COMMUNITY HEALTH NURSING (Handout) Community Health Nursing: SAFE AND QUALITY CARE, HEALTH EDUCATION, AND COMMUNICATION,

COLLABORATION AND TEAMWORK The 3 Broad Concepts 1. What is a community? a group of people with common characteristics or interests living together within a territory or geographical boundary place where people under usual conditions are found The community is the object or focus of care in CHN, with the family as the unit of service. LEVELS of CLIENTELE: Individual, Family, Population Group, and Community FOCUS in CHN: Health Promotion and Disease Prevention FACTS of CHN Focus: promotion and preservation of health Area of Content: skills and knowledge relevant to both nursing and public health Clients: general populations (individuals, families, communities) Time: continual, not limited to episodic care Scope: comprehensive and general, not limited to a particular age or diagnostic group Concepts on Community Health Nursing: Community as a CLIENT Composed of different levels of clientele: Individual, family, population group, and community Community as a SETTING for CHN PRACTICE School Health Nursing- School Occupational Health Nursing- Workplace Public Health Nursing-Home 2. What Is Health? A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity (WHO, 1995). Health Illness Continuum What influences OLOF? Behavioral (culture, habits, mores, ethnic customs) Socio-economic (employment, education, housing) Political (safety, oppression, people, empowerment) Hereditary (genetic endowment, familial, racial) Health Care Delivery System (promotive, preventive, curative, rehabilitative) Environment (air, food, water, wastes, noise, radiation, pollution, congestion) 3. What is Nursing? The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980). Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele individuals, families or groups, and communities It operates within the realm of health care both independently and interdependently. The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning. Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson)

COMMUNITY HEALTH NURSING FOCUS: Health Promotion and Disease Prevention

HEALTH EDUCATION (IEC) General Steps: Create and Heighten awareness, Motivation, Decision-making Characteristics of CHN: it is a developmental service development of health capability of people > enabling service self-reliance > health education and community organizing transfer of technology it > > it > > > it It is community-based applied in the three fields of CHN practice catchments point of responsibility or accountability place of residence determinant for catchment area is population-focused the greatest good for the greatest number Community diagnosis Vital statistics Priority setting is a promotive-preventive service adheres to Primary Health Care is a generalist practice deals with all cases

The ULTIMATE GOAL of CHN Promotion of the clients wellness or OLOF through teaching and delivery of care based on the worth and dignity of man (Shetland) The PRIMARY FOCUS of CHN Health promotion wherein health teaching is the primary responsibility of the community health nurse, who is a generalist in terms of practice Principles of CHN E ducation as primary tool M ade available to all regardless of race, creed and socio-economic status P eoples initiative O rganizing for health, with the family as the unit of service W orks as a member of the health team (PHN) E xisting active organizations R ecording and reporting M onitoring and evaluation E xisting indigenous resources N eeds recognized by clienteles T raining and development as opportunities for continuing staff education programs Other 1. 2. 3. 4. 5. Principles in CHN: The patient in CHN is the community with the family as the unit of service Active not a passive recipient of care CHN practice is affected by any changes in society and environment Multi-sectoral effort is the key to goal achievement CHN is a part of health care system and the larger human services system

HIGHLIGHTS in CHN Concepts CHN is based on the recognized needs of communities, families, groups, ands individuals. CHN is a unique blend of nursing and public health practice, and is oftentimes used interchangeably with the term Public Health Nursing. Philosophy of Public Health Health and longevity as birthrights Longevity average lifespan or life expectancy OBJECTIVE OF PUBLIC HEALTH: 3 Ps: Promote health Prevent Disease Prolong Life Basic Competencies Needed by the Public Health Nurse Teaching Management

Critical Thinking Physical Caregiving Application of the Nursing Process Application of the Epidemiological Process Documentation

Functions of the PHN Manager Health Care Provider Researcher Community Organizer Trainer Role Model **If MHO cannot function- PHN takes charge In the In the care of the families: Provision of primary health care services Developmental/Utilization of family nursing care plan in the provision of care care of the communities:

Community organizing mobilization, community development and people

empowerment

Case finding and epidemiological investigation Program planning, implementation and evaluation Influencing executive and legislative individuals or bodies concerning health and
development Responsibilities of CHN: be a part in developing an overall health plan, its implementation and evaluation for communities provide quality nursing services maintain coordination/linkages conduct researches relevant to CHN services provide opportunities for professional growth and continuing education for personal growth thru staff development The National Health Situation Population: 12th in the world (Aug 2007) 88.6 M Median Age: 21 yo (YOUNG) Life Expectancy: F: 72.8; M:67.5 Dependency Ratio: 69 per 100 CBR: 23.1 per 1000 popn. CDR: 4.8 per 1000 popn. IMR: 26 per 1000 LB MMR: 2 per 1000 LB Health Indices A. LEADING CAUSES OF MORBIDITY (2007) 1. Acute Lower RTI and Pneumonia 2. Bronchitis/ Bronchiolitis 3. Acute Watery Diarrhea 4. Influenza 5. Hypertension 6. TB Respiratory 7. Chicken Pox 8. Heart Diseases 9. Malaria 10. Dengue Fever B. Leading Causes of Mortality 1. Heart Diseases 2. Vascular System Diseases

3. Malignant Neoplasm 4. Accidents 5. Pneumonia 6. Tuberculosis, all forms 7. Ill defined and unknown causes of mortality 8. Chronic Lower Respiratory diseases 9. Diabetes Mellitus 10. Certain conditions originating in the perinatal period II. Other Indicators: A. Infant Mortality Rate 1. Respiratory condition of the newborn 2. Pneumonia 3. Congenital anomalies 4. Birth injury and condition r/t difficult labor 5. Diarrheal diseases B. Maternal Mortality Rate-LOW C. Life expectancy at birth D. Median Age E. Crude Rates

HEALTH CARE DELIVERY SYSTEM Health Care Delivery System is the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary. Categories: According to Increasing Complexity of the Services Provided Type Service Health Promotion, Preventive Care, Continuing Care for common health problems, attention to psychological and social care, referrals Surgery, Medical services by Specialists Advanced, specialized, diagnostic, therapeutic & rehabilitative care Type Health Promotion and illness Prevention According to the Type of Service

Example Information Dissemination

Primary

Secondary Tertiary

Diagnosis Treatment Rehabilitation

and

Screening

PT/OT

THE HEALTH SECTOR

The Health Sector Department of Health Vision: The DOH is the leader, staunch advocate, and model in promoting Health for All in the Philippines Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized Major Functions: 1. Leadership in Health 2. Enabler and Capacity-Builder 3. Administrator of Specific Services Local Government Units (LGU) RA 7160 Local Government Code Private Sector Composed of both commercial and business organizations, non-business organizations Non-Government Organizations Assumes the following roles: Policy and Legislative Advocates Organizers, Human Rights Advocates Research and Documentation Health Resource Development Personnel Relief and Disaster Management Networking LEVELS OF HEALTH CARE SYSTEM: Primary, Secondary, Tertiary LEVELS OF HEALTH CARE SERVICES: Primary, Secondary, Tertiary RURAL HEALTH CARE UNIT PERSONNEL: Midwife, PH Nurse, RH Physician, Sanitary Inspector, Med tech, Dentist, MHO PRIMARY HEALTH CARE How can it be possible? Control of Communicable Diseases Offers Health Education Maternal and Child Care Provision of Medical Care and Emergency Treatment Operation on Immunization Nutrition and Food Supply Environmental Sanitation Natural and Artificial Family Planning Treatment of Locally Endemic Diseases Supply and Proper Use of Essential Drugs

PILLARS A. Multi-sectoral approach

Intersectoral linkages (population control, private sectors, social welfare, public service, enrironmental, etc.) Intrasectoral linkages (peoples empowerment; within own system) B. Community Participation e.g. Community Organizing C. Appropriate Technology - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost. 10 Medicinal Plants: Bawang-anti cholesterol Ulasimang-Bato-lowers uric acid Bayabas- antiseptic; diarrhea Lagundi-cough, asthma, and colds Yerba Buena- toothache, pain, and arthritis Sambong- renal calculi Ampalaya- diabetes mellitus Niyog-niyogan- anti-helminthic Tsaang-Gubat- diarrhea Akapulko- fungal infection D. Support mechanism made available FAMILY HEALTH NURSING PRACTICE Clinic Visit Home Visit Clinic Visit Four Phases -Pre-consultation Conference -Medical Examination -Nursing Intervention -Post-consultation Conference Standard Procedure: 1. Registration/ Admission 2. Waiting time 3. Triaging 4. Clinical Evaluation 5. Laboratory and Diagnostic tests 6. Referral 7. Dispensing and Prescribing drugs 8. Health Education

Home Visit Kinds: - Case Finding - Case Follow-up Principles: Planning should be done It should have a purpose or objective It should make use of available data There is no definite rule with regards to its frequency

Factors Influencing Frequency Health Agencies involved Acceptance of the family Needs (physical, psychological, and d educational) Evaluation of past services rendered Policy of a given agency

Steps: Greet client Introduce self and explain purpose Ask for any health concern Conduct 1st and 2nd level assessments

Give appropriate health teachings/Provide nursing care Schedule an appointment for next visit

Nursing Care in the Home Objectives: to give nursing care specific to illness to help the client reach/maintain a level of functioning; or to die peacefully in dignity Principles: Skills Utilization Opportunity for Health Teaching Use of plan Period of Assessment/ Appraisal Isolation Technique in the Home Objective: To prevent cross-infection Principles: SPARE! Principles: Suot ng Gown (Gown Use) Pakulo (Boiling) Aeration/ Washing Remove/ Discard Ehiwalay (Never Mix) BAG TECHNIQUE A tool making use of the public health bag through which the nurse during the visit can perform nursing procedures with ease and deftness, saving time and effort at the end view of rendering effective nursing care. PHN Bag essential and indispensable equipment of the public health nurse which contains basic medications and articles necessary for giving nursing care. Principles: Technique varies Offers ways to minimize or avoid infection Time and effort conserved Effectiveness of total care ensured Special considerations: Never violate the principle (clean-to-clean) Everything needed should be present Arrangement is a consideration Trade/ substitute supplies when needed THERMOMETER TECHNIQUE Wiping Before Use: from clean to dirty area (starting from the bulb going through the body or stem of the thermometer) Temperature-taking: Oral - 2-3 min Axilla - 5-9 min or 9 10 min Rectal - 1 min Wiping After Use: from fingers downward to the bulb in twisting motion use a dry cotton ball wiping should be done before reading Cleaning the Thermometer: should be done in a downward spiral motion wiping from the stem to the bulb should follow this sequence: 1. 3 cotton balls moistened with soap 2. 3 cotton balls moistened with water 3. 1 cotton ball moistened with alcohol

Community Health Nursing Process 1. Establishing a working relationship with the client Initiating contact Communicating interest in the clients welfare Showing willingness to help with expressed need of the client Maintaining a two-way communication with the client 2. Assessment of needs, taking into consideration personal, environmental and psychosocio-cultural factors influencing health A. Collection of Data A. Community B. Family and Individual 3. Planning of care 4. Implementation of care 5. Evaluation of care (Structural elements, Process Elements, and Outcome elements)

Structural-Functional Initial Data Base Family structure and Characteristics Socio-economic and Cultural Factors Environmental Factors Health Assessment of Each Member Value Placed on Prevention of Disease First Level Assessment Health threats Health deficits Stress points/ Foreseeable crisis situation: Wellness State/ Potential Second Level Assessment: Problem Prioritization: Nature of the problem Wellness State Health deficit Health threat Foreseeable Crisis Preventive potential High Moderate Low Modifiability Easily modifiable Partially modifiable Not modifiable Salience High Moderate Low *Family Service and Progress Record Population Group Vulnerable Groups: Infants and Young Children School age Adolescents Mothers Males Old People

COMMUNITY DIAGNOSIS Determines the health status of community and the factors affecting it is an integral part of the assessment phase of the CHN Process It is also known as community assessment or situational analysis The community and the health team assess the communitys health problems A learning process for the community to identify their own health problems and needs. A profile that depicts the health problems and potentials of the community. 2 types of Community Diagnosis: 1. Comprehensive 2. Specific or Problem-Oriented STEPS: Preparatory Phase site selection preparation of the community statement of the objectives determine the data to be collected identify methods and instruments for data collection -METHODS: Ocular survey, RR, KII, FGD, Survey 6. finalize sampling design and methods 7. make a timetable (Gantt chart) Implementation Phase 1. data collection 2. data organization/collation 3. data presentation 4. data analysis 5. identification of health problems 6. prioritization of health problems 7. development of a health plan 8. validation and feedback Evaluation Phase Parts of Community Diagnosis: A. Demographic Variables B. Social Indicators C. Economic Indicators D. Cultural Factors E. Environmental Indicators F. Health Patterns G. Health Resources H. Political and Leadership Patterns Steps in Conducting Community Diagnosis: 1. Determining the objectives 2. Defining the study population 3. Determining the data to be collected 4. Developing an instrument - survey questionnaire - interview schedule - Stakeholder Analysis 5. Data gathering - Records review - Observation - Surveys - Interviews 6 .Data collation 7.Data presentation 8.Data analysis 9.Identification of CHN Problems

1. 2. 3. 4. 5.

10.Prioritization of CHN Problems (consider the scoring) Nature Magnitude Modifiability Preventive potential Social concern COMMUNITY ORGANIZING Basic Concepts and Principles: 1. Objective analysis of conditions 2. Basic trust on the people and on their innate potentials and capabilities 3. From the people, for the people, and by the people with the people 4. People want and can change 5. Self-willed will have more meaning and permanence than imposed changes CONTEXT: Current situation GOAL: Community Development

COMMUNITY ORGANIZING AND PARTICIPATORY ACTION RESEARCH PAR ESSENTIAL ELEMENT: Participation BENEFICIARIES OF THE RESEARCH: The main actors in the research process. - it enables the community to experience a collective consciousness of their own situations It involves: - research - education - actions > to empower people to determine the cause of their problems, analyze these problems, and act by themselves in responding to their own problems In PAR, there is an outside researcher, a professional one who through immersion and integration on the community becomes a committed participant and learner in the community PHASES: A.Pre-entry Phase (School) 1. Formulation of institutional goals, objectives, and targets of the program. 2. Revision of curriculum 3. Train HRDP Staff and Faculty members in CO-PAR 4. Coordinate participation of other departments within the institution.

Pre-entry (Community) Community consultations/dialogues Setting of issues/considerations related to site selection Development of criteria for site selection Poor and underserved community Inaccessible health care services Community is in poor health status Acceptance of the program There is relative peace and order No other agencies are involved with the community Preliminary Social Investigation (PSI) Networking with LGUs, NGOs, and other departments within the HRDP-NGO

OTHER PRODUCTS/ HIGHLIGHTS: Community profile Survey tools Spot map Courtesy calls B.ENTRY PHASE Integration Sensitization/ Info dissemination Deeper social investigation Core Group formation (Criteria) Respected Must belong to the poor sector Responsible and committed Willing to learn, open-minded Able to express oneself/ communicate Coordination/Dialogue/Consultation with other community organizations Self-Awareness and Leadership Training (SALT)/Action Planning C.COMMUNITY STUDY/DIAGNOSIS PHASE (Research Phase) Selection of the research team Training on data collection methods and techniques/Capability-building (includes development of data collection tools) Planning for the actual gathering of data Data gathering Training on data validation (includes tabulation and preliminary analysis of data) Community validation Presentation of the community study/diagnosis and recommendations Prioritization of community needs/problems for action. D.COMMUNITY ORGANIZATION AND CAPABILITY-BUILDING PHASE Community meetings to draw up guidelines for the organization of the CHO Election of officers Development of management systems and procedures including delineation of the roles, functions, and tasks of officers and members of the CHO Team building Working out legal requirements Organization of working committees/task groups (education and training, membership of committees) Training of the CHO Officers/Community leaders E.COMMUNITY ACTION PHASE Organization and training of CHWs - Development of criteria for the - Selection of CHWs - Training of CHWs Setting up of linkages/network referral systems Plan for health services/intervention schemes and community development projects PIME Initial identification and implementation of resource mobilization schemes

F.SUSTENANCE AND STRENGTHENING SCHEME Formulation and ratification of constitution and by-laws Secondary leaders identified and developed Setting-up and institutionalization of financing scheme for community health program/activities Formalize and institutionalize linkages, networks and referral systems Develop and implement viable management systems and procedures, committees, continuing education/training of leaders, CHWs, community residents Continuing education Development of medium/long-term plans

PUBLIC HEATH PROGRAMS MATERNAL HEALTH PROGRAM: COMPONENTS: Antenatal Registration Tetanus Toxoid Immunization Micronutrient Supplementation Treatment of Diseases and other Conditions Clean and Safe Delivery Strategies: A. Provision of Regular and Quality Maternal Care Services regular and quality pre-natal care hx-taking, utilization of HBMR (Home-Based Mothers Record) as a guide in the identification of risk factors PE: weight, height, BP-taking Perform head-to-toe assessment, abdominal exam Tetanus Toxoid Immunization Fe supplementation: given from 5th mo. of pregnancy to two months postpartum (60 mg orally/day for 210 days) Laboratory exam: Heat-acetic acid test. Benedicts test Oral/Dental exam Classification of Pregnant Women: > Normal Patients > Patients with mild complications > Patients with Serious or Potentially Serious Complications Prenatal Visits: > 1st: as early in pregnancy as possible, during the first trimester > 2nd: during the second trimester > 3rd and subsequent visits: during the third trimester > Every 2 weeks after the 8th month of pregnancy until delivery Iron supplementation: > given from 5th month prenatal up to 2 months postpartum > 60mg per orem daily for 210 days + 400mcg of folic acid In goiter endemic areas: > one iodized oil capsule per year Malaria infested areas: > Chloroquine prophylaxis > 2 tab (150mg/tab) per week for the whole duration of pregnancy Tetanus Toxoid Immunization Pre-natal counseling Provision of safe, delivery care all birth attendants shall ensure clean and safe deliveries at home or at the facilities (RHUs/hospitals) at-risk pregnancies and mothers must be immediately referred to the nearest institution untrained TBAs who actively practice must be identified, trained and supervised by a personnel of the nearest BHS/RHU trained on maternal care. REPORT if (+) for: Vaginal bleeding Edema of face and hands Headache Pallor Dizziness Blurred vision REFER if (+) for DANGER SIGNS: Vaginal bleeding Convulsion BP >140/90 Severe abdominal pain

 High Risk Factors in Pregnancy: -Age - Height - Gravida - History of C/S or P/P Hemorrhage - Having any of these medical conditions: PTB, Heart Dse., DM, Bronchial Asthma, Goiter, 3 consecutive abortions/miscarriage/ still birth Qualifications for Home Delivery Full term Less than 5 pregnancies Cephalic presentation Without existing diseases No Hx of complications like P/P hemorrhage No Hx of difficult delivery/prolonged labor No previous C/S No premature rupture of the membranes Provision of quality postpartum care Proper schedule of follow-up must be followed after a home delivery: 1st postpartum visit for home deliveries must be done within 24 hours after delivery 2nd, done at least 1 week after delivery 3rd, done 2-4 weeks thereafter ESSENTIAL SERVICES (during post a partum visit): Physical and abdominal exam Vitamin A (200,000 IU) within 1 month post partum IRON supplementation (at least 90 tabs) COUNSELING: BF, FP, hygiene, NB care, STD/HIV/AIDS prevention B. Improvement of the health personnels capabilities on newborn care, midwifery thru trainings. Trainings for hilots must also be conducted. C.Improvement on the quality of care at the First Referral Level Orientation, training should be done on the use of proper filling-up of HBMR card Proper referrals/endorsements must be done for future If-ups D. Prevention of unwanted pregnancies through family planning services E. Prevention and management of STDs F.Promotion of Appropriate health practices G. Upgrade reporting services H. Mobilize political commitment and community involvement to provide Support to basic health care delivery

FAMILY PLANNING METHOD GOAL: Improve maternal and child health through: - proper timing - proper spacing= 3 years - no. of pregnancies= 3 Types: I. Spacing A. Hormonal 1. Oral contraceptives 2. Injectables 3. Implants B. Barrier 1. IUD

II.

2. Condom 3. Diaphragm, Cervical cap C. Biologic 1. LAM (Lactation-Amenorrhea Method) D. Natural 1. BBT (Basal Body Temperature 2. Sympto-thermal 3. Cervical Mucus Permanent (surgical/irreversible) A. Tubal Ligation B. Vasectomy

Family Planning: MISCONCEPTIONS 1. Some methods cause abortion 2. Using contraceptives can cause sterility 3. May result to loss of sexual desire FAMILY HEALTH: CHILD HEALTH PROGRAMS Child Health Injuries Health thru Micronutrition Illnesses of Children and Its Management Lactation and Other Forms of Infant Feeding Dental Health Rendering Early Child Development Expanded Program on Immunization Newborn Screening Under Five Care Program UFC Program (Under Five Care Program) A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival A. Growth and Health Monitoring Growth Monitoring Chart (GMC) B. Oresol Therapy a.Diarrhea b. Dehydration ORS, assess after 4 6 hours Management of Moderate and Severe Dehydration Intravenous fluids If NOT possible, assess if the child can drink (give ORS and refer for IV) If cannot drink ( give fluids via NGT) **If no NGT, refer immediately! Diarrhea Management at home: Fluids, Frequent feeding, Fast Referral + Zinc ORESOL: 1 L water + 1 pack Or 1 L water+ 8 tsp of sugar+ 2tsp of salt or 1 glass of water+2 tsp of sugar+ a pinch of salt Measures on Diarrhea Prevention: Breastfeed infants Appropriate supplemental feeding Hand washing Utilize clean and potable water Clean toilet and observe proper feces disposal Immunize the child with measles

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES -Assess, Classify, Treat - Pneumonia - Diarrhea, Persistent diarrhea, Dysentery - Ear infection (Acute/ Chronic), Mastoiditis - Malaria, Measles, DHF Family Health: Infant and Young Child Feeding Breastfeeding versus Complementary Feeding POTENTIAL BARRIERS TO BREASTFEEDING: - Inverted nipple: First instruction: retract using index finger and thumb - Working mothers: expressed milk to a glass container Storage Room Refrigerato r Freezer Deep Freezer Full Term 8-10 hrs. 48 hrs. 3 mos. 6 mos. Pre-Term 4 hrs. 24 hrs. 3 mos. NA

FAMILY HELTH: NUTRITION PROGRAM Components of the Phil. Nutrition Program: > Nutritional Assessment and Guidelines > Nutrition Education > Feeding Programs/Food Assistance > Livelihood and Food Production > Prevention and Treatment of Condition Associated with Malnutrition Conditions Associated with Malnutrition > Infections: diarrhea, vomiting, fever (+17% in basal metabolic needs) > Intestinal Parasitism

Common Intestinal Parasites > Ascaris > Hookworm > Pinworm > Tapeworm Anthropometry major tool in the diagnosis of protein deficiency (Protein Energy Malnutrition or PEM) Weight for Age: ABW/EBW > under 5 clinic: operation timbang > do not use if the client has edema > used in detection of: 1. Chronic undernutrition (stunting, with previous malnutrition) 2. Acute malnutrition (current malnutrition) 3. Overweight (obesity) 4. Underweight (wasting) Gomez Classification of Nutritional Status % of EBW = (ABW/EBW) x 100 > 110% = overweight 91 110% = normal 76 90% = 1st degree malnutrition (mild) 61 75% = 2nd degree malnutrition (mod)

 60% = 3rd degree malnutrition (severe) Height for Age: AHt/Eht Weight for height: BMI Mid-upper Arm Circumference > 1-4 y/o > rapid screening for malnutrition > procedure: 1. Determine midpoint between acromion and olecranon 2. Measure circumference at midpoint 3. Interpret findings 13 cm = normal nutritional status 13 cm = acute undernutrition wasting Management of PEM

1st & 2nd degree malnutrition

> home management > nutritional education rd 3 degree malnutrition > referral to hospital > nutritional education Fortification addition of a nutrient to food during processing RA 8172: Asin Law > sale of iodized salt RA 8976: Food Fortification Law > Sangkap Pinoy seal Tools utilized (anthropometric measurements):

Weight for Age- measures degree and presence of wasting or stunting Height for Age- measures the presence of stunting; <90% of standard- stunting or
past chronic malnutrition Weight for height- determines the presence of muscle wasting Skin fold measurement- indicates amount of body fat with the use of fat-caliper sites: triceps, biceps, subscapular, suprailiac MUAC- estimates lean body mass or skeletal muscle reserves

CAUSES OF MALNUTRITION a. Nonbreastfeeeding/ early weaning b. Prolonged beastfeeding c. Dependence on artificial w/o complementary feeding d. Absence or inadequate complementary feeding (weaning period) e. Inadequate skills in managing diarrhea at home Protein Energy Malnutrition MARASMUS- dec. CHO, < 1 yo when malnutrition started KWASHIORKOR- dec. CHO and Protein ;disease of older child when the next baby is born, 1-3 yo when malnutrition started Iron- Deficiency Anemia Decrease hemoglobin secondary to lack of iron CAUSES: Low intake of Fe-rich foods esp. the more absorbable Fe from foods of animal origin Blood loss secondary to hookworm, menstruation, childbirth SIGNS AND SYMPTOMS: Pallor Easy fatigability Lack of concentration Lack of appetite Lack/ insufficient sleep

SOURCES: Heme-iron liver, internal organs, pork & chicken, blood, fish, shellfish

 Non-heme leafy vegies (alugbati, kangkong, saluyot, pechay, kamote tops,

dried beans Vitamin A deficiency Decrease Vitamin A in blood and liver stores CAUSES: Low intake of: Vitamin A rich foods Oil and Protein SOURCES: - Breastmilk - Best animal sources: whole milk, eggs, liver and meat - Best plant sources: yellow/ orange fruits (papaya, mango), green leafy vegetables (malunggay, kangkong) Signs and Symptoms: - groping in the dark, - photophobia, - night blindness, - xerophthalmia, - Bitots spot (foamy, soapy white spots) Iodine-deficiency Disorder form mild goiter to serious E.g. stillbirth, congenital abnormalities, growth and mental retardation, physical and motor abnormalities CAUSES: Low intake of Iodine rich foods; low content of Iodine in foods Goitrogens and environmental factors SOURCES: 90% from food (seafoods) 10% from drinking water Expanded Program on Immunization Principles: Based on epidemiological situation Mass approach is utilized Integrated in health services by the RHU Elements of EPI: Target setting Cold chain logistic management Information, education, and communication Assessment and evaluation of the programs overall performance Surveillance, studies, and research Types: BCG DPT HEP-B OPV Measles Principles: - Even if interval exceeded that of the expected, CONTINUE doses - Can still be given until 6 yo - Measles can be given as early as 6 mos. - BCG should be given to school entrants regardless of the presence of BCG scar - No contraindication to immunization except when child had convulsions after DPT1 - Malnutrition is not a contraindication but rather an indication COLD CHAIN A system used to maintain the potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.

Principles: I. Storage Storage of vaccine should not exceed: -6 mos. at the Regional Level -3 mos. at the Provincial Level/District Level -1 mo. at Main Health Centers (with refrigerators) -not more than 5 days at Health Centers (using transport boxes) Important points to remember: Arranging of stored vaccine according to : Type Expiration date Duration of Storage Number of times they have been brought out to the field

Family Health: Reproductive Health Reproductive Health Goals: 4 Es > Every pregnancy should be intended > Every birth should be healthy > Every sex act should be free of coercion > Every family should achieve its desired size International Framework > Focus: WOMENS health > Ultimate Goal: Quality of life Local Framework > Focus: RH status of both MEN and WOMEN > Consideration: in terms of its ELEMENTS TEN ELEMENTS OF RH: A VERB F MP3 A dolescent RH V iolence Against Women (VOW) E ducation & counseling on sexuality & sexual health R eproductive Health of Men B reast & reproductive tract cancers & other Gyne conditions F amily planning M aternal & child health & nutrition P revention & management of abortion complications P revention & treatment of reproductive tract infection P revention & treatment of infertility & sexual disorder COMMUNICABLE DISEASES - PTB - LEPROSY - SCHISTOSOMIASIS - LYMPHATIC FILARIASIS - DHF - MALARIA Public Health Program: Mental Health Mental Health a state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively the emotional adjustment the person achieve in which he can live with reasonable comfort, functioning acceptably in the community where she lives involves the promotion of a healthy state of mind among the whole population through developing positive outlook in life strengthening coping mechanisms Four Facets: 1. Defined Burden- currently affects the person 2. Undefined Burden- felt by other people

3. Hidden Burden- stigma attached 4. Future Burden- results from the existing burden Vulnerable group to the development of Mental Illness: Street children Victims of Torture or violence Internal refugees Victims of aimed conflict Victims of natural and man-made disasters Components of Mental Health Program A. Stress Management and Crisis Intervention B. Drugs and Alcohol Abuse Rehabilitation C. Treatment and Rehabilitation of Mentally-Ill Patients D. Special Project for Vulnerable Groups POINTERS FOR HAVING MENTAL HEALTH - Maintain physical health - Medical examination annually - Healthy lifestyle - No o substance abuse and alcohol abuse - Set realistic goals - Vent-out feelings - Here-and-Now - One day at a time - NO to STRESS - Strengthen spiritual values SUPPLY AND USE OF ESSENTIAL DRUGS GENERIC ACT OF 1998: RA 6675 Formally proclaims the state policy of promoting the use of generic terminology in the importation, manufacture, distribution, marketing, promotion and advertising, labeling, prescribing and dispensing of drugs. Reinforces the NDP with regards to the assurance of high-quality and rational drug use

DANGER DRUGS AT: RA 6425 The safe, administration and transportation of prohibited drugs is punishable by law 2 Types of Drugs Prohibited LSD Eucaine Cocaine/codeine Opiates Regulated Benzodiazepines Barbiturates ENVIRONMENTAL SANITATION Environmental Sanitation is defined as the study of all factors in mans physical environment, which may exercise a deleterious effect on his health, well-being and survival. Goal: To eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all households. Components: Water Supply Sanitation Program

 Proper Excreta and Sewage Disposal Program Insect and Rodent Control Food and Sanitation Program Hospital Waste Management Program Strategies on Health risk immunization Water Supply Sanitation Program 1. Level I: Point Source 2. Level II: Communal faucet system or stand posts 3. Level III: Waterworks system or individual house connections Proper Excreta Disposal 3 Types of Approved Toilet Facilities: Level I Non-water carriage toilet facility: - Pit latrines - Reed Odorless Earth Closet - Bored-hole - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space - Pour flush - Aqua privies Level II Level III Proper Solid Waste Management Refers to satisfactory methods of storage, collection, and final disposal of solid wastes. Food Sanitation Program Policies: Food establishment are subject to inspection (approved of all food sources containers and transport vehicles) Comply with sanitary permit requirement Comply with updated health certificates for food handlers, helpers, cooks All ambulant vendors must submit a health certificate to determine present of intestinal parasite and bacterial infection 3 Points of Contamination: Place of production processing and source of supply Transportation and storage Retail and distribution points Programs related to health-risk minimization 2o to environmental pollution These include the following: Anti-smoke Belching Campaign and Air pollution Campaign Zero Solid Waste Management Toxic, Chemical and Hazardous Waste Management Red Tide Control and Monitoring Integrated Pest Management and Sustainable Agriculture Pasig River Rehabilitation Management VITAL STATISTICS

Fertility Rate Crude Birth Rate General Fertility Rate Mortality Rates Crude Death Rate Specific Mortality Rate Infant Mortality Rate Neonatal Mortality Rate Post-neonatal Mortality Rate Maternal Mortality Rate Proportionate Mortality Rate

 Swaroops Index Case Fatality Rate

Cause-of- Death Rate Morbidity Rate Prevalence Incidence Rate C. EPIDEMIOLOGY The study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution The study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations Basic Concepts: Epidemiologic Triad Transmission Incubation period Herd immunity Factors affecting distribution: PERSON PLACE TIME Patterns of Disease Occurrence: Epidemic Epidemic potential Endemic Sporadic Pandemic Biostatistics A. Demography A study of population size, composition, and spatial distribution as affected by births, deaths, and migration SOURCES OF DEMOGRAPHIC DATA: 1. Survey 1. Census- De jure or De facto 2. Sample Survey 2. Continuing Population Registers 3. Other Records and Registration Systems

COMPONENTS: Population Size 1. Natural increase 2. Net migration 3. Rate of natural increase Population Composition 1. Age Distribution 2. Median Age 3. Dependency Ratio 4. Sex Ratio 5. Population Pyramid 6. Others: occupational groups, economic groups, educational attainment, and ethnic groups Population Distribution 1. Urban-Rural 2. Crowding Index 3. Population Density