tomas – College of Nursing / JSV
Electronic Medical Records
 Comprehensive patient records that are stored and
accessed from a computer or server.
 An example is the Community Health Information
Tracking System (CHITS) of the University of the
Philippines Manila
Telemedicine
 Using information and communication technologies for
the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries,
research and evaluation, and for the continuing
education of health care providers, all in the interests of
advancing the health of individuals and their
communities. (WHO)
Four Elements specific to Telemedicine (WHO)
1. Its purpose is to provide clinical support
2. It is intended to overcome geographical barriers,
connecting users who are not in the same physical
location
3. It involves the use of various types of ICT
4. Its goals is to improve health outcomes
 An example of which is the National Telehealth Service
Program (NTSP)
eLearning
 The use of electronic tools to aid in teaching
 Instructional videos, informational textblasts, interactive
simulations
eHealth Projects in the Community
 BuddyWorks – allowed RHU physicians to send
telereferrals to clinical specialists in PGH via SMS and
Email
 CHITS – an EMR, designed for and by the community
health workers, divided into different modules based
one existing DOH programs
 Electronic Field Health Service Information System
(eFHSIS) – An online version of the FHSIS developed by
DOH
 eIMCI - IMCI accessible in mobile devices
 NTHC eLearning Videos - funded by USAID, created
eLearning videos on TB, stroke, bird flu, and child
poisoning
 Segworks Rural Health Information System (SEGRHIS) -
EMR created for rural health units by Segworks, local
software company in Davao
 RxBox - mobile computer connected with medical
devices such as ECG, pulse ox, eBP and HR monitors
intended for mobile deployment to rural health centers
 Secure Health Information Network Exchange (SHINE) -
An EMR developed by Smart Communications
 Synchronized Patient Alert via SMS (SPASMS) - a SMS
reminder system for patients who are due for follow-up
 Surveillance in Post Extreme Emergencies and Disasters
(SPEED) – allows community health nurse to submit daily
reports of prevalent diseased immediately after
disasters via SMS, email, and other information and
communication technologies
 Wireless Access for Health (WAH) - augmented CHITS
by connecting health centers through broadband
Internet access; implemented in 2010 in Tarlac provide
through the public private partnership (PPP) of
 Community Health Nursing
Qualcomm, UPM-NTHC USAID, Smart DOH-IMS, Center with outlet
for Health development (CHD). Region III, RTI  No description system –
International; National Epidemiological Center (NEC), Source
Tarlac State University, and the local government  Adaptable for rural areas,
15 – 25 household
Community eHealth Nurses’ Roles  Within 250m from the
 Data and Records Manager farthest user
 Change Agent  Source + Reservoir + Piped
 Educator – development of eLearning videos distribution
 Client Advocate II (communal faucet or
 Within 25 m from the
 Telepresenter stand-post)
farthest house
 Researcher  100 households
 Source + Reservoir + Piped
Project NOAH III (waterworks system/ distribution + Household tap
 Nationwide Operational Assessment of Hazards individual household  Suited for urban areas
 The DOST response to the call for a more accurate, connection)  Undergoes treatment at
integrated and responsive disaster prevention and water facility
mitigation system, especially in high-risk areas
throughout the Philippines Unapproved Types of Water Facilities
 Water coming from doubtful sources
Legislations on Environmental Sanitation  Unimproved springs, wells that need priming
 PD 442 – Labor Code on Prevention and Compensation
o 50 – 200 = full time RN Water Quality and Monitoring Surveillance
o Non-hazardous = graduate first aider 1. Every Municipality check quality and conduct
o 200 – 300 = MD, Dentist, RN surveillance every year
o More than 300 = MD, Dentist, RN, dental clinic, 2. Meet quality standards of the National Standards for
infirmary or emergency hospital, 1 clinic bed: Drinking Water by DOH
100 employees 3. Examination of water performed in private or
government lab accredited by DOH
 Art. 156 – first aid medicines and equiome
 Art. 157 – free medical and dental attendance to
employees Water treatment in a Level III Water Supply System
 EO 307 – creating occupational safety and health 1. Sedimentation
center (OSHC) o Let it stand for a few hours and the solid particles
will settle at the bottom of the container
Environmental Health 2. Flocculation or Coagulation
 Environmental health is the component of the man’s o Solid particles in the water binds to alum (Tawas)
well-being that is determined by interactions with the and settles at the bottom
physical, chemical, biological, social, and psychosocial 3. Filtration
factors external to him. o Use of filters
 In the Philippines, maintenance of environmental o Sand filter, gravel filter
health records is one of the responsibilities given to the 4. Chlorination
city, municipal, and provincial health nurses o Kills microorganism except Entamoeba
Histolitica
Eight Environmental Health Indicators in the Field Health Service 5. Aeration
Information System o Enhance odor and taste of water; usually done
1. Households with access to improved or safe water- after chlorination
stratified to Levels I, II, III 6. Fluoridation
2. Households with sanitary toilets o Add fluoride to water
3. Households with satisfactory disposal of solid waste o Excessive fluoride  dental fluorosis  teeth
4. Households with complete basic sanitation facilities becomes chalky or mottled
5. Food establishments o Greater number of processes used, the more
6. Food establishments with sanitary permit (PD 522 - sterile
Mandatory implementation of sanitary permit to all o Humans: mineral water—undergoes
food establishments; City Hall) mineralization (ideally, with high specific gravity
7. Food handlers  NAKAKABUSOG), distilled (HINDI
8. Food handlers with health certificates (From the NAKAKABUSOG)
municipal office) o The best is Wilkins (highest purity); “Pag gusto
lang mawala yung uhaw, mag-distilled!

Approved Types of Toilet Facilities

Approved Types of Water Facilities

Level Description
I (point source)  A protected well or spring

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 Community Health Nursing
Type I  Reuse
 Pit privy, antipolo type, aqua privy, overhung, trench  Recycle
latrine, temporary toilet, chemical toilet, cathole
 May contaminate water tables underground Solid Waste Management
 Aqua Privy - Water Tank underground  RA 9003: The discipline associated with the control of
 Overhung - Over a body of water; may cause generation, storage, collection, transfer and transport,
infections (Schistosomiasis) processing, and disposal of solid wastes in a manner
 Trench Latrine/Temporary Toilet - Dug that is in accord with the best principles of public
 Chemical Toilet - Porta-potty health economics, engineering, conservation,
 Balot system/Flying saucer aesthetics and other environmental considerations
 200 meters away from water facility
Methods of Solid Waste Management:
Other Type 1 – Non Water Carriage Excreta Disposal Facilities  Recycling
 Trench latrine/ Temporary Toilet  Total recycling
 Chemical Toilet  Waste recovery method
 Cathole – most unsanitary  Zero waste management
 Volume reduction method
Toilets  Sanitary land-fill - Biodegradable
Characteristics of an Acceptable Toilet  Incineration
1. Should minimize contamination of water and soil ex.  Open dumping
Septic Tank  Dumpsite - non-biodegradable waste products
2. Should require the use of materials that are readily
available in the community Food Sanitation – 4R in food safety
3. Should be aesthetically acceptable (odor, 1. Right Source
appearance)
4. Should provide privacy Level Description
 Non-water carriage toilet – ex. Pit latrine
5. Should prevent the entry and exit of small animals
 Toilet facilities requiring small amount of
I water to wash the waste into the receiving
Solid Waste Management: Need for sorting/ waste segregation space (pour flush toilet and aqua privy)
 Refuse – all solid and semi-solid wastes except human
excreta II
 Water carriage type with water-sealed –
 Garbage – biodegradable wastes Flush type (with specific septic tank)
 Rubbish/Trash – non-biodegradable wastes  Water carriage type connected to
III sewerage system to treatment plant
Solid Wastes
2. Right Preparation
 Municipal Wastes
3. Right Cooking
o non-hazardous household commercial &
4. Right Storage
institutional waste, street sweepings, debris
 Healthcare Wastes (Biomedical Waste)
Rule: When in doubt, throw it out!
o Infectious - contain bacteria, viruses, parasites,
Epidemiology
fungal
 Demography – the study of a population
o Pathological - tissues, organs, body parts, human
Demographic Data:
fetus
 Population Size
o Pharmaceutical - drugs, vaccines, sera
 Population Composition
o Chemical - from lab, housekeeping, disinfectant
 Distribution of Population Space
o Sharps - cause cuts, punctures
Measuring Population Growth
o Radioactive - liquids or gaseous materials
 Natural Increase
 Industrial Wastes
o 𝑁𝑜 𝑜𝑓 𝑏𝑖𝑟𝑡ℎ𝑠 − 𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
o Agricultural & mining
 Rate of Natural Increase
 Hazardous Wastes
o 𝐶𝑟𝑢𝑑𝑒 𝐵𝑖𝑟𝑡ℎ 𝑅𝑎𝑡𝑒 − 𝐶𝑟𝑢𝑑𝑒 𝐷𝑒𝑎𝑡ℎ 𝑅𝑎𝑡𝑒
o Toxic, corrosive acids, explosive, cytostatic
Population Composition
drugs, genotoxic drugs
 Sex Composition – Sex Ratio (M:F)
𝑡𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑚𝑎𝑙𝑒𝑠
Wastes Segregation o 𝑆𝑅 = × 100
𝑡𝑜𝑡𝑎𝑙 𝑛𝑜.𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠
 Black or colorless - non-hazardous, non-biodegradable o
wastes, plastic covers, IV glass bottles  Age composition
 Green - non-hazardous biodegradable wastes,
leftovers =
𝐷𝑒𝑝𝑒𝑛𝑑𝑒𝑛𝑐𝑦 𝑟𝑎𝑡𝑖𝑜𝑛 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 < 15 𝑦𝑟𝑠 + > 65 𝑦𝑟𝑠𝑟
× 100
 Yellow with biohazard symbol - 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒𝑑 15 – 64 𝑦𝑟𝑠

pathological/anatomical wastes
Field Health Services and Information System (FHSIS)
 Yellow with black band - pharmaceutical, cytotoxic, or
1. Individual/ family health record
chemical wastes (labeled separately)
2. Target/ client list – used in monitoring compliance to
 Yellow bag that can be autoclaved - infectious wastes
treatment
 Orange with radioactive symbol - radioactive wastes
3. Tally report – prepared by RHU
 Red - sharps, needles
4. Output report – collation of tally reports
 Yellow - tissues, syringe
3Rs
Tally report (RHU)
 Reduce


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 Community Health Nursing
Output report (PHO)
 =
𝑡𝑜𝑡𝑎𝑙 𝑐𝑎𝑠𝑒𝑠 (𝑜𝑙𝑑 + 𝑛𝑒𝑤)𝑜𝑓 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒
× 100
Regional Health Office 𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛


 Incidence Rate
National Office, DOH
𝑁𝑜. 𝑜𝑓 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒
= × 100,000
Types of Data According to Source 𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
1. Primary
a. Census Mortality Rates
 Every 5 years  Crude death rates
 Midyear – June to July
 An official and periodic enumeration of 𝑡𝑜𝑡𝑎𝑙 # 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟
= × 1000
population; data gathering about 100% 𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
of the population

2 ways of Assigning People in a Census  Age-specific death rate

o De jure – place of usual residence
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑒𝑑 𝑔𝑟𝑜𝑢𝑝 𝑖𝑛 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟
o De facto – where people are =
𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑒𝑑 𝑔𝑟𝑜𝑢𝑝
× 1000
physically present at the time of
the census  Sex-specific death rate
b. Survey/ Sample Survey
c. Experiment 𝑁𝑜 𝑜𝑓 𝑚𝑎𝑙𝑒/𝑓𝑒𝑚𝑎𝑙𝑒 𝑑𝑒𝑎𝑡ℎ𝑠
= × 100 000
2. Secondary 𝑁𝑜 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠/𝑓𝑒𝑚𝑎𝑙𝑒𝑠
a. Registry of vital events
b. Records and reports  Cause-specific mortality rate
c. Publications
d. Informal sources =
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
× 100 000
𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
Registry of Vital Events  Proportionate mortality rate
 RA 3753 – Civil Registry Law
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑝𝑒𝑐𝑖𝑎𝑙 𝑐𝑎𝑢𝑠𝑒 𝑜𝑟 𝑎𝑔𝑒 𝑎𝑡 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟
 PD 651 – Birth Registration Law =
𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
× 1000

1. Certificate of Live Birth

o Signed by birth attendant, must be filed within
30 days
o Municipal Office
o Nurses may sign – present during delivery
 Case fatality rate
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
= × 100
𝑛𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠

2. Death Certificate  Swaroop’s index – high index – healthy members

o Must be filed within 48 hours from the
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 50 𝑦𝑒𝑎𝑟𝑠 𝑜𝑙𝑑 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
occurrence of death = × 100
𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
o Death registry is almost complete  Mortality
data most accurate data/ best reflection of
 Maternal Mortality Rate
health status of a population
o Physicians – authorized to sign – diagnose cause 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑝𝑟𝑒𝑔𝑛𝑎𝑛𝑐𝑦, 𝑙𝑎𝑏𝑜𝑟 𝑎𝑛𝑑 𝑝𝑢𝑒𝑟𝑝𝑒𝑟𝑖𝑢𝑚
= × 1000
of death 𝑛𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠

o Nurses cannot sign

Vital Statistics
 Application of statistical techniques to vital events
 Thus
1. It describes status of health of the community
2. Reflects the effectiveness of the services/
programs
3. Identifies the health needs of the community
Fertility Rates
 Crude Birth Rate
𝑛𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
= × 1000
𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
 General/ Total Fertility Rate
𝑛𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
= × 1000
𝑛𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠 𝑜𝑓 𝑟𝑒𝑝𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑎𝑔𝑒
o Female reproductive age: 15-44 y/o
Morbidity Rates
 Prevalence Rate
 Infant Mortality Rate
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 11 𝑚𝑜𝑛𝑡ℎ𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
= × 1000
𝑛𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
 Neonatal mortality rate
𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 28 𝑑𝑎𝑦𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
= × 1000
𝑛𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
Pinoy MD
 “Gusto ko Maging Doctor”
 A medical scholarship grant for indigenous people,
local health workers, barangay health workers,
Department of Health employees or their children
 Joint program of the DOH, PCSO, and several state
universities and medical schools
 Qualifications:
o Must have completed a 4 year undergraduate
degree with a general weighted average of 2.0
o Must not be more than 35 years old upon
admission
o Must be good moral character

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
o Family income for the indigenous people and
BHWs shall not be more than P200,000 per
annum (combined)
o Parents, local health workers and DOH
employees shall have a salary grade of 15 and
below
o Must be willing to render 2 years’ service to the
government for every year of study
o Must not shift to nursing nor take a nursing
course after graduation
 Scholarship Package:
o National Medical Admission Test (NMAT)
o Registration Fees
o Tuition Fees
o Miscellaneous Fees/Laboratory Fees
o Living Subsidy
o Lodging, transportation, book, and uniform
allowances
 Submit the following documents:
o Transcript of records or form 137
o Birth certificate
o Certificate of good moral character
o Certificate of employment
o Certificate of parents as BHW
Rural Health Midwives placement program (RHMPP) / Midwifery
scholarship program of the Philippines (MSPP)
 The MSPP aims to produce and ensure constant supply
of competent midwives who are ready to serve the
DOH identified priority areas of the country
 The RHMPP addresses the inequitable distribution of
midwives and equip them for facility-based BEmONC
practice. Likewise, it provides competent midwives to
areas that have not performed well in terms of facility-
based deliveries, fully immunized child and
contraceptive prevalence rates, improve facility-based
health services
 Career Track/Return Service Obligation
o Upon completion of the MSPP and obtaining the
midwife’s Certificate of Registration and license,
the scholars shall render two (2) years of service
to the DOH for every year of scholarship granted
as a form of return service
 Partner Schools
o NCR: Dr. Jose Fabella Memorial Hospital, School
of Midwifery
o Luzon: Naga College Foundation, Naga City
o Visayas: University of the Philippines, School of
Health Science, Palo, Leyte
o Mindanao: Tecarro College Foundation, Inc.,
Davao City
RN HEALS (Registered Nurses for Health Enhancement and Local
Service)
 During Arroyo Regime—NARS (Nurses Assigned in Rural
Service)
o Part of the mitigation program of the Arroyo
administration
o Originally for 6 months
 3 months—Community
 3 months—Hospital
 Aquino - RN HEALS
 Now - NDP (Nurse Deployment Project)
University of Santo Tomas – College of Nursing / JSV
 Is a training and deployment project, jointly
implemented by the DSWD, the DOH, and the PRC-
BON, DOLE, PNA designed to mobilize unemployment
10,000 registered nurses to the 1,221 poorest
municipalities of the country and to improve the
delivery of health care services
 Nurses will be mobilized n their hometowns as warriors
for wellness to do the 3 I’s:
1. Initiate primary health, school nutrition, maternal
health programs, first line diagnosis
2. Inform about environmental sanitation practices
and also do health surveillance;
3. Immunize children and mothers
 They shall likewise serve identifies CCT and BemONC
identified areas
 Delivery Mechanisms:
o Nurses will be deployed at an average of
5/town in the 1,211 poorest municipalities, for
12 months tour of duty. Another batch will be
deployed for the second half of the year.
These nurses will undergo training and
development for competency enhancement
in accordance with the training program
designated by the PRC-BON in collaboration
with the DOH
o While on training, nurses will be given a
stipend of P18,000/month. This translates to
about P366.00 per day for 40º
training/workweek. As these nurses are
already in their hometowns, transportation
expenses will no longer be a problem
o The stipend of P18,000.00 may be increase if
the host LGUs will offer a counterpart of say
P2,000.00 LGUs may provide Philhealth
coverage to nurse-trainees. Corporations may
chip in by providing shirts, insurance, vitamins,
etc., making the project a national enterprise
with private equity
o A certificate of completion/competency
shall be issued jointly by the DOLE, DOH and
PRC after an assessment of the gained
competencies of nurse trainees.
Project Entrepre-Nurse
 Concept of nurse entrepreneurship
 An initiative of DOLE, in collaboration with BON-PRC,
DOH, PNA, UPCN, OHNAP and other government and
non-government entities, and academic institutions to
promote nurse entrepreneurship in the Philippines
Forms of nurse entrepreneurship
 Hospice, domiciliary and health care facility
management
 Public health advocacy
 Home health care services
 Outsourcing public health delivery for LGUs, NGAs
and other government institutions
 Medical transcription services
 Health care training management
 Emergency medical services
 Tourism health care services
 Wellness and fitness management for private
companies
 Community Health Nursing
 Outsourcing health services for private
establishments
What can you do to help?
 SEND two or three or a hundred nurses for 6 months to a
poor rural community
National Greening Program
 EO 26 of 2011: National Greening Program Law, all
students and government employees shall be
individually required to plant a minimum of 10 seedlings
per year.
COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
Community Organizing
 Definition
o A development approach that aims to
transform the apathetic, individualistic, and
voiceless poor into dynamic, participatory &
politically responsive community
o A collective, participatory, transformative,
liberative, systematic & sustainable process of
building people’s organizations mobilizing and
enhancing the capabilities and resources of the
people for the resolution of their issues and
concerns towards effecting change in their
existing oppressive and exploitative conditions
(1994 National Rural CO Conference)
o A process by which a community identifies its
needs and objectives, develops confidence to
take action in respect to them and doing so,
extends and develops cooperative and
collaborative attitudes and practices in the
community (Ross)
o Community organizing as a process consists of
steps or activities that instill and reinforce the
people’s self-confidence on their own collective
strengths and capabilities (Manalili, 1990)
o A continuous and sustained process of:
 Educating the people to understand and
develops their critical awareness of their
existing conditions
 Working with the people collectively and
efficiently on their immediate and long
term problems; and
 Mobilizing the people to develop their
capability and readiness to respond and
take action on their immediate needs
towards solving their long term problems
(CO: A Manual of Experience; PCPD)
o A process whereby the community members
develop the capability to assess their health
needs and problems, plan and implement
actions to solve these problems, put up and
sustain organizational structures which will
support and monitor implementation of health
initiatives by the people (Maglaya, Aracelli,
2007)
o Process by which people, health services, and
agencies of the community are brought
together to:
 Learn about common problems
 Identify these problems as their own
University of Santo Tomas – College of Nursing / JSV
 Plan action
 Act
Basic Values in Community Organizing
 Human rights
 Social Justice
 Social Responsibility
 Apostolate Work of the Church
“The church must exert efforts to reduce the gap between the
faith and the practice in the area of social transformation to
achieve social justice and equality” (PCP II Art. 20 No.1)
Approaches in Community Organizing
 Social Welfare/Dole-out
o The intermediate and/or spontaneous response
to ameliorate the manifestation of poverty,
especially on the personal level
o Assumes that poverty is GOD-given
o The poor should accept their condition since
they will receive their just reward in heaven
o Believes that poverty is caused by bad luck and
natural disaster
 Modernization/Project Development
o Considered a national strategy which adopts the
western mode of technological development
o Believes that poverty is due to lack of education
 Participatory Action Approach
o The process of empowering/ transforming the
poor and the oppressed sectors of society so
that they can pursue more just and human
society
Participatory Action Research
 An investigation on problems and issues concerning life
and environment of the underprivileged by way of
research collaboration (PCPD 1990)
 Participatory action research (PAR) is an approach to
research that aims at promoting change among the
participants. Members of the group being studied
participate as partners in all phases of the research,
including design, data collection, analysis and
dissemination (Brown et. al. 2008)
COPAR
 Community Organizing Participatory Action Research
(COPAR) is a community development approach that
allows the community (participatory) to systematically
analyze the situation (research), plan solution, and
implement projects/programs (action) utilizing the
process of community organizing. It is essentially a
research project done by the community that leads to
actions that improve conditions in the community
(Famorca, 2013)
 It is done to educate the people and develop their
critical awareness of their present condition
 It helps the community to develop and enhances its
resources to the fullest thus making the community self-
reliant
Principles
1. Change = Development
 Community Health Nursing
2. Poor Profiling/Community survey (Demographic,
3. People-centered Geographic, Socio-cultural, Economic Indices,
4. Participative Environmental, Health Indices,
5. Democratic Physical/Infrastructure resources)
6. Developmental  Subjective – Interview or Participatory
8. Process-oriented Observation
9. Self-reliance = high degree of self-awareness among  Objective – Community Survey Tool
people o Community Diagnosis/Research/Analysis
 Graphs
Critical Steps (Activities in COPAR) o Bar - for comparison
1. Integration – Immersion o Pie - Percentage distribution
2. Social Investigation – collection of data about the o Line - Trend
community o Scatter – correlate variables
3. Tentative Program Planning – community organizer
(plan on how to do community organizing)  Phase 3 - Organization/Building Phase/ Activity Phase
4. Groundworking – solicit the participation of the o Social preparation through community assembly
community o Spotting potential leaders
5. The Meeting  Criteria for Selection of Potential Leaders:
6. Role Play 1. Belong to the poor sectors and
7. Mobilization or Action – action phase classes and is directly engaged in
8. Evaluation production
9. Reflection 2. Well respected by members of the
10. Organization community and has relatively
wide influence
Community Organizing with Participatory Action Research (COPAR) 3. Desirous of change and is willing
Objectives to work for change
 To help people harness their human material resources 4. Must be able to communicate
 To help people understand their own situations and effectively
develop awareness (process of action-reflection- o Core group formation – SALT
action)  Self-Awareness and Leadership Training
Phases Program)
 Phase 1 - Pre-entry phase/Preparatory o Formation of Organization/ Committee
o Site/Area/Community Selection o Planning/Designing Phase (SMART)
Criteria of Potential Site  Specific
 Socio-economically depressed  Measurable
 Inaccessible health services  Attainable
 Poor community health status  Realistic
 Relative peace and order situation  Time-bound
 Acceptance of the program by the o 5 Areas of Community Life (HELPS)
community  Health
 Not currently served by similar  Education
agencies/organizations  Livelihood
 At least 100-200 families  Physical Environment
o Courtesy Call to local government unit/  Socio-spiritual
barangay level o Mobilization/Implementation/Action
 Mayor down to Barangay  Training potential leaders
 Safety of organizers
 Phase 4 - Sustenance and Strengthening
o Community Consultation/Dialogue/Preliminary Phase/Maintenance
Social Investigation o Evaluation/Reassessment
o Community organizers prepare  Criteria: Effectivity, Efficiency,
Appropriateness, Adequacy
 Phase 2 - Entry phase/ Integration/  3 Types of Evaluation
Immersion/Preparatory o Process – evaluate how the
o Integration/Immersion/Sensitization of the program was implemented
community/Information Campaigns o Impact – how the program affects
 Establish rapport and assess the needs of the people in the community –
the community interview
o Guidelines in Integration: o Outcome – evaluate if the lives of
1. Recognize local authorities – Courtesy the community members
Call improved
2. Adapt the lifestyle of the community o Linkaging /Establishing partnership
3. Choose a modest dwelling
4. Avoid expectation from the people
5. Be clear with your objectives & limitation
6. Participate in the production process
7. Participate in social activities

o Social Investigations/Community Methods of Establishing Partnership

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing
Exchanging information
about the organizational
goals and objectives,
services or facilities. It
Networking
provides awareness of
the organization’s
capabilities to
accomplish the networks
goals and objectives.

Modifying the
organizations activities
Coordination
responsive to the needs
of the community.

Sharing information and

resources to
Cooperation
accommodate the
organization’s agenda

Assisting organization to
enhance their
Collaboration capabilities in performing
their tasks and quality of
services

Forming partnership
between the
Coalition organization and the
members of the
community

 Phase 5 - Phase Out/ Exit Phase

o Documentation
o Follow-up/Expansion
 Must be done once a year

University of Santo Tomas – College of Nursing / JSV

 Community Health Nursing

University Of Santo Tomas – College Of Nursing Page 25