COMMUNITY HEALTH NURSING
Community ö a group of people with common characteristics or inherent living together within a territory or geographical boundary. ö place where people are found. COMMUNITY AS THE CLIENT/PATIENT IN CHN ö client- well; patient- sick World views on Community: 1. Famil Family, y, commun community ity,, and and societ society y Levels of Contradictions: Individual Intrapersonal Family Intrafamilial/ Intrafamilial/ Interpersonal Community- Intracommunity/ Interfamilial Society strong regional, parochial, Intrasocietal/ Intercommunity 2. Contraindications/ conflicts 3. Change COMMUNITY AS SETTING IN CHN PRACTICE - place where people under usual or normal conditions are found (ex. Schools) - outside of purely curative institutions (hosp is not a part of population) HEALTH1. illn illnes ess s con conti tinu nuum um mode modell ö degree of client wellness ranging from optimum wellness to death ö dynamic state, matters as a person adopts to changes in internal & external envi Coital debut- sex before age 20- increase cervical CA 2. high level level wellness wellness modelmodel- maintain maintain a continuum continuum balance balance & purposeful purposeful directi direction on with envi envi ö progress to a higher level of fxn to live to the fullest potential 1978- UNICEF & WHO- Alma Ata, Russia Russia ö Global health situation ö Strategy/ approach: PHC ö Goal: HEALTH FOR ALL BY 2000 (old) 1994- Riga ö HEALTH FOR ALL BY 2000 AND BEYOND! 1979 Alma Ata declaration ö PHC as the thrust of DOH VISION of DOH ö HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE PEOPLE BY 2020 MISSION of DOH ö In partnership with the people, provide equity & access & quality health services especially to the marginalized segment of the population VISION & GOAL- same with DOH, PHC program 3. Agent-host Agent-host environmen environmentt modelmodel- (EPIDEM (EPIDEMIOLO IOLOGIC) GIC) ö interplay of agent (causative etiologic factor)
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1. Healt Health h beli belief ef model model –pre –preven venti tive ve ö relationship bet. a person’s belief & his behavior in health ex. HIV infectn (commercial (commercial sex farers, sea workers, medical medical team Susceptibility, Susceptibility, possible MOT (mode of transmission)--- unprotected sex- occupational hazard Prevention: A bstinence B e faithful C orrect, consistent, continuous use of condom D o not penetrate (SOP) HIV infected age groups Males age 40-49 Seafarers ratio: 1: 5 Anal sex- won’t get pregnant, common in rural
Females 20-29 Vaginal: 1: 1000 Anal: 1: 200
2. Evolution Evolutionary ary based modelmodel- illness illness & death death serve an evoluti evolutionary onary fxnfxn- survival survival of the fittest fittest 3. Health Health promotion promotion modelmodel- direc directed ted at increas increase e clients clients well-b well-being eing 4. WHO de defini finittion ion Health- a state of complete physical, mental, & social well-being and not merely an absence of a dse, illness or infirmity WHO: health is a social phenomenon ö it is a result of interplay of diff societal factors: -biological - Physical- heat, temp - Ecological- adaptation to envi - Political - Economic - Social cultural ö it is an outcome of many theories Descartes – dualism Multi Casual theory- holistic- General systems theory Community health ö Part of paramedical & medical intervention/ approach concerned on the number of the whole population AGENT (Etiologic)- virus, bacteria 1. bio infection infectionss- fungi, fungi, protozoa, protozoa, helminthes helminthes,, ectoparasites 2. chemi chemical cal-- carcinog carcinogens ens,, poisons poisons,, allergen allergens s ex. GMO’s – carcinogen MSG- poison 3. mech mech-- car car acci acciden dents ts,, etc etc 4. envir environm onment ental/ al/phy physic sicalal- heats heatstro troke ke 5. nutrit nutritive ive-- exce excess ss or or defi deficie ciency ncy 6. psyc psycho hollogi ogical cal
HOST Intrinsic factors and environmental factors 1. Incr ncreasi easing ng age 2. sex (m or f) F- weak emotional; morbidity: common diseases M- mortality ( killer dses) 3. behavior4. educat educatio ional nal atta attainm inment ent-- occup occupati ation on 5. prior prior immun immunolo ologic gic-- respon response se Extrinsic factors 1. natura naturall bounda boundarie riess- physic physical al environmental, geography 2. biol biolog ogic ical al env envii 3. socioe socioecon conomi omic c envienvi- politic political al bounda boundary ry 2
Aims: 1. Promotion of health 2. Prev Prevent entio ion n of of illn illnes ess s 3. Mgt of factor factors s affec affecti ting ng heal health th INDIVIDUAL: Anatomy Physio Patho
APPLIED STUDY: Structure Function Malfunction
Community: Demography- study of population Sociology Epidemiology- study of dses
COMMUNITY HEALTH / PUBLIC HEALTH WINSLOW ö sci and art of preventing dse, prolonging life, promoting health & efficiency through organized community effort ö To enable each citizen to realize his birth right of health and longevity. ö Major concepts: i. Heal Healtth prom promot otio ion n ii. People’s People’s participat participation ion towards towards self-r self-relian eliance ce HANLON ö most effective total dev & life of the indiv & his society PURDOM ö applies holism in early years of life, young, adults, mid year & later ö prioritzes the survival of human being Nursing- assisting sick individual to become healthy and healthy individual achieve optimum wellness Early years- fetus- 12 years/ younger adults- 12-24 years Orem- self care, autonomy, independent patient Theoretical bases of CHN practice Theories and principles: 1. Nursing 2. PH Community health nsg—by Maglaya ö the utilization of the nsg process in the diff levels of clientele- indiv, families, pop grps, and comm. concerned with i. prom promot otio ion n of of heal health th ii. ii. prev preven enti tion on of of dses dses iii. iii. disa disabi bili lity ty and and reh rehab ab Goal: Goal: to raise the level of health of the citizenry citizenry by helping comm. & families families to cope with the discontinuities in in & threats to health in such a way as to maximize their potential for high-level wellness. WHO CHN ö
Special field of nursing that combines the skills of nsg, PH, and some phases of social assistance & functions as part of the total PH program for the: 1. prom promot otio ion n of hea healt lth h 2. improveme improvement nt of the condit conditions ions in in the social social and physical physical envi 3. rehab rehab of of ill illness ness asnd asnd disab disabili ility ty
ö
CHN is learned practice discipline with the ultimate goal of contributing, as individual and in collaboration with others, to the promotion of the client’s optimum level of functioning through teaching & delivery of care.
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CHN is service rendered by a professional nurse with the comm., grps, fam, and indiv at home, in H ctrs, in clinics, in school, in places of work for the ff:
Jacobson
Freeman
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1. prom promo o of of hea heallth 2. prev preven enti tion on of illn illnes ess s 3. care care of the sick sick at home home and and rehab rehab Philosophy ö ö
Dr. Margaret Shetland philo of CHN is based on the the WORTH AND DIGNITY of man
Basic concepts of CHN 1. primary primary focus/ focus/ emphasisemphasis- health health promo promo 7 dses prevention prevention primary goal- self reliance in health or enhanced capabilities ultimate goal- raise level of # of citizenry Philo of CHN- Worth and dignity of man 2. CHN practi practices ces -to -to benefit benefit ( indiv, indiv, fam, fam, special special pop, pop, comm.) comm.) - CHN is integrated and comprehensive 3. CHN are generalist generalistss- matter matter of comm. comm. health health work work 4. all all typ types es and and leve levels ls of HC Levels of HC: PHC- comm. SHC- regional, provincial, district, municipal, and local hosp (complicated sx) THC- sophisticated med ctr—heart ctr, QI, KI 5. Nature Nature of CHN CHN practice practice requir requires es knowledg knowledge e on biologic biological, al, social social sciences sciences 6. Implic Implicit it in CHN CHN is is the nsg nsg practi practice ce (ADP (ADPIE) IE) Basic principles of CHN: (adopted fr Gardner, Cobb & Jones) 1. The comm. comm. is the patient patient in CHN, CHN, the family family is the unit of care care and the 4 levels of cliente clientele le are: a. indiv b. pop grp ( those who share share common common char, char, dev stages and common common exposure exposure to to the problems ex. Children, elderly) c. family d. comm. 2. In CHN, the client client is considered considered as an ACTIVE ACTIVE partner NOT NOT PASSIVE PASSIVE recipient recipient of care-par care-partici ticipator patory y approach Client- active participant, full involvement recipient care 3. CHN practice practice is affected affected by devts devts in Health technology technology,, in particular, particular, changes changes in society, society, in general. general. 4. The goal of CHN CHN is achieved achieved through through multisecto multisectoral ral effortsefforts- coordin coordinated ated with with other sectors. sectors. 5. CHN is a part of health health care care system and and the larger larger human services services system. system.-- Nsg practice, practice, human human service service Nsg fxn 1. Indepe Independe ndentnt- with without out supe supervi rvisio sion n of MD 2. Collaborat Collaborativeive- in collaborat collaboration ion with with other H team ( interdiscipl interdisciplinary inary,, intrasector intrasectoral) al) Basic Concepts of CHN (fr DOH bk) 1. Primary Primary focus focus is on health health promotx. promotx. The comm. comm. H nurse nurse by the nature nature of her work work has the the opportunit opportunity y& responsibility for eval the health status of people & groups & relating them to practice. 2. CHN practic practice e is extended extended to benefit benefit not only the the indiv but the the whole family family and communit community. y. 3. Community Community health health nurses are generali generalists sts in terms of their their practice practice through through life’s continuu continuumm- its full range range of health problems and needs. 4. Contact Contact with with the client client and/or family family may continu continue e over a long period period of time which which includes includes all ages ages and all types of health care. 5. the nature nature of CHN practice practice requires requires that current current knowledge knowledge derived derived fr the biological biological and social social sciences, sciences, ecology, clinical nsg, and community health organizations be utilized. 6. The dynamic dynamic process of assessing, assessing, plannin planning, g, implementin implementing g and intervening, intervening, provide provide periodic periodic measurements of progress, eval, and a continuum of the cycle until the termination of nsg is implicit in the practice of CHN. Summary: 1. Primary Primary focus/ focus/ emphas emphasis is – health health promotion promotion & dse preventx preventx Primary goal: self reliance in health or enhanced capabilities of people 4
2. 3. 4.
5. 6.
Ultimate goal: raised the level of healthe of citizenry Philosophy of CHN- worth and dignity of man CHN Pract Practiceice- to to benefit benefit indiv, indiv, fam, special special pop, pop, comm. comm. CHN are generalist generalistss- integr integrated ated and comprehensi comprehensive ve All All typ types es and and leve levels ls of HC ö Primary HC- mgt at the level of comm. ö Secondary HC- managed H problems regional, provincial, district, municipal & local hosps (for complicated pregnancies) ö Tertiary HC- sophisticated medical centers, NCMH, Lung Ctr. Heart Ctr, Nature Nature of CHN practic practice e requires requires knowledge knowledge on biolo biological gical,, social social sciences. sciences. Implicit Implicit in in CHN is the the nsg process process w/c w/c is an independe independent nt nsg action action ADPIE ADPIE
Key principles in CHN (page 19) 1. Recognized Recognized needs needs of indiv indiv famili families es and common common provider provider is is the basis basis for CHN CHN practice practice CHN process Assessment- data collectx (fam, comm.) Data analysis- H problems Community dx with people (people’s participation) Active and full involvement of people in decision making. 2. Knowledge Knowledge and understand understanding ing of agency objecti objectives ves & policies policies facilitat facilitates es goal achievement achievement Planning: 1. prio priori riti tiza zati tion on 2. goa goal se setting 3. obj object ectives 4. actions 5. evaluation evaluation// outcome outcome indicator indicators s –criteri –criteria/ a/ standar standard d ö measure outcome ö Criteria/ obj 3. Fami Family ly is unit unit of ser servi vice ce 4. Respec Respectt values values,, customs customs and and beliefs beliefs of clie clients nts Implementation ö pt/ ct- comm. ö Focus of care: indiv, families, sp grps, comm.. ö Attitude: non-judgmental 5. Healt Health h educ and and counsel counseling ing-- vital vital parts parts of CHN CHN Health educator- counselor—have the same goal: behavioral change Difference bet: Health educator – gives advice Counselor- gives options (never gives direct advice) 6. Collaborat Collaborative ive working working rel with with health health team team faciliti facilities es goal achieve achievement ment ö nurse coordinator of health services 7. Periodic Periodic and containing containing evaluation evaluation is necessary necessary 8. Contin Continuin uing g staff staff educeduc- upgrad upgrade e msg pract practice ice 9. Inde Indegen genous ous and and exi exist stin ing g Appropriate technology- methods & tech that a re: 1. scient scientifi ifical cally ly soundsound- experi experimen mentat tation ion 2. socia sociall lly y acce accept ptabl able e 10. Indiv, families, families, & comm. must must actively participate participate in decision making making 11. supervision of of nsg service by qualified qualified personnel 12. accurate recording/ reporting serve as eval & guide for future future actions Who supervises the nurse in 1. CH Nsg Nsg prac practic ticee- RN RN super supervis vision ion 2. Projec Project/ t/ progr program am imple implemen mentat tation ion –MD –MD 3. Mgt, Mgt, & adm admin in con conce cern rnss- May Mayor or a. MD b. RN super upervi viso sor r c. Major d. All of them 5
Roles of the PHN Clinician who is a health care provider, taking care of the sick people at h ome or in the RHU. Health educator, who aims towards health promo & illness preventx through dissemination of correct info; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors & supervises the performance of midwives
In the event that the Municipal Health Officer (MHO) is unable to perform his duties/fxns or is not available, the PHN will take charge of the MHO’s responsibilities
Roles of the PHN II and III Qualifications: BSN + RN in the Phil 1. Planner/ Planner/ programm programmerer- identifies identifies needs, needs, priorit priorities ies & problems problems if indiv, indiv, fams, & comm. comm. ö formulates nsg component of H plans ö In doctorless areas, she is responsible for the formulation of the municipal health plan ö Provides technical assistance to rural health midwives in health matters like target setting. 2. Provider Provider of Nsg carecare- provides provides direct direct nsg care to the sick, sick, disabled disabled in the homes, homes, clinics, clinics, schools schools,, or places of work ö provide continuity of patient care 3. Manager/ Manager/ supervisor supervisor-- formul formulates ates care plan for the: 4 Clientele: a. Requisitions, allocates, distributes materials (meds & medical supplies & records & reports equips b. Interprets and implements programs, policies, memoranda, & circulars c. Conducts regular supervisory visits & meetings to diff RHMs & gives feedbacks on accomplishments 4. Comm organizer- motivates motivates & enhance community participation participation in terms of planning, org, implementing implementing and evaluating H programs/ services. 5. Coordinator of Health Health Services- coord with other health team team & other gov’t org (GOs & NGOs) NGOs) to other health programs as envi sanitation health educ, dental health & mental health. 6. Trainer/ Trainer/ Health Health educator/ educator/ counselorcounselor- conducts conducts training training for RHMs, RHMs, BHWs, BHWs, hilots who aim towards towards H promo promo & illness prevention through dissemination of correct info; ö educating people 7. Researcher Researcher-- coordinate coordinates s with with govt & NGOs NGOs in in the impleme implementati ntation on of studies studies// researches researches ö Participates in the conduct of surveys studies & researches on Nsg and H related subjs. Responsibilities of CHN 1. Be a part in deliver delivering ing an overall overall health health plan; plan; its its implementa implementation tion & eval eval for comm. comm. 2. Provide Provide quali quality ty nsg nsg services services to 4 levels levels of clien clientele tele 3. Maintain coordinatio coordination/ n/ linkages linkages of nsg nsg service with with other other health team members NGO/GO in the provision of PH services- multisectoral app 4. Conduct research relevant relevant to CHN services services to improve provision of health health service- research—to improve HC 5. Provide opportunities opportunities for for professional professional growth and continuing continuing educ for for staff devt. Sources of CHN standards: BON & PNA PNA Multisectoral approach: ö other sectors ö intersectoral linkages ö own sector ö intrasectoral linkages ö comm. based referral network
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The CHN Process 1. Assessment –collection of data ( subjective: expressed by client or SO; o bjective: measurable- interview and observations,sensed, intrn) - analysis of data 7. Nsg Dx 8. Planning 9. Impl Implem emen enta tati tion on 10. Evaluation- measurable outcome or objective objective 4 tools/ instruments for data collection: 1. Nurs Nursin ing g his histo tory ry – sub subjj 2. PE- Obj 3. Lab- Obj 4. Proces Process s record recording ing-- obj (analy (analyzed zed by by RN) RN) Data analysis Group data- cues- health problem Nsg Dx- health problem r/t etiology ( somethind that we can intervene) Planning-goal Implementation Evaluation DEVELOPMENTAL DEVELOPMENTAL MODEL by Evelyn Duvalll Stages of Family Dev’t. Stage 1- Beginning family - marital & sexual adjustment, fxnal, communication, adjustment to roles, pre-natal educ. Stage 2- Early childbearing - changing roles, parenting Stage 3- Families with preschool children - discipline, childbearing, accidents, poisoning, CD Stage 4- Families with school age children - balancing time and energy to meet demands of work, children’s needs & activities, adults social interests, harmony in marital & in-laws relations. Stage 5- Families with teenagers - open comm.., continuing intimacy in marital relation, peer pressure, sex educ. Stage 6- Launching ctr marital dyad, identifying post parental interest, - releasing children as adults, reestablishing marital grandchildren, divorce/ separatx, menopause Stage 7- Middle Aged Families - rebuilding marriage & maintaining satisfying rel with aging parents children with their families, retirement plans, health, new career. Stage 8 – Aging ( retirement & old age) - continuous maintenance of fam rel, income changes & living arrangements physiologic aspects of aging, death of spouse. 8 Family tasks or Basic Tasks: • physical maintenance • allocation of resources- income given to wife • division of labor – joint parenting • socialization of family members reproduction, recruitment & release • • maintenance of order- high crime rate • placement of members in larger society- indication family’s success • maintenance of motivation and morale Structural fxnal Model ( Ruth Freeman) Initial data base Family structure and characteristics nuclear- basic family 7
extended- in-law relations, or grandparents relations ö members of household in relation to head ö demographic data (sex- male or female, age, civil status) live-in- married/ common law wife male- patriarchal female- matriarchal ö type & structure of family ö dominant members in health ö general family relationship
Assessment: Family ö initial data base ö 1st level assessment ö 2nd level assessment Socio- economic & cultural factors ö resources & expenses ö educ attainment ö ethnic background ö religious affiliations ö SO ( do not live with the family but influences decisions) ö Influences to larger comm. Environmental factors ö housing- # of rooms for sleeping ö kind of neighborhood ö social & health facilities available ö comm. & transportatx facilities Health assessment of a member- PE Value placed on prevention of dse ö immunization ö compliance behavior First Level Assessment 1. Health Health Threat- conditio conditions ns conducive conducive to dse, accidents accidents or failure failure to realize one’s one’s health potentia potentiall healthy people ö ö ex. Family hx of illness- hereditary like DM, HPN nutritional problems- eating salty foods personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking inherent personality char- short temperedness, short attn span short cross infectx poor home envi lack/inadequate immunization hazards- fire, falls, or accidents family size beyond what resources can provide
2. Health Health DeficitsDeficits- instances instances of failure failure in health health maintenance maintenance ( dse, disabilit disability, y, dev’tl lag) lag) ö -ex. Dse/ illness- URTI, marasmus, scabies, edema disabilities- blindness, polio, colorblindness, deafness dev’tl problems like mental retardatx, gigantism, hormonal, dwarfism 3. Stress Stress points/ points/ Foreseeabl Foreseeable e crisi crisis s Situa Situations tions ö anticipated periods of unusual demand on indiv or fam in terms of adjustment or family resources ( nature situatxs) school ö ex. Entrance in school adolescents (circumcision, menarchs, pubarche courtship (falling in love, breaking up) marriage, pregnancy, abortion, puerperium death 8
ö
unemployment, transfer or relocation graduation, board exam
Second Level Assessment Recognition of the problem decision on appropriate health action care to affected family member provision of healthy home e nvironment utilization of comm. resources for health care
Family Health Nursing Diagnosis ö combination of health problems and health Ex. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit p rioritization n ö problem prioritizatio Nature of the problem Health deficit Health threat Foreseeable crisis
=3 =2 =1
A. 2 x 1= 0.61 3 B. 3 x 1 = 1 3
wt.= 1 pt.
Preventive potential (ability) High Moderate Low
=3 =2 =1
A. 3 x 1 = 1 3 B. 3 x 1 = 1 3
wt. = 1 pt.
Modifiability Easily modifiable Partially modifiable Not modifiable
=2 =1 =0
A. 1 x 2 = 1 2 B. 2 x 2 = 2 2
wt. = 2 pts.
Salience High (serious- immediate action) Moderate (serious not immediate) Low (not felt)
=2 =1 =0
A. 0 x 1 = 0 2 B. 1 x 1 = 0.5 2
Ex. A. Inability of the family to recognize the health threats of a poor home environment r/t knowledge deficit. B. Inability to provide care to a pregnant member with anemia as a health deficit r/t knowledge deficit. Score= add all ( the higher the score, the higher the problem) Formula: _________given score_______ x weight Increase possible score Who to visit last? Health D A – adolescent with psychological problems Health D B – DM Health D C – pregnant Health D D – typhoid (RN shd practice aseptic technique) Clue: identify nature of problem first Top Priority Health case A unemployment HD B anemia in pregnancy 9
HD C scabies HT D poor home environment Population groups- composed of indivs Vulnerable grps: or “High Risk Groups” (before) ö infants & young children – dependent to caretakers ö schoolage- most neglected ö adolescents – identify crisis, HIV ö mothers – 1/3 of pop health problem (pregnancy, delivery, puerperium) ö males – too macho to consult ö old people – degenerative dse.
Specialized fields: 1. Community Community Mental Mental Health Health Nsg- a unique process process which which includes an integrati integration on of concepts fr nsg, nsg, mental health, social psychology, psychology, community networks and the basic sciences. Focus: mental H promotion- no need to identify dse, increase mental wellness of people Psychiatric Nsg- focus: mental dse preventx Focus: mental dse preventx- indentify dse & shorten dse process 1. Occupation Occupational al H Nsg- applicat application ion of Nsg principl principles es & procedures procedures in conservi conserving ng H of workers workers in all occupations. Aims: Health promotion & prevention of dses & injuries From industrial to service 2. School School Health Health Nsg- the applicat application ion of nsg theorie theories s & principles principles in the care care of the school pop pop Components: School H services- maintain school clinic, screening a ll children- visual, hearing, scoliosis Health instruction- health educ/ counselor direct & undirect Healthful school living- health monitor ö mental health- substance abuse, sexual H ö environmental health- food sanitation, water supply, safe environment, safe toilet ö school comm. linkage- comm. organizer ASSESSMENT OF COMMUNITY HEALTH NEEDS Community Dx- descriptive research ö profile general picture of comm. ö process by which the people in the conn & H team assess the comm. H problems & needs as bases for H programs devt. ö A learning process for the comm. to identify their own H problems & needs ö A profile that deposits the H problems & potentials of the comm. 2 types of community dx 1. Comprehensive- provides the general health profile of the comm. 2. Specific or problem oriented- yields a comprehensive profile of a particular H problem. Steps: Preparatory phase 1. Site selection- location of 1st criteria poor community- bec. Vulnerable to dse- H problem free from other agency 2. Prepa Preparat ration ion if the commun community ity 3. Statement of obj- dependent of comm. dx 4. Identify Identify methods methods & instrumen instruments ts for for data data collecti collection on A. Method Method of surve surveyy- quest question ionnai naire re 10
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census (100%) most ideal, enumeratx of data conducted 6 mos. Sample survey- most practical practical study representative of a comm. Size matters in terms of validity validity
B. Inte Interv rvie iew w meth method od - instrument- interview guide/ schedule C. Reco Record rds s rev revie iew w - instrument: checklist D. Ocular Ocular insp inspect ection ion// observat observatio ion n - instrument: checklist E. Partic Participa ipant nt observ observati ation on 5. Finali Finalize ze sampl sampling ing desi design gn & meth method ods s A. Probab Probabili ilityty- equal equal chan chances ces-- rando randomm- ( simpl simple, e, strat stratifi ified, ed, cluste cluster) r) B. Non- probabi probability lity-- everyone everyone will not not have equal equal chances/ chances/ not not equal 6. Make Make a time timeta tab ble
Implementation Phase 1. Data Data coll collec ecti tion on 2. Data Data organi organizat zation ion// collat collation ion 3. Data Presentat Presentation ion (narrative (narrative,, tubular tubular,, graphic graphical) al) 4. Data ata Anal nalysi ysis 5. Identi Identific ficati ation on of health health probl problems ems 6. Prior Prioriti itizat zation ion of heal health th prob problem lems s 7. Deve Develo lopm pmen entt of a hea healt lth h plan plan 8. Validati Validation on and and feedbac feedbackk- present presentation ation of result results s Evaluation Phase 1. Proc Proces ess s eval evalua uati tion on 2. Prod Produc uctt eval evalua uati tion on Statistics- (science) collection, organization, analysis, interpretation of numerical data. Biostatistics- refers to the application of statistical method to the life science like biology, medicine. A. DemographyDemography- study study of pop size, compositi composition on & spatial distrib distribution ution as affected affected by births, births, deaths deaths and migration. Phenomenon of variation ö tendency of a measurable character to change from 1 indiv or 1 setting to another or from 1 instant of time to another within the same indiv or setting Types of data: 1. ConstantConstant- value value remains remains the same same from person person to person, person, time time to time, time, place place to place place Ex. Minutes/ hour, speed 2. Vari Variab able le-- ex. ex. Temp Temper erat atur ure e Qualitative- categories are simply used to label to distinguish & group to another, rather than a basis for saying that 1 group is greater, higher than the o ther. Ex. Sex, Religion, Color Quantitative- numerical ö can be measured e. temp ö discrete- whole number or integral values ö continuous- fractions, decimals, can attain any decimal Sources of Demographic Data: 1. Survey a. Census Types: De Jure- data fr place of origin De Facto0 registration where it happened 11
Ex. If death happened at PGH, report in Manila regardless of place of residency—report to that place b. Sampl ample e surve urvey y 2. Continuing Population Registers- used computers to monitor their birth record. 3. Other records & registration systems Sources of data on health 1. Vita Vitall regi regist stra rati tion on reco record rds s ö RA 3753 ( Civil Registry Law) registration of births, deaths to local registrars (city health officer or municipal treasurer) ö Problem: under registration & de facto registration Unreported birth- unreported death 2. Weekly Weekly reports reports fr field field health health personnel personnel RA 3573 ( Law on on reporting reporting of notifi notifiable able dse) dse) ö report to provincial & duty health office ö midwife reports – under supervision of the nurse ö report within 24H –measles or polio ö report within a week- tetanus neonatorum, severe & acute diarrhea, HIV ö Problems: under reporting- crisis oriented, concept in health, sx, dx, syndromic approach. 3. Populatio Population n censuscensus- shd shd have interval, interval, accura accurate te estimati estimation on
4. Indiv. Indiv. Healt Health h record records/ s/ fami family ly reco records rds ö birth cert., school clinic records, employment records, health ctr records, hosp records, health facility logbooks, death cert 5. Publi ublica cattions ions Demography- study of pop size, composition & spatial distribution as affected by births, deaths and migration.
Components: Population Size: 5. Natu Natura rall incr increas ease e (NI (NI)) NI= birth – deaths 6. Net Net mig migra rati tion on (NM (NM)) NM= in-migrants – outmigrants (immigrants) (emigrants) 7. Growth Rate ate Crude birth rate/ 1000 – crude death rate/ 1000= current growth rate/ 1000 Ex. 26/1000- 6/1000= 20/1000 pop growth rate Population Composition: 1. Age dist distrib ributi ution on – percen percentt in term terms s of age age grp 2. Medi Median an age age – midd middle le mos mostt age age MA 20yo 50%= 20yo 50%= 20yo MA younger 3. Dependency ratio= number of dependent (0-14) +65 100 indiv in the prod age ( 15-64 yo) 4. Sex ratio ratio – number number of of males males for every 100 femal females es Males x 100 Females = SR = 100 (M-F) SR > 100 ( M) SR < 100 ( F) 5. Populatio Population n pyramidpyramid- double double bar graph graph depictin depicting g the age & sex sex structure structure of the the pop 6. Publ Public ic heal health th-- SR= SR= 105 105 (birth) SR = age 12
SR
= poor countries
SR = rural communities 0-1 vulnerable age for boys 0-6 7. other other char charac acte test stic ics: s: ö occupational groups ö economic grps ö educ attainment ö ethnic grps- visayan %, bicolano %
Population Distribution 1. UrbanUrban- ruralrural- % of pop in urban urban - % of pop in rural Ex. NCR region Urban 100 % 27 Rural 0 % 73 2.
shows the proportio proportion n of people people living living in urban compared compared to rural areas
Crowding Index- no. of household members ex. 20 = 4/rm Room for sleeping 4 - indicates the the ease by which a CD can be transmitted fr 1 host to another susceptible susceptible host
3. Population Density-
-
no. of indiv or Square km
indiv 2 Km
determines congestion of the place
Vital Statistics ö direct health indicator ö the application of statistical measures to vital e vents (births or fertility, deaths or mortality, and common illnesses or morbidity) that is utilized to gauge the levels of health, illness and health services of a community. VS= numerator x factor Denominator 1. Numerator A. fertility- number of birth mortality- no. death morbidity- no. of cases B. Numerator is always < denominator d enominator Quotient is always < 1 decimal no. C. Factor- 1000 (100%) – 100,000 Ex. CBR There is 0.0064 births/indiv = 6.4 X 1000 How to read: there are 6 births in every 1000 pop There are ANS (numerator) in every factor (denominator) Fertility Rate 1. CBR (Crude birth rate)- relative pop due to births Total number of births in a calendar year CBR= Birth x 1000 Pop ex. 25.8= CBR There are 26 births in every 1000 pop 2. General Fertility Rate (GFR) - true fertility rate – specific segments of pop that is fertile 13
GFR= ________Birth___________ ________Birth___________ x 1000 1000 Pop of women (15 to 44 yo) Ex. GRF=32 There are 32 births births in every woman in 15-44 Mortality Rates 1.Crude Death Rate ____ x 1000 Decrease in pop due to death CDR= death x 1000 Pop Ex. CDR= 6 there are 6 in every 1000 pop 2. Specific Mortality RateRate - can apply to any pop grp SMR = death from or particulare grp x 1000 Pop of that grp a. SMR (males) = death (males) x 1000 pop of males b. SMR (females) = death of females 15-44 pop of females 15-44
Infant Mortality Rate: Rate :
Neonatal Mortality Rate: Rate:
Post Neonatal Mortality Rate: Rate :
IMR= Death Death 0 -1 year x 1000 Births NMR= deaths 0-28 days x 1000 Births PNMR = deaths 28 days to 1 year x 1000 Births
NMR + PNMR = IMR Neonatal deaths + Post neonatal deaths= Infant deaths Ex. Birth 200 NMR= 20 Death – 28 to 1 NMR + PNMR = IMR 20 + 10 = 30 3 0 (ANS) 2 _ x 1000 = 1000 = 10 200 100
Maternal Mortality Rate (MMR) MMR= death of women r/t pregnancy, delivery, & puerperium x 1000 Births Ex. IMR = 30 There are 30 infant deaths in every 1000 births NMR = 20 There are 20 neonatal deaths in every 1000 births PNMR = 10 MMR = .92
Proportionate Proportionate Mortality Rate = PMR ( for any grp) PMR= death from a particular grp x 100 total death Ex. 52% PMR of males = deaths of males x 100 total deaths In every 100 death, 52 are males
PMR = deaths 0-1 x 100 0.1 0.1 tota totall death deaths s PROPORTIONATE MORTALITY INDICATOR A. Swar Swaroo oop’ p’s s Ind Index ex = SI SI SI = death of 50 yrs & up x 100 total deaths The SI, the better the situation is! 14
B. Relative Relative import importance ance of a killer killer ( TB, TB, heart dse, diarrhe diarrhea) a) Death due to TB x 100 total deaths PMR
= 30% TB --In every 100 deaths, 30 are due to TB
Case Fatality Rate (CFR) ö How is survival rate, how strong is killing power, prognosis CFR= death due to part cause x 100 total cases Ex. CFR
= 98 HIV
___death HIV ___ x 100 Total cases of TB In every 100 cases of HIV, there are 98 deaths
Cause-of-death Rate (mortality rate) ö Rank as a killer C of DR= death due to particular cause x 100,000 total pop Ex. C of DR
=320 TB
In every 100,000 pop there are 320 deaths due to TB
Prevalence Rate = (Morbidity (Morbidity rate) Rank as a common dise ö PR = old and new case of TB x 100,000 TB total pop Ex. PR = old & new case of TB x 100,000 TB Ex. PR = 326 TB There are 326 cases of TB out of 100,000 population.
Incidence Rate IR= ___new cases___ x 100,000 pop at risk
Epidemiologyö study of distribution of dse or physiologic condition among human pop & the factors affecting such distribution. ö distribution means the frequency of dses and physiologic cond in terms of who gets sick where and when. 15
Basic Concepts: 1. Epidem Epidemiol iologi ogic c TriadTriad- Agent Agent-- hosthost- envi envi 2. transmission of CD – common vehicle, source- serial- transfer- propagated fr host to host 3. Incubation prd- fr every of pathogens up to appearance of the 1st s/sx 4. Herb Immun Immunityity- % of immune immune pop- some indiv indiv are immune immune Dengue- aedes – daytime C Arthropod malaria – anopheles- nighttime L E A Neem tree Types of Immunity 1. Passive- quick to come, quick to go Natural- in water, breast feeding Artificial- serum globulin, antiserum, antitoxin 2. Active- slow to come, slow to go Natural active- getting the dse itself Artificial- tetanus toxoid Preg 1 --- 4th month --------------------------TT1 --- 8th month (before delivery) ---- TT2 Preg 2 --------------------------------------------------------------------------------------- TT3 ( 1 st booster dose) Preg 3 ------------------------------------------------------------------------------------- TT4 (2 nd booster dose) Preg 4 -----------------------------------------------------------------------------------------TT5 ---TT5 (3 rd booster dose) Factors affecting distribution of Dse 1. Person ö exposure, susceptibility or response to agents. ö influenced by intrinsic characteristic ö genetic/ family, human behavior, prior immunologic experience ö age, sex, ethnic grp, physiologic status Some identified increase risk grps. ö mothers, infants, and young children ö school children, old people, contacts
ö ö ö
people far fr medical assistance people in areas with endemic dse people at certain times
Attack Rate- incidence of illness among exposed pop Number of cases x 100 Pop at Risk 2. Place- extrinsic factors, existence of etiologic factors & exposure & susceptibility of human host influenced by extrinsic factors. 3. Time- temporal patterns- fluctuations of incidence a. short term- fluctuations - time of day - days of the week b. cyclic pattern- regular pattern seasonal cydicity – annual cydicity secular dycylicity – every other year typhoid, measles Patterns of dse occurrence
Epidemic- a situation when there is a high incidence of new cases of a specific dse in excess of the expected. - when the proportion of the susceptible are high compared to the proportion of the immunes. - ex. 20-30 dses that you d on’t know Current number of cases exceeds the usual expectancy. 16
Endemic- Habitual presence of a dse in a given geographic location accounting for the low number of b oth immunes and susceptible. - causative factor is constantly available or present to the area Ex. Malaria, constant
Sporadic- dse. Occurs every now and then affecting only a small number of people relative to the total p op - intermittent
-
on and off _______________ _______________
Pandemic- global occurrence of a dse, bigger pop -- Patient epidemic- easily the person can identify the cause _______________ cause _______________ Common Epidemiologic Studies:
Retrospective (Past) Case control study
Cross- sectional (Present) prevalence study- old and new cases - get prevalence of dse (Lung CA) - get prevalence of risk factor (smoking)
Prospective Cohort (future)
Independent variable (cause) Dependent (effect) National Health Situation Health Indices I. Basic Health Indicators Nutrition Disease Patterns Leading causes of Morbidity Context of CHN: health situation Nutrition- under nut of 0-6 yo Commerciogenic malnutrition 1998- 6 out of 10 fil (0-6) are undernourished Anemia- 48% of filipinos 58 % are pregnant women
2001-1999 1. diarrhea 2. bronc onchitis 3. pneumonia 4. influenza 5. HPN 6. TB 7. dses dses of the hear heartt 8. malaria 9. measles 10. varice varicell lla a
10 Leading Causes of Morbidity 1998 1. diarrhea 2. pneumonia 3. bronchit hitis 4. influenza 5. HPN 6. TB 7. malaria 8. dses dses of the the hea hearrt 9. dengue 10. varice varicell lla a
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 10.
1997 diarrhea pneumonia bronchi nchittis influenza TB malaria dses dses of the the hea heart rt measles varicella deng dengue ue
10 Leading causes of Death 1998 1. dses dses of the hear heartt 2. dse dse of the the vasc vascul ular ar sys syste tem m 3. pneumonia 4. mali malign gnan antt neop neopllasm asm 5. accidents 6. TB 7. COPD
1995 1. 2. 3. 4. 5. 6. 7.
dses dses of the the hear heartt dses dses of vasc vascul ular ar syst system em pneumonia mali malign gnan antt neop neopllasm asm TB accidents COPD 17
8. DM 9. other ther pes pesp dse dse 10. nephri nephritis tis
8. DM 9. othe otherr resp respir irat ator ory y dse dse 10. nephri nephritis tis
II. Other indicators A. Infant Mortality Rate UNICEF 53.95 in 1998 DOH 18.7 17.3 Global indicator for IMR : 50 Increase IMR- decrease MCHS (poor nutrition and child health service) 10 Leading Causes of Infant Deaths (1998) 1. Respiratory conditions of fetus and NB 2. Pneumonia 3. Congenital Anomalies 4. Birth injuries and conditions r/t difficult labor 5. Diarrheal dse 7. Septicemia 8. Meningitis (no BCG) 9. Avitaminosis & other nutritional deficiencies 10. Measles (complications underlying cause of death) Increase IMR= decrease MCHS Poor maternal child health service B. Maternal Mortality Rate Leading causes of maternal deaths 1. Normal Normal delivery delivery and other complica complications tions r/t r/t pregnancy pregnancy occurring occurring in the course of labor, labor, delivery, delivery, and puerperium 2. HPN complicati complicating ng pregnancy pregnancy,, childbi childbirth rth and and puerperi puerperium um 3. Post Post partu partum m hem hemor orrh rhag age e 4. Pregna Pregnancy ncy with with abor abortiv tive e outco outcome me 5. Hemo Hemorr rrha hage ge r/t r/t preg pregna nanc ncy y Life expectancy at birth—life span either: age specific or sex specific Median Age- 20.1 years - The Philippines is an agricultural country- 55% E. Crude rates 1. CBR- ____ 2. CDR- ____ HEALTH CARE DELIVERY SYSTEM “The totality of all policies, facilities, equipments, products, human resources, and services which address the health needs, problems, problems, and concerns of the the people. It is large, complex, complex, multi-level multi-level and multi-disciplinary.” multi-disciplinary.” FOUR QUESTIONS: Who are served?—only a few bec only a few can afford Who provides the services? – health professionals Where are the services given? – hospitals- access p hysical inaccessibility- financial What is the focus of care? – curative Participation in the production process
_____
ability to satisfy basic need
health status
5 Major Functions: 1. Ensure equal access to basic health services 2. Ensure formulation of nat’l policies for proper division of labor & proper coordination of operations among the government agency jurisdictions. 18
3. Ensure a minimum level of implementation nationwide of services regarded as public health goods – family planning, EPI, ____, _____ 4. Plan and establish a rrangements for the public health systems to achieve economies of scale—Phil Health 5. Maintain a medium of regulations and standards to protect consumers and guide providers —Sentrong Sigla- training and infrastructure Local Gov’t Units RA 7160 Local Govt Code – local health board- Governor ö Municipal health officer- mayor
ö
Assist ____ - municipal ö Provincial health officer Health Promotion- no threats, no risk- approach behavior Health Prevention- identified health problem- avoidance behavior Private Sector ö composed of both commercial and business orgs, non- business orgs NGOs Assumes the ff roles: ö Policy and Legislative Advocates ö Organizers, Human Rights Advocates ö Research and Documentation ö Health Resource Dev Personnel ö Relief and Disaster Mgt ö Networking THE NATIONAL HEALTH PLAN National Health PlanPlan- a long-term directional plan for health. health. This is the blueprint defining the country’s country’s health. PROBLEMS POLICIES STRATEGIES THRUSTS Goal: (To improve the health situation) - To enable the Filipino pop to achieve a level of health which will allow Filipinos to lead a socially and economically-productive economically-producti ve life, with longer life expectancy, low infant mortality, low maternal mortality, and less disability through measures that will guarantee access of everyone to essential HC. Broad Objectives: Promote equity in health status among all segments of society Address specific health problems of the population Upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to changing the health needs of the population Promote active and sustained people’s pa rticipation in HC. MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020” “23 IN 1993” ö refers to the 23 programs, projects, activities of the DOH for the year 1993, which marks the beginning of its journey towards DOG vision. “ Health for more in ‘94” ö activities in 1994 focused on Cancer prevention, reproductive health, mental health, and maintenance of a safe envi. “ Health Focus in 1995” – “ Think Health, Health Link” ö a national and multi-sectoral health promotion strategy aimed at conveying health messages to people wherever they are aimed at a t building supportive environments through advocacy, community action and networking. “Health Sector Reform Agenda” 19
ö emphasizing on improvements in health care delivery by maximizing people’s participation in health “ Sentrong Sigla Movement” ö pertains to development & implementation of standards to provide quality health services to the people. Strategies and Methodologies ö Strategies and Health Status Targets to Achieve Objectives Strategies to promote equity in health: --priority for the vulnerable and marginalized Marginalized people- those who live geographically and culturally isolated areas; are victims of poverty, armedconflict, man-made and naturall disasters and poor envi conditions. Vulnerable sector of the pop—composed of infants (0mo-1yr) and children (1-4yo), women or reproductive age (15-44 yo), youth and adolescents and the elderly (65 and above). Primary Health Care as the Key Approach 1. Health PromotionPromotion- consists consists of activities directed towards towards increasing increasing the level level of well-being & actualizing actualizing the health potentials of indiv, families, communities, societies - Goals: wellness level – no risk risk factor, no threats threats Differences with Dse Prevention: ö not dse/ dysfunction or health problem specific
ö ö
approach _____ behavior not “avoidance behavior” risk to expand positive potential for healthful prevention thwarts the occurrence of pathogens with ____ __ health & well-being.
Levels of Health Promotion 1. Indi Indiv v wel welllnes ness 2. fami family ly well wellne ness ss 3. comm commun unit ity y well wellne ness ss 4. envi enviro ronm nmen enta tall wel welln lnes ess s 5. soci societ etal al well wellne ness ss Methods of health promotion: 1. health educ 2. good nu nutritx 3. person personali ality ty devdev- groom grooming ing and hygi hygiene ene 4. provision provision of adequat adequate e housing, housing, recreatio recreation, n, and amenable amenable workin working g condition condition
HEALTH PROMOTION AND DISEASE PREVENTION IN THE CONTEXT OF A PATHOGENESIS Health promo Healthy person-----------time---------person-----------time------------------------------- healthy person (pathway of health) No risks, no threats, no problems
Pathway of dse---recovery Permanent Death 2.DISEASE PREVENTION: PRIMARY LEVEL OF DSE PREVENTION -Still healthy - prevention and dse - risk factors and threats present
s/sx-self-medication -health seeking behavior kuto- kalachuchi, malunggay, Acapulco, madre de cacao
A. Through people ex. 20
1. immunization - method of health p romotion 2. chemoprophylaxis - intake of drugs, ex. Vit C to avoid URTI 3. RSH ( reproduction and sexual healthhealth - _______
ö ö ö
Family solidarity Safe motherhood Child survival ö responsible parenthood (child spacing # of preg ideal thing) women health safe motherhood child survival. ö Ideal age to get pregnant: 20-30yo ( Less than 18-20=with risks) ( more than 30-35 with risks) ideal number of pregnancies= pregnancies= 3 (4 kids- with risks, >4 increase risk) risk) ideal interval= 3 years (every 2 years with risk, every year= with risk) what to discuss: basic human sexual response 2 types of family planning method 1. spacing # of preg ideal timing 2. permanent method B. Through Environmental Control 1. Safe water supply - physical characteristics - chemical characteristics-with minerals in H2O- hard water (better!), little mineral in water( soft water) - biological- (-) for e.coli Common household water fxn= boil H2O Boil with low fire, wait 5 mins agter boiling SedimentationAeration FiltrationFiltration- fr ascariasis due to airborn solid block Water supply- 25 meters away fr toilet, pig pen, poultry refuse disposal system 2. Food Sanitation/ good food hygiene Ensure the health of the ff: 1. source sources s of raw raw foodfood- with without out pest pestici icides des no double dead meat 2. food ood han handler dlers s 3. envi enviro ronm nmen enta tall sanita sanitati tion on 4. safe safe excr excreta etall dispo disposal sal (toil (toilets ets)) a. needs H2O b. no need need for H2O
Needs Needs trans transpla plant nt No tra trans nspl plan antt
water Ciste Cistern rn flush flush with with sewa sewage ge system system -ci -cister stern n flflush ush wi with sep septi tic c tan tank k
No water Flying Flying sauc saucerer-pai paill system system (buc (bucket ket latr latrine ine)) 1. PIT PIT-- pr privy> vy> ant antiipolo, olo, bor bore hol hole, e, compo ompost st,, tw twin > ventilate 1 improved pit- less smell > reed odorless earth closet (ROEC) 2. overhung latrine (batalan) – bangin 3. cat-hole latrine
Consider culture of the peoplePublic toilet- disadvantage- pay, maintenance -very old, young -typhoon & night – dangerous 4. Refuse ManagementManagement- solid and semi-solid waste excluding human excretal Garbage- fruit peelings, left over food- biodegradable Rubbish- broken glass, plastic- non-biodegradable Acceptance refuse mgt 1. open bu burnin ning 21
2. composting 3. burial No-no: open dumping Community Level a. Sanitary Landfill problem: prone to scavenging b. incinerator- no residue, pure smoke 5. Vector animal reservoir control 6. Disinfestations Disinfestations & sterilizatio s terilization n 7. Good living & working condition 8. Health educ Health promotion best source of prevention Secondary prevention- early dse prompt intervention to halt pathological process to shorten du ration, severity & return to normal fxn at earliest possible time. Screening methods - mass screening- shd be simple & inexpensive - case finding- dse of leading causes of morbidity Gold Standard for TB test: Culture and Sensitivity Sputum smear microscopy- TB test - contact tracing- pt with dse- check source of infectx fr family - multiple screening- HIV test - surveillance a. pre-test pre-test counseling counseling-- risk risk apprais appraisal al for for dse dse preventi prevention on - risk situation, risk behavior b. ELISA I c. Post Post tes testt cou couns nsel elin ing g - behavioral modification- IMPT - uniqueness of indiv - risk factor: increase probability of dse d. ELISA II e. Western Western block block testtest- (-) (-) or (+) result result with post counseling counseling - Ochar Characteristics of an ideal screening test: 1. Sensitivi Sensitivityty- true true positive positive rate rate or strength strength of associa association tion bet bet presence presence of dse & sx sx 2. Speci ecificity Tertiary Prevention- during symptomatic phase - defects or disability is present - rehab is goal, resting to an optimum level of functioning within the constraints of disability - rehab states when indiv enters facility Methods: People’s participation People’s participation (continuous & sustained) Awareness raising Organizing Mobilizing Awareness ability to identify or ____ personal concerns & troubles to bigger context
3. Community Organizing – CO Levels of Awareness: Political socializationsocialization- highest level of a. people with 22
common problems/concerns will mobilize - test of unity & will lead as guide to future actions Political mobilization-common Interest aggregation – people with problems will grp together & relate to one another, *identifies a common problem Interest articulation- people recognized problems & ___ & ___ diff ways; crying, wailing, swearing due to a problem. problem. People recognizes the prob prob & expresses it Culture of silence/passivitysilence/passivity- lowest/ low salience salience to existing problem. People are not aware “naturalizing” “naturalizing” but not considered considered as a problem. problem. ex. Battered wife Key concepts and Principles of CO: 1. obj analysi analysis s of obje objecti ctive ve condi conditi tions ons 2. basic trust on people people & on their their inmate inmate potent potentials ials & capabilit capabilities ies 3. from the people people for the people people & with with the the people people subj of CO= people 4. peop people le wan wantt to chan change ge 5. self-will self-willed ed changes changes will will have have more meanin meaning g ___ then impos imposed ed changes changes – fear fear tactics tactics don’t don’t work work (imposed (imposed)) Context of CO: - Current situation- CO is is class based. CO is given to the poor, deprived & oppressed oppressed Goals of CO: -equal chance/ access for people CO in health: HSO (health sector organizing) establish communication based health programs - component of __ & health component - thrust is PHC 4. PRIMARY HEALTH CARE (PHC) - essential care based on scientifically sound & socially acceptable methods & technology made universally available to ___. Families & communicates communicates at a cost they can afford at any given stage of dev’t through their full participation participation towards self-reliance self-reliance and self-determination. PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health dev. It is a strategy aimed to provide essential HC that is C ommunity-based A ccessible P art and parcel of the total socio-economic dev effort of the nation A cceptable S ustainable at an affordable cost
Health Care System (HCS) vs. PHC Recipients- a few - many Providers- health professionals - brgy health workers Venue- hospitals - community
DOH framework: People’s empowerment & partnership is the key strategy to achieve the goal “Health for All Filipinos by the Year 2000 and Health in the Hands of the People by the year 2020”. WHAT DOES ESSENTIAL HC IN PHC MEAN? It stands for: E ducation of prevailing health problems L ocally-endemic dse prevention and control E xpanded program of immunization M aternal and child health and family planning E nvironmental sanitation and safe water supply N utrition and food supply T reatment of communicable and non-communicable dses/conditions S upply and proper use of essential drugs and herbal med 23
D ental health promotion A ccess to and use of hospitals h ospitals as centers of wellness M ental health promotion Pillars (major elements): A. MultiMulti-sec sector toral al approa approach ch Intersectoral linkages Intrasectoral linkages B. Commun Community ity Partic Participa ipati tion on Phases of CO in health: C. Approp Appropria riate te Techno Technolog logy y - method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost. Criteria: F easible A cceptable, Affordable C omplex E ffective S afe S cope- wise Ex.
Herbal Medicine 1. aromatic- has volatile oil for for tx of fever, cough, colds, itchiness and gas pain. pain. Luya, bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong, lagundi, _ __ or petals of sampaguita, jasmine & rosal Luya- shd not be taken on an empty stomach Elixir- ______ Shake week after week—tx for TB Bawang crush 1 ear & drink it Tincture of bawang 1:5 Add 5 tbsp. of gin; 1 tbsp chopped bawang Shake 10 mins for 1 week – good for superficial wounds Tanglad- lemon grass—for fever Sambong—stomachache Suha/kalamansi- for fever, TSB 2. astringent-tasting- bitter- has tannin & pectin for diarrhea & wound A vocado leaves B ayabas leaves K amilo leaves D uhat leaves S aging leaves (saba cut into chips, let dry, pulverize then add to _____) 3. bitter-tasting a. skin problems--Acapulco, kalachuchi, malunggay, kakawati, inakabuhay b. depressants- to put hyper people to sleep--dapdap, dita, makabuhay, makahiya c. anti-cancer drug-- tsitsirika d. aches & pains-- sambong, damong arya e. asthma- talampugay- can cause psychosis 4. seeds- fixed oils, anti-helmentics- niyug-niyogan (urine), patola, ipil-ipil, betel nut or bunga, balanyog, squash seeds, lanzones- do not throw peelings instead, burn it—good insect repellant 5. grass family- diuretics—kagon, tubo, tanglad, pandan, pugo-pugo, buto-butones, gatas-gatas, atajuo kahol, pansit-pansitan or ulasimang bato, stones- meis hairm, HPN- palay 10 Medicinal Plants: L agundi- asthma, cough, colds U lasimang bato- uric acid, HPN B awang- HPN 24
B ayabas- Diarrhea Y erba Buena- arthritis, toothache, swollen gums, cough & colds S ambong- cough and colds, renal stones A mpalaya- DM N iyug-nyogan- ascariasis T saang gubat- diarrhea A capulco- fungal infection, scabies RA 8423- utilization of medicinal plants as alternative for high cost medications. Policies: 1. the indica indicati tions ons// uses uses of plants plants 2. the the part part of of the the plan plantt to be be used used 3. pre prepar parati ation of a. deco decoct ctio ionn- laga laga/b /boi oill b. poul poulti tice ce-- tapa tapall (may (may add add oil) oil) c. infu infusi sionon- tea tea at at lea least st 24H 24H d. syrup- add sugar sugar and for for storagestorage- lasts lasts for 3-5 days days e. oilsoils- bawan bawang, g, luya, luya, mans mansani anilya lya extr extract act f. oin ointmen tmentt- wit with h wax wax g. tinc tinctu ture re alco alcoho holl h. eli elixir ba based D. Support mechanism made available
TYPES OF PRIMARY HEALTH WORKERS VILLA LLAGE/ GRA GRASSROO OOTS TS HEALTH LTH WOR WORKERS ERS INTE INTERM RME EDIATE LEVE LEVEL L EX
C H A R A C T E R I S T I C S
Trai Traine ned d com communi unity Health worker; health auxillary volunteer; traditional birth attendant
General medical practiotioners Public health nurses Midwives
HEALTH LTH PER PERS SONN ONNEL OF OF FIRST LINE HOSPITALS Physicians with specialty area Nurses dentists
Initial link, 1 st contact of the
1st source of
Establish close
community Work in liason with the local health service workers Provide elementary curative preventive health care measures
professional Health care Attend to health problems beyond the competence of village health workers Provide support to the frontline health workers in terms of supervision, training, referral services and supplies thru linkages with other sectors
contact with the village and intermediate level health workers to promote the continuity of acre from hosp to community to home. Provide back-up health services for cases requiring hosp or dx facilities not available in HC
Strategies/ programs to promote health of the vulnerable sectors of the population Maternal Care Program
Strategies: A. Provision Provision of Regular Regular and Qualit Quality y Maternal Maternal Care Care Services Services Regular and quality pre-natal care - hx-taking, utilization of HBMR (Home-Based Mother’s Record) as a guide in the identification of risk factors - PE: weight, ht, BP-taking 25
Perform head to toe assessment, abd exam Tetanus toxoid immunization - Fe supplementation: given from 5th month of preg to 2 months postpartum (100-120 mg orally/day for 210 days) - Laboratory exam: heat-acetic acid test, benedict’s test - Oral/dental exam Pre- natal counseling Provision of safe, delivery care - all birth attendants shall ensure clean and safe deliveries at home or at the facilities ( RHUs/hospitals) - at-risk pregnancies and mothers must be immediately referred to the nearest institution - untrained TBAs who actively practice must be identified, trained, and supervised by a personnel of the nearest BHS/RHU trained on maternal care. Major program policies: 1. Improvemen Improvementt of family welfare welfare with with main focus on women’s women’s health, health, safe motherho motherhood od & child survival survival 2. free freedo dom m of choi choice ce 3. promotion promotion of family family solidari solidarity ty and responsibl responsible e parenthood parenthood (except (except birth birth control) control)
-
Causes
Possible Effects
Short interval of pregnancies Pregnant before 20 or > 30 yo More More than than 4 delive deliveri ries es
MOM Bleeding, malnutrition, anemia, HPN Anemia, miscarriage, still birth, prolonged labor HPN, HPN, bleedi bleeding, ng, ruptur rupture e of uterus uterus.. cervical CA
BABY Pneumonia, bronchitis, diarrhea, measles, congenital deformities Low birth wt, fetal death, infant death, physical defects LB wt, respiratory distress
FAMILY PLANNING PROGRAM
Family Planning Method: 1. spacing 2. hormon hormones es (pills (pills,, inject injectabl ables) es) 3. barrierbarrier- IUD- condoms condoms (male/fem (male/female), ale), cervical cervical cup, diaphrag diaphragm, m, sponge, spermici spermicides, des, dental dams dams 4. scie scient ntif ific ic fami family ly plan planni ning ng - natural cervical mucus method - standard days method- urban poor women, red beads- start of mens 5. perm perman anen entt meth method od - tubal ligation- ok even if without consent of husband - vasectomy
EPI
Goal of EPI- reduction of morbidity and mortality of immunizable dse Types and Schedule of Vaccines: AT BIRTH BCG
1 ½ months
2 ½ months
3 ½ months
9-12 months
DPT1 OPV1
DPT2 OPV1
DPT3 OPV3
MEASLES 26
HEPB 1
HEPB 2
HEPB 3
BCG: infant – 0.05ml – ID School entrants – 0.1 ml ID (double dose) DPT: HepB TT
.5 ml, SQ – destroyed by freezing
Measles .5ml. SQ most sensitive to heat OPV – 2 gtts/PO Cold- all vaccines are sensitive to heat i. Koch’s phenomenon- inflammation of the site of injection after 2-4 days warm complex j. Deep Deep absce abscess ss at at sitesite- incisi incision on and and drai drainag nage e k. Indole Indolent nt ulcera ulceratio tionn- ulcer ulcer after after 12 wks l. Glan Glandu dula larr enl enlar arge geme ment nt-- abs absce cess ss 2-3 weeks abscess will leave scar 12 wks after DPT- fever for a day - soreness at site within 3-4 days - abscess after a week or more- incision and drainage - convulsions Measles- fever 5-7 days after within 1-4 days - mild rashes Provision of quality postpartum care Proper schedule of follow-up must be followed: - 1st postpartum visit for home deliveries must be done within 24H after delivery - 2nd, done at least 1 week after de livery - 3rd, done 2-4 wks thereafter
Attendants must be aware of the early signs, signs, sx, and complications. They shd follow the 3 CLEANS: CLEAN hands CLEAN surface CLEAN cord B. Improvement of the health personnel’s personnel’s capabilities capabilities on on NB care, midwifery midwifery thru trainings. trainings. Trainings for for “hilots” must also be conducted C. Improvemen Improvementt on the quality quality of of care at the the First First Referral Referral Level Level Orientation, training shd be done on the use of proper filling-up or HBMR card Proper referrals/endorsements must be done for future if-ups D. Preventio Prevention n of unwanted unwanted pregnancies pregnancies through through family family plannin planning g services services E. Preven Preventio tion n and mana managem gement ent of of STDs. STDs. F. Promot Promotion ion of approp appropri riate ate health health pract practic ices es G. Upgrad Upgrade e repor reportin ting g servi services ces H. Mobilize political political commitment commitment and community involvement involvement to provide support to basic HC delivery delivery
Remember the principles Even if the interval exceeded that of the expected interval, continue to give the doses of the vaccine. Immunization can still be given until the child reaches 6 yo If there has been a reported epidemic of measles, measles vaccine can b e given as early as six months BCG booster dose must be given to school entrants regardless of presence of BCG scar. There is no contraindication to immunization, EXCEPT EXCEPT when the child had convulsions upon giving the 1st dose of DPT. 27
MALNUTRITION MALNUTRITION is not a contraindication, but RATHER AN INDICATION for immunization since common childhood disease are often severe to malnourished children. Cold Chain – a system used to maintain the potency of a vaccine from that of manufacturer to the time it is given to child or pregnant woman. Principles: 1. Storage- it should not exceed: - 6 months @ the regional level - 3 months @ the provincial/ district level - 1 month @ main health centers ( with refrigerators) - not more than 5 days @ h ealth ctrs.( using transport boxes) Important points to remember: ♥ Arranging of stored vaccine according to: ≈ Type ≈ Expiration date ≈ Duration of storage ≈ # of times they have been brought out to the field ♥ The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST shd be distributed or used 1st. ♥ It is a MUST to mark ampules/vials with an “X” mark each time they are carried to the field, bec if a VACCINE IS NOT USED on the 3 rd trip, it must already BE DISCARDED. II. Transport Use of cold dogs III. Handling Once opened or reconstituted, vaccines must be placed in a special cold p ack during immunization sessions.
Vaccine BCG DPT Polio Measles TT HepB
Half life 4 hours
8 hours
TARGET SETTING: - Iinvolves the calculation of the eligible pop. - “ELIGIBLE POP” consists of any grp of p eople targeted for specific immunizations due to susceptibility to one or several of the EPI dses. UNDER FIVES CARE PROGRAM
UFC Program (under five care program) A package of child health-related services focused on the 0-59 months old children to assure their wellness and survival. A. Growth and Health Monitoring (GMC) A standard tool used in health centers to record vital info rel to child growth and dev, to assess signs of malnutrition Sallen “Ming Scale”, Bar and Detect type scales are being used o o All NBs must be enrolled for UFCP B. Oral Rehydration Therapy Diar Diarrh rhea ea
(Unu (Unusu sual al freq freque uenc ncy y of bowe bowell move movem ments ents more ore tha than n 3x/d 3x/day ay)) (Marked change in the amount of stool) (Increase in stool liquidity)
3 Classifications of diarrhea: 28
Mild- 5-10 unformed stools/24H Moderate- 10-15 unformed stools/24H Severe- >15 unformed stools/24H with associated s/sx Dehydration ♥ Mild-first sign: thirst, sunken fontanels and eyeballs, dry lips, is irritable but conscious, (-) skin fold test Tx: give ORS for 4-6H then reassess after 4-6H < 2 yo= ½ cup rice H2O/ H2O/ ___ or ½ glass of ORS ORS 2 years and above= 1 cup rice water or 1 glass of ORS ♥ ♥
Moderate- lethargic, normal blood glucose, (+) skin fold test- 10% weight loss Severe- comatose, almost (-) urine output, dry tear ducts, (++) skin fold test-15% wt loss
DIARRHEA MANAGEMENT AT HOME 3 F’s ◊
◊
Fluids Oresol Rehydration Therapy Encourage/ensure inta intake ke of any any frui fruitt juices, “am”, “lugaw”, homemade soup
◊ ◊
◊ ◊ ◊
Frequent feeding Continue breastfeeding With With childr children en over 6 mos; mos; cereal cereals/ s/ starchy foods mixed with meat or fish and vegetables Mashed banana or any fresh fruit Feed the child at least 6x/day After diarrhea episode, feed 1 extra meal/day for 2 weeks
Fast Referral If child doesn’t get better in 3 days, or if danger signs develop-refer patient Danger signs: ◊ Fever ◊ Sunken fontanel ◊ Sunken eyeball ◊ Frequent watery stools Repeated vomiting ◊ ◊ Blood in stool ◊ Poor intake of meals ◊ weakness
ORS: 1 pack 1 liter of water Contains: Glucose for Na absorption NaCl for fluid retention NaHCO3 to serve as a buffer system KCL for smooth muscle contraction Home-made oresol: 1 L water 8 tsp of sugar OR 1 tsp salt
1 glass water 2 tsp sugar 1 pinch of salt
REMEMBER: Infant must be given ¼- ½ cup every after LBM Child must be given ½ -1 cup every after LBM Adult must be given 1 or more cups every after LBM Measures on diarrhea preventx ö breastfeed infants ö Provide appropriate supplemental feeding ö handwashing ö utilize clean and potable water ö clean toilet and observe proper feces disposal ö immunize the child with measles * No antibiotics must be given to a diarrheic px except in infectious diarrhea like cholera.
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C. BreastfeedingUnique characteristics of Breast milk: B R educed allegic reaction E conomical A lways available S afe/ maintains the stool soft T emperature always right
F resh E motional bonding E asily established D igestible I mmunity N utritious G IT disorders are decreased
Difference of breast milk from formula milk: Breastmilk CHO CHON (LACTALBUMIN) fats Linoleic acid content (3x) Minerals
vs. > < = > <
Formula CHO CHON (CASEIN) fats Linoleic acid content minerals
* The high CHON and mineral content of cow’s milk may overwhelm the NB’s kidney, thus it still needs to be diluted. Casein is more difficult difficult to digest. digest.
D. Immun Immuniza izatio tion n (see (see EPI EPI)) E. Care of of Acute Acute Respirato Respiratory ry Tract Tract Infectio Infections ns (CARI) (CARI) Goal: identify and tx pneumonia Program: Assessment: History: age, cough & duration, able to drink or stop feeding, fever, duration, convulsion PE: RR- one whole minute Fast breathing Less than 2 months—60/min 2 months- 1 year—50/min 1-5 years old—40/min Observe for: -chest in-drawing - stridor during inhalation - LOC - wheeze during exhalation - fever - malnutrition Diagnosis ♥ Infants 2 mos to 5 yrs - very severe dse not able to drink, convulse, sleepy, stridor, severe malnutrition - pneumonia-chest in-drawing, nasal flaring, grunting, cyanosis tx: 1. refer refer urge urgentl ntly y to hospi hospital tal 2.1st dose of antibiotics 3. tx of fever (TSB) and wheeze (nebulize) 4. anti-malarial Severe pneumonia- chest in-drawing, cyanosis, nasal flaring, grunting tx: same with very severe but anti-malarial is not given Not severe pneumonia- no chest in-drawing and fast breathing Tx: 1. home care- tsb, nutrition, steam inhalation 2.antibiotics- for 2 days & follow up after 2 days- if it improves, consume all meds finish the course of the treatment. treatment. If worse, refer. refer. ♥
Infants less than 2 mos 30
1. very severe severe dse—stopped dse—stopped feeding feeding well, well, convulsions, convulsions, abnormal abnormally ly sleepy, sleepy, stridor, stridor, wheeze, severe severe malnutrition, fever of 38 °C or hypothermia (<35.5°C). Tx: refer Keep warm Give first dose of antibiotic 2. Pneumonia—severe chest indrawing, fast breathing Tx: refer to hospital First dose antibiotics Keep warm 3. No pneumonia—assess for other problems, provide home care _____ with sore throat __________ Sore throat in children: very light tea with syrup STANDARD ARI/PNEUMONIA ARI/PNEUMONIA Case Management (EO 110-E s. 1991) Cotrimoxazole adult tabs Injectable penicillin should be regularly available in DOH facilities IM gentamycin IM chloramphenicol No DOH fund shall be used to regularly provide cough meds except only for the ff emergency conditions:
-
single ingredient cough suppressant for severe pertussis single antihistamine for confirmed allergic conditions such as a llergic rhinitis.
O2 and flow meters must be regularly available in all gov’t hospitals, with O2 delivered properly according to Standard ARI/ Pneumonia Case Management Children found to have severe pneumonia, very severe pneumonia, wheezing, otitis media, streptococcal sore throat shd be referred to Municipal Health Officer (MHO) or hospital physicians for proper management according to the referral scheme. STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS COMMUNICABLE DISEASE PREVENTION AND CONTROL
Communicable Diseases
Chronic communicable Tuberculosis Leprosy (LCP)
vector-borne communicable diseases Malaria (MCP) Schistosomiasis Filariasis (FCP) H-fever (dengue)
1. National Tuberculosis Control Program (NTBCP) “Tuberculosis is a highly infectious, infectious, chronic, respiratory disease caused caused by TB bacilli. It is one of the 10 leading causes of morbidity and mortality in the Philippines, which is also known as “Koch’s Dse”. Objective of the Program To control TB by reducing the annual risk of infection (prevalence and mortality rates) Key Policies: Prevention BCG vaccination under the EPI program Annual identification of at least 45% of its prevalence Public health education re: PTB mode of transmission, methods of control, and impotance of early dx Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive tx of contacts. Case finding Direct sputum microscopy for identified TB symptomatics X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam 31
Establishment of passive and active collection points for sputum samples of all identified TB symptomatics, as well as validation centers to ensure the standart & quality of sputum exam. Case finding and treatment services shall be made available in the BHS/RHUs Treatment All TB cases must be treated for free, on ambulatory and domiciliary (home) basis, except those with acute complications and emergencies. All sputum positive and cavitary cases shall be given priority for short course chemotherapy or SCC for 6 mos. Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all infiltrative but sputum negative. SR: isoniazid and streptomycin sulfate SCC: Combo pack, multi drug therapy PTB TREATMENT REGIMEN Categories: 6 SCC Patient will be: 2 months on
Rifampicin Isoniazid Pyrazinamide
Rifampicin + 4 months Isoniazid
Indicated for patients who are: (+) sputum smear Seriously ill (-) sputum smear, (+) extensive lung lesion (+) extrapulmonary cases
-
8 SCC Patient will be: Rifampicin Rifampicin 2 mos on Isoniazid
Isoniazid
Rifampicin + 4 months
Isoniazid
Pyrazinamide
+5 months
Ethambutol
Ethambutol Streptomycin Indicated for those with relapse: - failures - others
4 SCC Patient will be: Rifampicin Isoniazid Pyrazinamide Indicated for PTB minimal (-) sputum smear
+ 2 mos
2 mos on
2
Rifampicin Isoniazid
Phas Phases es of Trea Treati ting ng a TB TB pat patie ient nt::
1. Intensive Phase
2 months
Rifampicin Isoniazid Pyrazinamide
Diagnostic: Sputum Exam If (+), proceed to Rifampicin 2. Main Mainten tenanc ance e Phas Phase e + 4 mont months hs on on Isoniazid If still (+) TB colonies proceed to 32
Rifampicin 3. Extensive Phase
up to 12 mos on Isoniazid
What is the purpose of SCC-MDT - prevent developing resistance against the tree drug combinations - shorten duration of treatment usually usually treatment lasts from 5-10 years. With SCC-MDT, SCC-MDT, tx can be reduced to a minimum of 6 mos - eradicate and completely prevent the relapse of the dse
Direct Observation Treatment of Short –Course Chemotherapy (DOTS) “Tutok-Gamutan” 2. Leprosy Control Program Leprosy is a chronic dse of the skin and peripheral nerves caused by Mycobacterium Leprae WHO CLASSIFICATION OF LEPROSY Paucibacillary (tuberculoid and indeterminate)- non-infectious Duration of treatment: 6-9 months Multibacillary (lepromatous and borderline)- infectious Duration of treatment: 24- 30 months Objectives of the Program: - provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the p rescribed period. - Identify all correctible deformities and institution of appropriate intervention - Reduce the stigma attached to the disease thru IEC - Formulate research proposals on topics a ssociated with leprosy. Key Policies: - MDT as the core strategy for the National Leprosy Control Program - Procurement and supply of MDT Drugs, IEC, and training materials by CDCS - Health education - Supervision and control of leprosy control activities
Strategies: Prevention
-
health education BCG vaccination Case finding Validate old registered cases Early referral of suspected leprosy patients Epidemiologic investigation
Treatment
-
ambulatory domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment.
MDT Treatment Regimen Paucibacillary Supervised dose: Rifampicin 600mg Dapsone 100 mg Taken once/month in the clinic Self-administered
Multibacillary Supervised dose: Rifampicin 600mg Lamprene 300mg taken once/mo in the clinic Self- administered dose 33
Dapsone 100mg Taken OD, daily by the patient at home
Lamprene 50mg taken OD, daily at home
Leprosy patients must be taught ways to prevent secondary injury caused by burns and rough sharp objs Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for medical checkup from time to time Provide mental and emotional support to the families of leprosy patients Refer patients as needed. Rehabilitation: Imbibe patient’s participation in occupational activities Family and community health (PD 304) - non-segregation of leprosy patients - counseling and guidance
LOCALLY-ENDEMIC DISEASE PREVENTION AND CONTROL
1. Malaria Control Program Malaria is a vector-borne disease caused by female Anopheles mosquito causing sx such as fever, sweating, intermittent chills, anemia, and splenomegaly 2 Major Strategies of the Program 1- Vector Control Chemically treated mosquito nets Larva-eating fish Environmental clean-up of stagnant water Anti- mosquito soap ≈ Chemoprophylaxis- chloroquine 1-2 weeks before entering an area then continuous until 4-6 weeks after leaving the area 2- Detection and Early Treatment of Cases ≈ Early Recognition, Prevention, and Control of Malaria epidemics identification of a patient with with malaria as soon as he is examined. This may be done thru: > Clinical >Microscopic - signs and sx - mass blood smear exam - history of visit to and endemis area In the event that an imminent epidemic occurs, the ff shd be done: Mass blood smear collection Immediate confirmation and follow-up of cases Insecticide-treatment of mosquito nets Insecticide-treatment 2. Schistosomiasis, H-fever, Filariasis Control Programs SCHISTOSOMIASIS CONTROL PROGRAM Schistosomiasis- a parasitic infection caused by blood flukes inhabiting the veins of their vertebral victims transmitted thru skin penetration causing diarrhea, ascites, hepatosplenomegaly
Activities: Case Finding: surveillance of the dse Health educ- encourage use of
H-FEVER (DENGUE) Dengue- acute febrile infection of sudden onset, caused by Aedes Aegypti, vector mosquito
FILARIASIS CONTROL PROGRAM > a mosquito borne dse caused by a tissue nematode attacking the lymphatic system of humans thereby causing elephantiasis, lymphedema and hydrocele > started in 1957 as an o perational research of malaria. Eradication Service Service Three Filaria Filaria Control were established and later on integrated with the Regional Health Officers
Activities: Case Finding Early reporting of any
Activities: Case finding Early reporting of any known case of outbreak
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rubber boots for protection Environmental Sanitation-proper disposal of feces Snail Eradication- use of moluscides
known case or outbreak
PREVENTION, CONTROL AND REHABILITATION OF NON-COMMUNICABLE DISEASES
1. Philippine Cancer Control Program AO 89-A s. 1990 Provided the Guidelines for the Philippine Cancer Control Program specifying its program policy, components, implementing guidelines and timetable. 6 Pillars: Public Information and Health Education Cancer Prevention and Early Detection Cancer Epidemiology and Research Cancer Treatment Cancer Pain Relief In Cancer Nursing, the aim of management is to relieve physical, mental, and spiritual distress Vital Task of the nurse: To help the patient maintain his dignity and integrity
Cancer care is multidisciplinary. multidisciplinary. Who are to be prioritized for health supervision? Newly diagnosed cases Post-op cases/discharge Indigent cases needing continuity of h ospital care Terminal cases 2. Smoking Control Program Health hazards of Smoking: Lung Cancer Cardiovascular diseases COPD Cancer of other body organs Program Objective: To decrease the prevalence of smoking-related diseases and subsequent premature deaths Program Components: Information and Education on Campaign and Social Mobilization Policy Development and Legislation Training of Counselors in Smoking Cessation Clinics for Specialty Hospitals Resource Management and Monitoring Strategies: National Anti-Smoking Campaign o World No Tobacco Day National No Smoking Month o o Yosi Kadiri Campaign 3. Renal Disease In “23 in ‘93” Preventive Cardiology and Nephrology Enhance public awareness through health education regarding healthy lifestyles Improve access to basic health services “Health for More in ‘94” “Buwan ng Buhay na Bato”
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Requires urinalysis af ALL children entering grade 1 so as to detect childhood kidney infections which may
lead to renal failure. Encourage adult Filipino to undergo urinalysis once a year. 4. Cataract National Focus: Cataracts Screening Week at DOH Centers OPLAN: Sagip-Mata > eye surgery for cataract and squint operations for cross-eyed children NUTRITION AND ADEQUATE FOOD SUPPLY
Goal: reduce M&M related to n utritional deficiencies The improvement of nutritional status, productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifestyle. Coverage: ____ energy ____, Vit A deficiency, Fe deficiency anemia, iodine deficiency disorder Philippine Food and Nutrition Programs Directed to the provision of nutrition services to the DOH’s identified priority vulnerable groups: Infants, pre-schoolers, schoolers, women of child bearing age( also included are the pregnant and lactating mothers) and the elderly. Objectives: to decrease the morbidity and mortality mortality rates secondary to Avitaminosis Avitaminosis and other nutritional deficiencies among the population mostly composed of infants and children. 1. Malnutrition Rehabilitation Program Targeted Food Task Force Nutrition Rehabilitation Wa Ward Assistance Program Provision of food rations of Every hospital must have a Nurse ward, bulgur wheat and green where an adequately trained n utritionist were peas assigned (RA 422) Target population: Pre-schoolers Pregnant women Lactating mothers
Akbayan sa sa Ka Kalusugan (A (ASK Project) Aimed to provide rice and corn soya blend supplemented with local foods. Target pop: 6 mos- 2 years Moderately and severely underweight Pre-schoolers not served by the DSWD and DA in Regions 2,8,9,10,11,12
2. Micronutrient Supplementation Program “23 in ‘93 Fortified Vitamin Rice
- a free enrichment program aimed to prevent deficiencies in vitamin A (blindness); iron (anemia); iodine (goiter, mental retardation and delayed development) (1 cavan of rice + fistful processed, binilid enriched with essential micronutrients)
“Health for More in ‘94” “Buwan ng Kabataan, Pag-asa ng Bayan’ National Focus: National Micronutrient Micronutrient Day or “Araw ng Sangkap Pinoy” -aimed to distribute vitamin A supplements, iodized oil for and seedlings of plants rich in Fe and other minerals.
3. Food Fortification Program Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning. It involves: Incorporation of Monosodium Glutamate (MSG) with vit A to reduce clinical signs of Xerophthalmia
The use of FIDEL of FIDEL salt in lieu with the National Salt Iodization Program F ortification for I odine D efficiency 36
EL imination 4. Nutrition Surveillanve System (operation timbang) - a system of keeping close watch on the state of nutrition and the causes of malnutrition within a locality, which involves periodic collection of data and analysis and dissemination of analyzed information. Tools utilized are anthropometric 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 Ideal body wt,: 135 Body mass index(BMI)= wt in kgs Ht in meters If BMI is > 27.2 in men or 26.9 in women there is the need for wt, reduction 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 Protein Energy Malnutrition MarasmusMarasmus- child lacks food rich in CHON & energy _ ___ usually < 1 year old when malnutritionj starts - very thin, no fat - prominent ribs - very poor wt gain - loose and wrinkled skin - enlarged abdomen - anxious, always hungry tx:
food high in protein and energy content frequency of feeding
variety of food ___ Kwashiorkor - disease of older children when the next baby is born. This is usually ___ the child 1-3 years old - Very thin, fails to grow - swollen legs, feet, arms, and hands -Light colored, weak hair - doesn’t want to eat - Moon-shaped, unhappy face - dark spots on skin - Enlarged abd - skin sores and skin is peeling - Muscle wasting - apathetic Iron Deficiency Anemia- no enough hemoglobin in the RBC bec of lack of Fe Causes: low intake of Fe-rich foods esp. the more absorbable iron fr foods of animal origin Sources: Liver, internal organs, meat (pork and chicken) blood, fish and shellfish leafy vegetables alugbati, kangkong, saluyot, petchay, kamote tops, mustard (mustasa), dried beans, kadyos, monggo, abitsuelas Supplementation: FeSO4 iron supplement- drink fruit fruit juice enhance Fe absorption Vitamin A DeficiencyConsequences: 1. blindness- night blindness due to Rhodopsin (visual purple) 2. nutritional blindness- due do destruction of cell of the cornea Causes: - low intake intake of Vitamin A rich food -low intake of ___ and protein - illnesses like measles, diarrhea, _____ 37
Sources: -Breast milk -animal sources, whole milk, eggs, liver,meat -yellow/orange fruits (papaya, mango) - ___ plant sources yellow/orange veg (carrots & squash) - green leafy vegetables (malunggay, kangkong) - Vit. A capsule Iodine Deficiency Disorder- abnormalities __ get enough iodine. Abnormalities Abnormalities range from mild such as goiter, to serious as stillbirth, congenital abnormalities, growth and mental retardation& physical and motor abnormalities Consequences: fetus: abortion or miscarriages -congenital abnormalities - stillbirths Causes: Goitrogens and other environmental environmental factors Low intake of Iodine rich foods or low content of iodine in food. Supplementation:
SUPPLY AND USE OF ESSENTIAL DRUGS Essential drugs are medicinal preparations necessary to fill the basic health needs of the population.
National Drug Formulary contains the list of essential drugs Generics Act of 1988 RA 6675 “Formally proclaims the state of promoting the use of generic terminology in the importation, manufacture, distribution, marketing, promotion and advertising, labeling, prescribing and dispensing of drugs.” “Reinforces the NDP with regards to the assurance of the high-quality and rational drug use.”
Dangerous Drugs Act RA 6425 “ The safe, administration and transportation of prohibited drugs is punishable by law.” 2 types of drugs: Prohibited Regulated LSD Benzodiazepines Eucaine Barbiturates Cocaine/ codeine Opiates
ENVIRONMENTAL SANITATION
Environmental Sanitation is defined as the study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and survival. Goal: to eradicate and control e nvironmental factors in dse transmission through the provision of basic services and facilities to all households. 1. Water Water Supply Supply Sanita Sanitatio tion n Prog Program ram 3 types types of Approv Approved ed Water Water Supply Supply Facili Facilitie ties s Level 1 Level II Point Source Communal Faucet system or stand posts A protected well of a developed
A system composed of a source, a
Level III Waterworks system or individual house connections A system with a source, a 38
sprung with an outlet but reservoir, a piped distribution network and without a distribution system for communal faucets, located at not more than rural areas where houses are 25 meters from the farthest house in rural thinly scattered. areas where houses are clustered densely. Water must pass the National Standards for Drinking Water set by the DOH.
reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.
2. Proper Proper Excr Excreta eta and and Sewage Sewage Dispos Disposal al Syste System m 3 types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non- water carriage toilet facility: On site toilet facilities of the Water carriage types of - Pit Latrines water carriage type with water toilet facilities connected sealed and flushed type with to septic tanks and/or to - Reed Odorless Earth Closet septic vault/tank disposal sewerage system to - Bored-Hole facilities. treatment plant. - Compost - Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space -pour flush -aqua privies Rural Areas- “blind drainage” type of wastewater collection and disposal facilities shall be emphasized until such time that sewer facilities and off-site treatment facilities are available. 3. Proper Proper Solid Solid Waste Waste Managem Management ent - refers to satisfactory methods of storage, collection and final disposal of solid wastes. Refuse Garbage Rubbish
2 ways to Refuse Disposal Household -Burial > deposited in 1m x 1m deep pits covered with soil, located 25m away from water supply - open burning - animal feeding - composting - grinding and disposal sewer
Community -Sanitary landfill or controlled tipping > excavation of soil deposition of refuse and compacting with a solid cover of 2 feet - Incineration
4. Food Food San Sanit itat atio ion n Pro Progr gram am Policies: Food establishment are subject to inspection (approved of all food sources containers and transport vehicles) Comply with sanitary permit requirement Comply with updated health certificates for food handlers, helpers, cooks All ambulant vendors must submit a health cert to det presence 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
5. Hosp Hospit ital al Was Waste te Man Manage ageme ment nt Goal: 39
To prevent the risk of contraction contracting nosocomial infection from type disposal of infectious, pathological and other wastes from hospital 6. Programs Programs related related to health-risk health-risk minimi minimizatio zation n secondary secondary to environmental environmental polluti pollution on 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 7. Educat Education ion of of prevail prevailing ing healt health h problem problems s Accepted activitiy at all levels of public health used as a means of improving the health of the people through techniques which may influence people’s thought motivation, judgement and action. Three aspects of Health education: Information- provision of knowledge Communication- exchange of information Education- change in knowledge, attitudes, and skills Sequence of Steps in Health Education Creating awareness Creating motivation Decision making action
HIV/ STI PREVENTION AND CONTROL Operational Strategies: Promotion of health/ health education Disease detection Treatment program Contact tracing Clinical services Program components: Case-finding Case management Training Monitoring Reporting system Operations research
MENTAL HEALTH - A state of well-being 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 he/she lives - Involves the promotion of a healthy state of mind amont the whole pop through ♥ Developing positive outlook in life ♥ Strengthening coping mechanisms 40
Vulnerable group to the dev of Mental Illness: ♥ Women ♥ Street children ♥ Victims of torture or violence ♥ Internal refugees ♥ Victims of armed conflicts ♥ Victims of natural and man-made disasters Components of Mental Health Program A. Stress B. Drugs and Alcohol Alcohol Abuse Abuse Rehabil Rehabilitati itation on C. Treatment Treatment and Rehabi Rehabilitat litation ion of Mentall Mentally-il y-illl Patients Patients D. Specia Speciall Project Project for for Vulnera Vulnerable ble Group Groups s Stresses in the environment of children such as times of disasters and natural calamities, disintegration of the values, structure and functions of the family and urbanization, migration, drugs, and physical and sexual abuse and poverty have direct effects on physical and mental health.
GOOD LUCK!
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