BARANGAY HEALTH WORKERS’ Reference Manual Towards Effective Service Provision and Improved Health Outcomes Department of Health 2015
BARANGAY HEALTH WORKERS’ Reference Manual Towards Effective Service Provision and Improved Health Outcomes January 2015 Published by the Health Human Resource Development Bureau (HHRDB), in cooperation with the Bureau of Local Health Systems Development (BLHSD) Department of Health San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila 1003 Philippines Telephone +632 651-7800
Articles may not be reproduced in full or in part for any purpose without prior permission from the aforementioned DOH offices.
ISBN No.
February 2015
Acknowledgment The Department of Health-Health Human Resource Development Bureau (HHRDB) and the Bureau of Local Health Systems Development (BLHSD) acknowledge the individuals, DOH offices and other partners that have contributed to the development of the Barangay Health Workers’(BHW) Reference Manual and Pocket Handbook. We are very grateful to Dr. Jennifer G. Coritico as the main author of this document. The BHW Reference Manual and Pocket Handbook were put together through the efforts of a core team--without which these documents would not materialize. The core team that spent countless hours consolidating technical materials, coordinating with technical and support offices, facilitating consultative meetings and pilot tests with BHWs, and facilitating administrative and technical processes, are composed of: Ms. Marjorie Dungca, Dr. Maria Lourdes Gajitos, Ms. Maria Olga Bulasa, Ms. Maria Teresa Santiago, Ms. Ma. Graziella Cardano, Ms. Dina Sarne and Ms. Janice Feliciano. Contributing to the focus group discussions, manual and handbook framework, editing and proofreading is Dr. Christine Joan Co. We also acknowledge the efforts of Ms. Cristina Flor Marifosque for the design and layout for both the BHW Reference Manual and Pocket Handbook. We very much appreciate the assistances rendered by the following DOH offices: Disease Prevention and Control Bureau, Health Emergency Management Bureau, and the Philippine Institute for Traditional and Alternative Health Care, for contributing to the contents of this document; and, DOH Regional Offices 1, 4-A and 9 for supporting the on-site consultative FGDs with regional BHWs. Special thanks to the regional BHW Coordinators and BHWs who were involved in the regional consultative meetings. Sincere appreciation is being extended to Director Nestor Santiago of the BLHSD and Director Kenneth Ronquillo of the HHRDB for their support.
Table of Contents Guide to Use this Manual Acronyms Scope and Limitations Introduction I. DOH PROGRAMS IMPLEMENTATION IN THE COMMUNITY A. Pre-pregnancy Healthcare 1. Family Planning B. Maternal Health in Pregnancy 1. Pre-natal Care 2. Intrapartum Care 3. Postpartum Care C. Newborn Health 1. Essential Intrapartum and Newborn Care 2. Newborn Screening 3. Breastfeeding D. Neonate and Infant Health 1. Expanded Program on Immunization 2. Infant and Young Child Feeding Program E. Child Health 1. Garantisadong Pambata (GP) Program 2. Integrated Management of Childhood Illnesses (IMCI) 3. Oral Health Program F. Adolescent Health 1. Substance/Drug Abuse 2. Alcohol Abuse 3. STI-HIV G. Healthcare for Adults 1. Communicable Diseases a. Dengue b. Filariasis c. Hepatitis d. Influenza e. Leprosy f. Leptospirosis g. Malaria h. Rabies i. Schistosomiasis j. Tuberculosis k. Typhoid Fever
2. Non-Communicable Diseases a. Breast Cancer b. Cervical Cancer c. Lung Cancer d. Prostate Cancer e. Chronic Obstructive Pulmonary Disease f. Diabetes g. Hypertension H. Elderly 1. Vaccines for the Elderly 2. Senior Citizens on Health Related Goods and Services II. SPECIAL HEALTH CONCERNS IN THE COMMUNITY A. Environmental Health 1. Proper Waste Disposal 2. Provision of Safe Drinking Water 3. Construction and Use of Sanitary Toilets 4. Food Safety B. Violence Against Women and Children C. Disaster Risk Reduction and Management III. FIRST AID TECHNIQUES FOR COMMON INJURIES AND ILLNESSES A. Benign Febrile Convulsion B. Shock C. Loss of Consciousness D. Drowning E. Poisoning F. Wounds G. Bleeding H. Suspected Fractures and Dislocations I. Insect Bites and Stings J. Snake Bites K. Essential Contents of the First Aid Kit IV. HERBAL MEDICINES References
Guide to Use this Manual DOH programs in this Manual are organized using the life-cycle approach. Each cycle is discussed based on the latest DOH program guidelines. Some special topics are subsumed under the life-cycle of the most vulnerable groups (e.g., Violence among Women of Reproductive Age). Using the latest IEC materials available in the community, the BHW will be oriented on what to say (e.g., signs and symptoms, or mode of transmission for infectious/communicable diseases). The BHW is required to refer to the latest recording and reporting forms. This is important when identifying danger signs or determining the DOH-recognized first aid methods that they are allowed to perform. Some DOH programs are not applicable to communities because the disease or illness is uncommon; in such cases, it is no longer necessary to conduct comprehensive discussions. However, it is still important for the BHWs to know what to say as part of their role on prevention and control. This manual also comes with a Handbook which can be readily referred to by the BHWs. This manual contains brief descriptions of the programs and diseases. The Handbook on the other hand, only contains information campaigns per program or disease. However, it is highly encouraged that this manual be translated to the local dialect of the community to facilitate ease of discussion among BHWs.
Acronyms BCG BHW BNS BP BTL COPD CPR DASH DOH DPT DSWD EDC EINC EPI FP GP HBMR HIV HPN IMCI IUD IYCF LAM LMP MMR NCD NFP NSV NTP OPV PEP PHN RHM SMS STH STI TB TT
Bacillus Calmette–Guérin Barangay Health Worker Barangay Nutrition Scholar Blood Pressure Bilateral Tubal Ligation Chronic Obstructive Pulmonary Disease Cardiopulmonary Resuscitation Dietary Approach to Stop Hypertension Department of Health Diptheria, Pertussis, Tetanus Department of Social Welfare and Development Expected Date of Confinement Essential Intrapartum and Newborn Care Expanded Program on Immunization Family Planning Garantisadong Pambata Program Home Based Maternal Record Human Immunodeficiency Virus Hypertension Integrated Management of Childhood Illnesses Intra-uterine Device Infant and Young Child Feeding Program Lactational Amenorrhea Method Last Menstrual Period Measles, Mumps, Rubella Non-Communicable Disease Natural Family Planning No-scalpel Vasectomy National Tuberculosis Program Oral Polio Vaccine Post-exposure prophylaxis Public Health Nurse Rural Health Midwife Short Message Service Soil Transmitted Helminthiasis Sexually Transmitted Infection Tuberculosis Tetanus Toxoid
Scope and Limitations This BHW Reference Manual aims to guide barangay health workers (BHWs) in promoting disease prevention and prompt referral of common cases in the community. It focuses on their specific roles and responsibilities in their respective catchment households while assisting their rural health midwives (RHMs) in providing basic and essential health care services for all. It aims to guide the BHWs on what to say, what to do, and when to refer using the latest Information, Education and Campaign (IEC) materials and recording/reporting forms from the DOH that are already available in the community. It does not aim to comprehensively discuss the various forms of DOH protocols, along with its accompanying rules and regulations, diseases and illnesses, or treatment modalities; nor does it require the creation of new records and reporting systems.
Introduction Good health requires a balanced interplay of the physical, social and mental wellbeing of any individual. Any imbalance will result to sickness, illness or disease. To establish a wholistic mindset among BHWs, the current DOH programs were discussed using the lifecycle approach, from womb to tomb (see Fig. 1), covering the physical aspects (e.g., signs and symptoms of communicable and non-communicable diseases or proper nutrition); the social aspects (e.g., community involvement in prevention and control); and, mental wellbeing (e.g., lifestyle modification techniques).
Figure 1. Life-cycle approach: DOH programs per life-cycle.
Risks that cause diseases/illnesses may also result from internal and external causes (see Fig. 2). Internal causes may include: inborn or acquired physical defect; decreased resistance against infection secondary to malnutrition; and/or, family history of diseases (e.g., diabetes or asthma). External causes, on the other hand, may include exposure to airborne or flood-borne diseases; smoke and chemical exposure; and, air and water pollution. Other contributory factors include poor nutrition due to lack of knowledge or ignorance, overcrowding, unhygienic practices, inadequate shelter, calamities and environmental destruction which results to air and water pollution, and inadequate health services provision (e.g., medicines, health facilities, services, and health personnel).
Figure 2. External and internal risk-associated factors that lead to disease formation.
BHWs need to understand the essential determinants of good health and their significant roles and responsibilities in keeping a population healthy not only in providing adequate information and education campaign to their respective communities, but also in establishing an adequate referral system for prompt health service delivery.
SPECIFIC ROLES AND RESPONSIBILITIES OF A BHWi:
1.
An advocate of current health programs, projects and activities to improve access and use of health services;
2.
An educator who will advise and counsel the community;
3.
A disseminator to maintain regular communication between local professional health workers and their catchment households;
4.
A linker to facilitate access to or association of the community with relevant network of health and non-health service providers within or outside their catchment areas; and,
5.
A record keeper to maintain updated lists/records of health data, health activities/events in the community.
Overall, to attain good health, the following contributory factors should always be considered by the BHW each time they conduct their household visits: 1. Proper nutrition 2. Proper sanitation 3. Good compliance to applicable DOH protocols among members of their HH catchment area 4. Regular exercise 5. Enough rest/sleep 6. Healthy lifestyle by avoiding high risk behaviours such as smoking, multiple sex partners, drug abuse and excessive alcohol intake
DOH PROGRAMS IMPLEMENTATION IN THE COMMUNITY
A. PRE-PREGNANCY HEALTHCARE The pre-pregnancy phase of the life-cycle approach refers to women of reproductive age (WRA) who are 15-49 yrs. old, single or married, and capable of becoming pregnant. This section covers discussions on the different roles and responsibilities of BHWs in promoting the Reproductive Health Programs of the DOH.
FAMILY PLANNING Family planning (FP) is a reproductive right of all women.ii It refers to a program which enables couples and individuals to decide freely and responsibly, and have access to a full range of safe, affordable, effective, non-abortifacient, modern, natural and artificial methods of planning pregnancy.iii There are 2 methods by which family planning may be achieved: Through adequate birth-spacing of at least 2-3 yrs., where couples can avail of the short-acting methods (e.g., pills, Lactational Amenorrhea Method, LAM; Natural Family Planning/NF methods; or use condoms); or, Through birth limiting, where couples can avail of the long-term methods such as intrauterine device (IUD) insertion or permanent methods such as No-scalpel Vasectomy (NSV) or Bilateral Tubal Ligation (BTL).
ROLE OF THE BHW: Under the FP, adequately trained BHWs are expected to identify and record the eligible population of their HH catchment areas who belong to WRA. They are not expected to be able to comprehensively discuss the FP methods to the eligible population.
WHAT TO SAY: What is the importance of FP? FP prevents high-risk pregnancies among those younger than 18yrs old or older than 35 yrs old; those with 4 or more pregnancies; who have closely spaced pregnancies; or who are currently ill. FP allows the WRA to regain her strength after pregnancies and avoid prematurity and malnutrition. FP allows the couple to produce healthy children and avoid malnutrition. FP allows the couple to send their children for better education and improved social welfare.
o If the couple decides to space their children, they can avail of the short-acting methods. o On the other hand, if the couple decides to limit their number of children, they can avail of the long-term or permanent methods such as IUD insertion or NSV. o Comprehensive discussion on the different FP methods can be counselled by the RHMs in the community.
WHAT TO DO: 1. Using the latest family profiling form for FP, the BHWs should have a masterlist/record of the following within their designated HH catchment areas: a. Name and age of the eligible client b. Number of pregnancies, if any c. FP method practiced, if any d. FP method preferred, if any 2. For BHWs who already have FP acceptors within their catchment areas, they should do the following: a. Replenish supply of condoms and pills during follow-up visits, if necessary; and, b. Identify and record complaints of the FP acceptor, if there is any, and refer to the midwife, or inform the client of the BHS schedule for FP counselling.
B. MATERNAL HEALTH IN PREGNANCY The pregnancy phase of the life-cycle approach covers discussions on the different roles and responsibilities of BHWs in promoting the Maternal Health Program of the DOH. Discussions on teenage pregnancies are also included in this section.
MATERNAL HEALTH Maternal health services refer to a range of services that covers care during the prenatal period, during childbirth or delivery and the postpartum period. Teenage pregnancy is currently considered as one of the priority public health concerns for maternal health due to its increasing trend. Along with it are the concomitant risks of abortion due to unwanted pregnancy; maternal death; and, infection. The DOH is currently encouraging the establishment of adolescent or teen health centers to cater to the adolescent who would like to seek medical consult if there are signs and symptoms of suspected pregnancy.
Consultations and counselling done in these centers are strictly confidential to ensure trust and increased active participation, through prompt consultation among teenagers.
ROLE OF THE BHW: Under the Maternal Health Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who belong to WRA, and are pregnant. Under the Adolescent Health Program of the DOH, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who belong to the adolescent age group at highest risk for teenage pregnancy. They are not expected to be able to comprehensively discuss all the essential elements of pre-natal checkups, childbirth or delivery, or the postpartum period to the eligible population. However, they are expected to refer them to the nearest health facility.
PRE-NATAL CARE
WHAT TO SAY: What is the importance of having a pre-natal check-up? 1. Prenatal check-ups are given to pregnant women to monitor the following: a. Health of the mother and the baby, and detect any abnormality brought about by pregnancy, such as high blood pressure, eclampsia or diabetes b. Nutritional status of the mother because of its consequent effects on the baby (e.g., Vitamin A deficiency) c. Good nutrition is important during pregnancy and this can be achieved by eating a balanced diet. A balanced diet refers to eating a variety of food from the 4 food groups namely: Rice or its alternatives like corn and sweet potato, which provide energy, fiber, vitamins and minerals Fruits which are necessary for the normal functioning of the body through adequate blood formation and building of body resistance Vegetables which are good sources of vitamins, minerals and dietary fiber Meat or its alternatives, which is necessary for the growth and repair of body tissues, and used for the formation of the fetus’ organs d. Growth, size and position of the baby in each trimester
e. Presence of infection to the mother, whether viral or bacterial which may greatly affect the condition of the baby (e.g., Rubella) 2. Help women and couples (pregnant woman and her husband/male partner) prepare for delivery and plan subsequent pregnancy 3. Health care services given during prenatal check-ups include: a. Tetanus toxoid immunization to protect the baby against neonatal tetanus Table 1. Tetanus Toxoid Immunization Schedule
VACCINE
MINIMUM AGE/INTERVAL
DURATION OF PROTECTION
TT1
As early as possible during pregnancy
Provides ptection for the mother for the first delivery
TT2
At least 4 weeks after 1st dose
Provides 3 yrs protection for the mother
TT3
At least 6 months after last dose
Provides 5 yrs protection for the mother
TT4
At least 1 year later after last dose
Provides 10 yrs protection for the mother
TT5
At least 1 year later after last dose
Provides LIFETIME protection to both mother and child
b. Micronutrient supplementation (e.g., ferrous sulphate with folic acid) once a day for 6 months to prevent nutritional disorders. Iron is essential to prevent anemia in mothers which causes them to get tired easily and look pale. Iron intake also helps to build the baby’s iron stored during the first 6 months of life. It is found in liver, meat, fish, eggs and green leafy vegetables. Folic acid is needed for cell growth and reproduction. A deficiency in folic acid also causes anemia in mothers. It is found in green leafy vegetables, eggs, nuts and liver.
Calcium helps in the development of a baby’s bones and teeth. A pregnant woman should consume 2-4 glasses of milk per day to meet their calcium requirement.
Prenatal check-ups should be done at least once during the 1
st
and 2nd trimester,
and at least twice during the 3rd trimester.
4.
Pregnant women should have a total weight gain of 11-15 kgs during the 2nd and 3rd trimesters of pregnancy. If the woman is already overweight before pregnancy, she has to gain only 6-9 kg more.
5.
To prevent excessive weight gain, pregnant women must limit their intake of sweets and sweetened drinks. They should also eat less fried food, and chocolate.
6.
The adolescent should seek medical consult from the nearest adolescent or teen health center if there are signs and symptoms of suspected pregnancy for proper evaluation and management; these include: Missed menstrual period Signs of morning sickness (e.g. nausea and vomiting) Swelling or soreness of breasts
7.
A urine pregnancy test can be still be read as negative for up to 2 weeks after a missed period, even if a woman is already pregnant. The pregnancy test should be repeated 2 weeks after the missed menstrual period.iii Once the test shows a positive result, the BHW should refer the adolescent to the nearest health worker in the nearest adolescent or teen health center available in the community.
8.
Conversations held in adolescent or teen health centers are strictly confidential.
WHAT TO DO: 1. Using the latest family profiling and risk assessment form for Maternal Health, gather the following data: a. Name and age of the pregnant woman b. Household number of pregnant mother c. Number of pregnancies, if any and type of delivery (e.g., Normal or through Caesarean Section) d. Number of miscarriages, if any e. Medical conditions, if any (e.g., Hypertension, Diabetes, Asthma) f. Last Menstrual Period (LMP) and Expected Date of Confinement (EDC) g. Preferred health facility for delivery, if any, and number of pre-natal check-ups made for the current pregnancy
2. If properly trained, assist the couple or pregnant mother to develop a birth plan (that includes transportation, companion during time of delivery, name of health or DOHaccredited birthing facility, estimate of necessary expenses, materials needed at the time of delivery, preferred family planning method after delivery, and contact information). 3. During household visits constantly remind the pregnant woman of the next scheduled prenatal check-up.
Among teen-agers, valid consent can only be given by minors if accompanied by an adult.
Pregnancy among those who are less than 18 yrs of age is always placed at a higher risk among other reproductive age groups; thus, it is always important to follow-up on the next scheduled prenatal check-up.
4. Regularly counsel pregnant woman to eat healthy and nutritious foods, avoid smoking and alcoholic beverages, maintain good personal hygiene and regular exercise (e.g. , walking, stretching). 5. Immediately refer the pregnant woman to the nearest RHM or health facility when she complains of any of the following: a. b. c. d. e. f. g. h. i. j.
Vaginal spotting/bleeding Fever Severe headache Abdominal pain Paleness or pallor Convulsions/loss of consciousness Vomiting Blurring or loss of vision Difficulty of breathing Chest pain
6. Pregnant women with co-morbidities (e.g., HPN, DM or asthma) should be immediately referred to RHMs or private practicing Obstetric-Gynecologists for proper prenatal care and management of co-morbidities. 7. Always ensure privacy and confidentiality of counselling among adolescent couples or women. 8. If the adolescent decides not to proceed with the pregnancy, assist the adolescent and her accompanying adult (preferably one or both of her parents), to the nearest mother and child protection unit or DSWD for proper counselling and management. 9. Assist RHMs during health related community activities such as Mother’s Class. 10. Constantly remind pregnant women within your HH catchment area of the scheduled Mother’s Class in the community.
BHWs may do the following: a. For mild nausea, vomiting and constipation, advise pregnant woman to drink small amounts of water frequently and refer to RHM if it persists for more than 1 day. b. For minimal vaginal bleeding or spotting, advise bed rest with buttocks elevated. DO NOT massage the abdomen; refer to RHM if it persists for more than 1 day.
Source: collections.infocollections.org
Figure 3. Buttocks lift for pregnant women
INTRAPARTUM CARE (Woman in Labor until 6 hours Post-partum) All pregnancies are considered high-risk and should be delivered only by adequately trained health personnel, in a health facility or a DOH-accredited birthing facility. Pregnant mothers should prepare the following. at least 2 weeks prior to the expected date of delivery: a. Home Based Maternal Record (HBMR) or Mother and Baby book b. Birth plan, if any c. Philhealth documents (e.g., Philhealth card and Member Data Record/MDR), if she is a member/beneficiary d. Materials for her and her baby (e.g., diapers, blanket, clothes and cap for the newborn)
The expected date of delivery is only an estimate; the pregnant woman may deliver either 2 weeks before or 2 weeks after the expected date of delivery.
WHAT TO SAY: What does the expectant mother need to prepare prior to her delivery? Expectant mothers should have pre-packed the following, prior to her expected date of delivery: 1. 2. 3. 4.
HBMR or Mother and Baby book Birth plan, if any Philhealth documents, if she is a member/beneficiary Materials for her and her baby e.g. diapers, blanket, clothes and cap for the newborn
If the pregnant woman cannot avail of Philhealth membership, request a certification from the barangay/municipality.
What are the signs and symptoms of active labor? The following are the signs and symptoms of active labor: Increased urgency to urinate or defecate Presence of blood-tinged or brownish discharge from the pregnant woman’s cervix Fluid gushing or leaking from the vagina Regular Contractions at intervals <10 minutes
WHAT TO DO: 1. Regularly advise pregnant women to monitor the signs of labor at home (e.g., regular contractions <10 minutes). 2. Once the signs and symptoms of active labor have been noted, inform the preferred health facility or the RHM through Short Message Service (SMS), or phone call or any other means of communication, prior to transport, of the pregnant woman’s name, age, number of previous pregnancies, if any, and presenting signs and symptoms of labor, to allow sufficient time for preparation on the health facility. 3. Assist the pregnant woman in preparing her pre-packed materials and documents for delivery and assist her, during transportation, to the preferred health facility in her birth plan. If there is none, assist and refer to the nearest RHM or the nearest health or DOHaccredited birthing facility, when the pregnant woman complains of any of the following: a. Increasing urgency to urinate or defecate - is a possible sign that the baby has already positioned itself for delivery. b. Bloody show - present as a blood-tinged or brownish vaginal discharge which can occur days before or at the onset of labor. c. Ruptured membranes - present as a fluid gushing or leaking from the vagina. This condition increases the chances of intrauterine infection hence, should be referred immediately. d. Regular contractions – contractions that occur at intervals of < 10 minutes usually indicate that active labor has already begun. 4. Any untoward incidents during transport should be referred immediately to the RHM or Public Health Nurse (PHN) through SMS, or phone call, or any other means of communication for appropriate first aid management.
POSTPARTUM CARE (More than 6 hours after delivery until 6 weeks) Postpartum visits should be done within 72 hours after delivery and on the 7 th day postpartum to check for any signs of infection or bleedingIV. It is crucial during this period that the mother starts to establish exclusive breastfeeding. Discussions on FP counselling for the next planned pregnancy can also be initiated during this period.
WHAT TO SAY: Risk of infection among pregnant women is highest during the postpartum period, thus the need to maintain good personal hygiene and adequate nutrition. What are the danger signs after delivery? Go to the nearest RHM or health facility if there are any of the following: Difficulty of breathing Severe headache with or without blurring or loss of vision High-grade fever Foul smelling vaginal discharge Severe lower abdominal pain Profuse or severe vaginal bleeding Paleness Breast engorgement and tenderness Loss of consciousness or convulsions As early as 30 minutes after delivery or childbirth, breastfeeding may already be initiated. Breastfeeding is also a natural method of family planning termed as LAM and helps reduce the risk of ovarian and breast cancer. Breastmilk is always available, highly nutritious for the newborn baby, safe and economical.
WHAT TO DO: 1. Gather the following data: a. b. c. d.
Name and age of the pregnant woman Date of childbirth/delivery Place of delivery Danger signs noted, if any
2. Immediately refer to the RHM or to the nearest health facility if there are note of any of the danger signs after delivery through SMS, or phone call or any other means of communication for appropriate first-aid management: a. b. c. d. e. f. g. h. i. j.
Difficulty of breathing and/or chest pain Severe headache with or without blurring or loss of vision Severe vomiting High-grade fever Foul smelling vaginal discharge Severe lower abdominal pain Profuse or severe vaginal bleeding Paleness or pallor Breast engorgement and tenderness Loss of consciousness or convulsions
3. For moderate to heavy vaginal bleeding, BHWs may apply first aid by placing ice packs over the lower part of the abdomen while massaging the uterus to help keep it contracted and firm. This can be done while waiting for the RHM or any other trained health personnel to arrive. Regularly monitor the blood pressure at least every hour.
The top 3 leading causes of maternal death are bleeding, infection and hypertension. Thus, it is very important that BHWs know and understand the danger signs of pregnancy from the prenatal period up to the postpartum period. In cases of maternal death, from whatever cause, within the household catchment area, report the incident to the RHM for proper maternal death review.
4. Family planning methods may already be introduced among adolescents by adequately trained BHWs to ensure good maternal and reproductive health. 5. If the adolescent couple or individual decides to give her child up for adoption, refer and assist the adolescent (preferably accompanied by her parents) to the nearest DSWD for adequate counselling and processing on the adoption of the child.
C. NEWBORN HEALTH (0-28 days old) The newborn phase of the life-cycle approach cover discussions on the different roles and responsibilities of BHWs in promoting Essential Intrapartum and Newborn Care, Newborn Screening, and Breastfeeding Programs of the DOH.
ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC) There are 4 important interventions during the immediate postpartum phase of pregnancy: 1. 2. 3. 4.
Immediate drying Skin-to-skin-contact and delayed cord clamping Non-separation of baby from mother Exclusive breastfeeding
ROLE OF THE BHW: Under the Newborn Package Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who have newborn babies. They are not expected to be able to comprehensively discuss all the elements of intrapartum and newborn care to the eligible population.
WHAT TO DO: 1. All pregnancies are considered high-risk and should be delivered only by adequately trained health personnel, in a health facility or a DOH-accredited birthing facility. However, in extreme situations where home or transit delivery is unavoidable, the BHWs may do the following, while waiting for the RHM or any other trained personnel to arrive: a. Using a clean, dry cloth, thoroughly dry the baby and wipe the face, eyes, head, front and back, arms and legs. b. If a baby is crying and breathing normally, place the newborn prone on the mother’s abdomen and cover newborn’s back with a blanket and head with a bonnet to prevent hypothermia. DO NOT manipulate or clamp the umbilical cord. Neonatal sepsis or neonatal tetanus can be caused by unsterile materials and environment.
2. Using the latest family profiling and risk assessment form for Newborns/Infants, gather the following data during your 1st postpartum visit: a. b. c. d. e. f. g. h.
Name of newborn or infant Place of delivery Name of parents Date of birth Place of delivery Type of delivery Date Registered at the municipal registry Compliance to newborn program of the DOH (e.g., BCG or Hepa B immunization, Newborn Screening, Breastfeeding)
3. Encourage mothers to have their newborn vaccinated and screened on time. 4. To prevent neonatal sepsis, educate mothers on proper cord care (e.g., keeping the umbilical cord dry without any dressing or any material, alcohol or betadine). 5. Immediately refer the newborn to your RHM or to the nearest health facility if there are any of the following: a. Poor suck, cry or activity b. Foul-smelling discharge on the umbilicus c. Yellowish discoloration of the skin and eyes for more than 2 weeks d. Difficulty of breathing 6. Educate mothers on the importance of breastfeeding and proper breastfeeding techniques. 7. Assist the mothers in registering their newborn to the local civil registry.
NEWBORN SCREENING Newborn Screening is a practical procedure to determine the possibility of having a congenital metabolic disorder that may lead to mental retardation and death, if not detected early and appropriately treated.
ROLE OF THE BHW: Under the Newborn Screening Program, BHWs are expected to assist RHMs in identifying within their household catchment areas who are qualified to undergo newborn screening, or those who were born within 24-72 hours. They are expected to assist in the information campaign on newborn screening (e.g., inform the community of the nearest health facility that is conducts newborn screening).
WHAT TO SAY: What is Newborn Screening? Newborn Screening is a procedure that detects congenital metabolic disorders that may lead to mental retardation or even death if not detected early. It uses Heel Prick Method. When should it be done? It is done ideally in the first 24 hours of life but not later than 3 days after complete delivery. The procedure is performed only by a physician, nurse, trained midwife, or medical technologist. Where can it be availed? It is available in hospitals, lying-in clinics, rural health units, health centers and some private clinics.v
WHAT TO DO: 1. Assist the mother in identifying the nearest newborn screening facility within the community. 2. If mothers are residing in far-flung areas or geographically isolated areas, assist the mother in the follow-up of results, if necessary. BREASTFEEDING Exclusive breastfeeding is best for babies during the first 6 months of life and may be initiated within 30 minutes after birth by initiating skin-to-skin contact. The first few drops of breast milk, called colostrum, contains high level of antibodies which can increase their babies’ resistance against common infections (e.g., diarrhea and pneumonia).
ROLE OF THE BHW: Under the Postpartum and Lactating Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas. There are women who can breastfeed. They are not expected to be able to comprehensively discuss the program to the eligible population.
WHAT TO SAY: Breastfeeding is still the best source of nutrition for babies until 6 months of age. It may be continued until 2 years of age and beyond. It is always available, safe and economical.
What do we mean by “exclusive” breastfeeding? Exclusive breastfeeding means giving only breastmilk without water, other liquids, teas, herbal preparations or other food and fluid intake for the first 6 months of life.vii It provides protection to the child against common infections such as diarrhea and pneumonia. For working mothers, they can still continue breastfeeding by storing expressed breastmilk in a clean, safe and cool place that is properly labelled and covered, or they may bring along with them their babies if there is a breastfeeding area within their office or establishment. How do we store breastmilk? Key points in storing milk: o Expressed breastmilk that is not refrigerated can be stored for at least 8 hours at room temperature o When stored in a refrigerator, it is good for 24 hours o When stored in a freezer compartment of the refrigerator, it is good for 2 weeks o When stored in a freezer section or refrigerator with separate door, it is good for 3 months o When stored in deep freeze in 180C or lower, it is good for 6-12 monthsvii
WHAT TO DO: 1. Teach the mother how to perform the proper techniques for breastfeeding: a. Wash nipples with a clean cloth and warm water before and after every breastfeeding. b. To prevent breast swelling or engorgement, breastfeed at least every 2-3 hours and use both breasts at each feeding. c. After breastfeeding or washing the nipples, leave some breast milk on the nipples and allow them to air dry. d. Breastfeed whenever the baby shows signs of hunger (e.g., sucking fingers or moving lips).
e. Allow the baby to suck at the areola of the mother’s breast and not just the nipples to allow free flow of breast milk. f. At each feeding, encourage the baby to empty the breast and then offer the other breast. 2. Using the latest materials on proper positions for breastfeeding, teach the mother these positions during postpartum or household visits. a. Key points in helping a mother position a baby: i. Baby’s head and body in line ii. Baby’s head held close to the mother’s body iii. Baby’s whole body supported iv. Baby approaches breast, nose to nipplevii
Source: mypositiveparenting.org
Figure 4. Proper Positions for Breastfeeding
b. Signs of good attachment : i. Mouth widely opened ii. Lower lip turned upward iii. Chin touching the breast iv. More of the areola is seen above the baby’s mouth than below it
Source: thepassionatemom.wordpress.com
Figure 5. Steps for Proper Breastfeeding
3. Encourage the mother to maintain good nutrition and avoid alcohol and tobacco, which can decrease milk production Nutritional advice for lactating mothers: Eat at least 2 additional servings of staple food per day Eat at least 3 additional servings of calcium-rich foods (e.g., dark green leafy vegetables, sardines, milk/dairy products) per day Drink at least 8 glasses of fluids (2 liters) each day Eat smaller, more frequent meals if unable to consume larger amounts in fewer meals Take micronutrient supplements such as iron and iodine through the use of iodized salt as directed 4. Encourage the mother to join breastfeeding support groups within the community to help her know more about the proper techniques for breastfeeding, and some practical answers to commonly asked questions about breastfeeding. 5. Refer to the RHM if the mother experiences difficulty in breastfeeding.
D. NEONATE AND INFANT HEALTH Neonates refer to babies from birth up to 28 days of life, while infancy refers to those who are older than 28 days old to younger than 12 months. The neonate and infant phase of the life-cycle approach cover discussions on the different roles and responsibilities of BHWs in promoting Expanded Program on Immunization and Infant and Young Child Feeding Programs of the DOH.
EXPANDED PROGRAM ON IMMUNIZATION (EPI) EPI aims to reduce neonatal, infant and child mortality due to vaccine-preventable diseases and ensures normal growth and development of infants by increasing resistance against infections and preventing malnutrition. Table 2. EPI Schedule VACCINE
BCG
MINIMUM AGE ST AT 1 DOSE
NUMBER OF DOSES
MINIMUM INTERVAL BETWEEN DOSES
PURPOSE
Birth or anytime after birth
1 dose
None
To prevent the possibility of tuberculosis meningitis and other tuberculosis infections
Pentavalent vaccine
6 weeks old
3 doses
6 weeks (DPT 1), 10 weeks (DPT2), 14 weeks (DPT 3)
To reduce the risk of severe pertussis, severe forms of pneumonia and diarrhea
OPV (Oral Polio Vaccine)
6 weeks old
3 doses
4 weeks
The extent of protection against polio is increased the earlier the OPV is given
HepaB (Hepatitis B)
At birth
4 doses (***final 3 doses as part of Pentavaccine)
4 weeks
Reduces the likelihood of becoming a carrier or becoming infected
Measles vaccine
9 months old
1 dose
None
Measles is preventable through immunization in almost 85% of those who were vaccinated
MMR (Measles, Mumps, Rubella)
12-15 months old
1 dose
None
Intended for those who do not respond to first dose
(Bacillus CalmetteGuérin)
ROLE OF THE BHW: Under the EPI program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas. They are not expected to comprehensively discuss the vaccine preventable diseases to the eligible population.
WHAT TO SAY: What are the vaccines needed to be adjusted to be considered as fully immunized? A fully-immunized child has 1 dose of BCG; 3 doses of DPT; 3 doses of OPV; 3 doses of HepaB, and 1 dose of measles before the age of 12 months. What are the vaccines included in Pentavalent vaccine? At present DPT vaccination is included in the Pentavalent vaccine which also contains immunizations against Haemophilus influenza type B (HIB) virus and Rotavirus. What are the possible side effects after immunization? Fever may occur after immunization, and swelling at the injection site is expected from administration of BCG vaccine.
WHAT TO DO: 1. Using the latest immunization booklet (e.g., Mother and Baby Book), gather the following data during your household visit: a. b. c. d.
Name and age of the child < 5 yrs old Immunization and micronutrient supplementation given, if any Weight Height
2. In areas where the BHW is also functioning as a Barangay Nutrition Scholar (BNS), the BHW should be able to do the following during their scheduled immunization: a.
Weigh the infant and plot his/her weight in relation to his/her age in months
b.
Using the plotted growth curve, inform and educate the mother on the following: i. The growth of the child is within normal limits if the plotted weight over age is between the line curves ii. The growth of the child is not improving if the plotted weight over age is in a straight or same line from the previous plot iii. The infant is at risk of malnutrition and decreased resistance to infection if his/her weight goes beyond the curve lines
3. If there is a possible risk of malnutrition based on the plotted growth curve, refer the infant to the RHMs for adequate management. 4. Encourage the mother to bring her infant on the next scheduled immunization or micronutrient supplementation date. This will provide increased resistance of her baby against infections. 5. Encourage the mother to continue breastfeeding until 6 months of age and start complementary foods (e.g., mashed vegetables, bananas) from 6 months until 12 months of age.
INFANT AND YOUNG CHILD FEEDING PROGRAM Exclusive breastfeeding is best for babies during the first 6 months of life and recommended to be continued until 2 yrs of age or beyond. During illness, increased fluid intake will help, along with continued breastfeeding.
ROLE OF THE BHW: Under the Infant and Young Child Feeding Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas. WHAT TO They SAY: are not expected to comprehensively discuss the diseases related to malnutrition or nutritional requirements of the eligible population.
When does complementary feeding begin? Complementary feeding may be given to infants 6 months of age or older. How do you initiate complementary feeding? Start with small amounts of nutrient-rich foods and increase gradually as the child gets older. Among infants 6-8 months of age, complementary feeding should be given 2-3 meals per day; 3-4 meals per day are given to infants 9-23 months of age.
WHAT TO DO: 1. Using the latest immunization booklet (e.g., Mother and Baby Book), gather the following data during your household visit: a. b. c. d.
Name and age of the child < 5 yrs old Immunization and micronutrient supplementation given, if any Weight Height
2. In areas where the BHW is also functioning as a Barangay Nutrition Scholar (BNS), the BHW should be able to do the following during their scheduled immunization day or household visit: a. Weigh the infant or young child and plot his/her weight in relation to his/her age in months. b. The growth of the child is within normal limits if the plotted weight over age is between the line curves. c. The growth of the child is not improving if the plotted weight over age in months is in a straight or same line from the previous plot. d. The infant or young child is at risk of malnutrition and decreased resistance to infection if his/her weight goes beyond the curve lines. 3.
If there is a possible risk of malnutrition based on the plotted growth curve, refer the infant or young child to RHMs for adequate management.
4.
Encourage the mother to bring her infant or young child on the next scheduled immunization or micronutrient supplementation date. This will provide increased resistance of her baby against infections.
5.
Encourage the mother to maintain proper nutrition, good personal hygiene, and proper sanitation with her baby or young child to help prevent risk of exposure to common childhood diseases (e.g., pneumonia or diarrhea).
Table 3. Complementary Feeding Guide APPROPRIATE FOOD(S) Cereals (first semi-solid foods given to the baby)
Fruits
Vegetables
Meat and Alternatives
Meat/Fish/ Poultry or Legumes, dried beans
AGE OF METHOD OF INTRODUCTION EXAMPLE PREPARATION (IN MONTHS) 6 months Cooked, well Thick rice gruel, strained oatmeal Cooked, mashed root crops 8 months Cooked Thick gruel, soft cooked rice 10-12 months Cooked Soft cooked rice Sliced bread, biscuits 6 months Mashed Ripe bananas, ripe papaya, ripe mango 8 months Cut into small Soft fruit pieces 10-12 months Cut into finger Any fruit sized pieces 7 months Cooked very Carrots, sayote, soft squash, abitsuelas, potatoes, kamote tops, kangkong tops, pechay, malunggay leaves 8 months Cooked and All vegetables finely chopped 10-12 months Cooked and All vegetables coarsely chopped 7 months Cooked Chicken egg 11 months 6-11 months
10-12 months
Cooked Deboned, cooked well, mashed or ground
Chicken egg Minced meat, fresh or dried fish or minced chicken, mashed monggo
Deboned, cooked, flaked or chopped well
Meat, fresh or dried fish or chicken monggo
AMOUNTS ½ cup thick gruel 2-3 tablespoons ¾ cup thick gruel 1 cup 1 piece 2 ½ tablespoons 3 tablespoons 4 tablespoons 1 tablespoon
1 tablespoon 1-2 tablespoons
½ egg yolk ½ egg 1 1/3 servings 1 serving cooked meat = 30 g or about 3 cm cube; fish:2 pieces, medium size (55-60 g each), about 16 cm long; 1 1/2 cups cooked dried beans/nuts preferably taken 3 times a week
APPROPRIATE FOOD(S)
AGE OF INTRODUCTION (IN MONTHS)
Whole milk/ follow on formula (if not on breastfeeding)
12 months
Other Foods
8 months
Fats and Oils Sugar
6-11 months 6-11 months
METHOD OF PREPARATION
EXAMPLE
AMOUNTS 2 cups
Steamed, baked
Custards, simple pudding, plain gulaman or jello Margarine, cooking oil
1 teaspoon
4 teaspoons 3 teaspoons
Source: FNRI-DOST, 2000
E. CHILD HEALTH Children 12 months to 59 months old are included under this age group. This section covers the different roles and responsibilities of BHWs in promoting the Garantisadong Pambata Program, Integrated Management of Childhood Illnesses (IMCI) and Oral Health Program of the DOH.
GARANTISADONG PAMBATA PROGRAM (GP) Malnutrition is still considered a nationwide problem among Filipino children. It causes decreased resistance against infections and often result to higher risk for complications. It is preventable through micronutrient supplementation and proper nutrition (i.e., eating nutrient-rich foods like vegetables and fruits). Intestinal parasitism or soil-transmitted helminthiasis (STH) is one of the multifactorial causes of malnutrition. It mostly affects children aged 1 to 12 yrs old causing nutritional deficiencies on iron and vitamin A.viii
ROLE OF THE BHW: School children are included in the GP Program. Adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas and assist RHMs in providing different services under this program on micronutrient supplementation. They are not expected to comprehensively discuss malnutrition or specific nutritional needs of children.
WHAT TO SAY: What is the importance of GP program? GP is an integrated package of services concerning health, nutrition and environmental sanitation but mainly covers micronutrient supplementation of vitamin A and iron among children. This program also include deworming among preschoolers ages 1-5 years. What is the importance of Deworming, Vitamin A and Iron supplementation? Deworming significantly improves language and memory development.viii Vitamin A supplementation provides protection to children against measles and prevents malnutrition which causes decreased resistance against infections. Iron supplementation provides protection to children against iron-deficiency anemia which is one of the most common forms of nutritional deficiency among children, causing paleness and easy fatigability.
WHAT TO DO: 1. Using the latest immunization booklet (e.g., Mother and Baby Book, and forms for GP), gather the following data during household visit: a. b. c. d. e.
Name and age of the child < 5 yrs old Name and age of school children Immunization and micronutrient supplementation given, if any Weight Height
2. In areas where the BHW is also functioning as a Barangay Nutrition Scholar (BNS), the BHW should be able to do the following during their scheduled household visit: a. Weigh the child < 6 yrs old and plot his/her weight in relation to his/her age in months b. Explain and discuss to the mother the meaning of the plotted growth curve: i. The growth of the child is within normal limits if the plotted weight over age is between the line curves. ii. The growth of the child is not improving if the plotted weight over age in months is in a straight or same line from the previous plot. iii. The child is at risk of malnutrition and decreased resistance to infection if his/her weight goes beyond the curve lines. 3. If there is a possible risk of malnutrition based on the plotted growth curve, refer the child to RHM for adequate management.
4. Constantly remind the mother to bring her child on the next scheduled micronutrient supplementation date. This will provide increased resistance against infections. 5. Encourage the mother to maintain proper nutrition, good personal hygiene and proper sanitation with her child to help prevent risk of exposure to common childhood diseases (e.g., pneumonia or diarrhea). 6. Assist the mother in going to their designated health facility for micronutrient supplementation of her child. 7. Constantly remind mothers that deworming activities for preschoolers 1-5 years old is simultaneously done during the GP campaign while deworming activities for schoolchildren is scheduled every January and July of the year.viii 8. Using the latest referral form for Integrated Helminth Control Program, refer a child who present with any of the following signs and symptoms within the first 10 hours after intake of the deworming drugsviii, to the RHMs or to the nearest health facility for appropriate management: Local sensitivity or allergy Mild abdominal pain Diarrhea Erratic worm migration 9. Using the latest IEC materials for nutritional guidelines for Filipinos, discuss to the mother nutrient-rich foods which can readily be found within the community. 10. Encourage mothers to plant vegetable gardens within their household for additional sources of fresh and nutritious foods for their family.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI) Early detection and adequate management of common childhood symptoms such as cough, diarrhea and fever are provided under the IMCI program. It aims to reduce morbidity and mortality of cases due to common childhood illnesses such as pneumonia, diarrhea and measles.
ROLE OF THE BHW: Adequately trained BHWs are expected to identify common childhood illnesses within their household catchment areas and assist the RHMs in providing adequate first-aid management. They are not expected to be able to comprehensively discuss the different types of childhood illnesses and its treatment modalities.
WHAT TO SAY: What are the childhood symptoms included in the IMCI program? Included in the IMCI program are the following common childhood symptoms: 1. Cough 2. Diarrhea 3. Fever 4. Ear infection COUGH, with or without phlegm, and difficulty of breathing, despite increased fluid intake lasting for more than 2 days should be consulted to BHWs, the RHM or nearest health facility for adequate treatment.
NEVER self-medicate with antibiotics to prevent occurrence of antibiotic-resistant bacteria.
What can mothers do at home when their children have cough? For ordinary cough and colds, encourage mothers of sick children to increase fluid intake of their child and provide nutrient-rich foods to improve resistance against infection and prevent dehydration. Adequately trained BHWs may teach mothers of sick children on how to prepare lagundi decoction (refer to Annex on Herbal Medicine), a DOH recommended medicinal plant for cough and asthma. Refer the sick child to the RHM or to the nearest health facility if cough persists for more than 3 days with or without signs of pneumonia for adequate management. DIARRHEA is a symptom of gastrointestinal infection that is highly preventable and curable. It is caused by a virus, bacteria or parasitic organism. Not all forms of diarrhea will require antibiotics. NEVER self-medicate with antibiotics to prevent complications. Diarrhea often results from ingestion of contaminated food and water because of poor personal hygiene and poor sanitation. Neonates and infants are at a higher risk for dehydration. A few hours of diarrhea can cause dehydration; thus, should be immediately consulted to the RHM or nearest health facility when there are any of the following:
o o o o o
Profuse, watery stools at least 3 times a day Foul smelling, yellowish to greenish stools with or without blood Excessive thirst Sunken eyeballs Sunken fontanel in infants
What can mothers do at home when their children have diarrhea? Mothers are encouraged to continue breastfeeding her child with diarrhea and/or give “am” or oresol to replace lost body fluids. Oresol sachets may be requested from BHWs or at the nearest health facility. If there are no available oresol sachets, homemade oresol may be prepared by mixing the following: o 1 Liter of clean water (5 glasses of 200ml each) o 6 teaspoons of sugar o ½ teaspoon of salt The best and practical way to prevent diarrhea include the following: o Regularly practice good hand washing techniques before eating and after using the toilet; o Wash fruits and vegetables before eating or cooking; and, o Drinking water only from safe sources and avoiding street foods that are not properly covered against insects or bacteria. What are the usual signs and symptoms of ear infections? The usual signs and symptoms of ear infections include any of the following: o Foul-smelling ear discharge o Ear pain o Fever o Impaired hearing capacity on the affected ear
WHAT TO DO: 1. Using the latest immunization booklet (e.g., Mother and Baby Book, and forms for IMCI), gather the following data during your household visit: a. b. c. d. e.
Name and age of the sick child < 5 yrs old Immunization and micronutrient supplementation given, if any Weight Height Danger signs of pneumonia, dehydration or measles, if any
2. For patients with cough, refer the child to the RHM immediately when there is cough with any of the following: Short rapid breathing Fever (37.8° C and above) Difficulty of breathing Loss of appetite or poor suck among neonates Table 4. Normal respiratory rate per age group
AGE OF PATIENT
NORMAL RESPIRATORY RATE
2 to 12 months
60 breaths per minute
1 to 5 yrs old
50 breaths per minute
More than 5 yrs old
40 breaths per minute
3. For patients with diarrhea, refer the child to the RHM immediately when there are of any of the following: Profuse, watery stools at least 3 times a day Foul smelling, yellowish to greenish stools with or without blood Excessive thirst Sunken eyeballs Sunken fontanel in infants 4. Encourage the community to avoid indoor air pollution and cigarette smoke within the household. 5. Encourage members of the household to cover mouth when sneezing or coughing within or outside their household to prevent spread of infection. 6. Encourage members of the household to regularly eat nutrient-rich foods (e.g., vegetables and fruits) for increased resistance against infections. 7. Encourage members of the household to maintain cleanliness and proper hand washing techniques most specially when handling neonates and infants.
ORAL HEALTH PROGRAM Dental carries or tooth decay and gum diseases are the two most common oral health diseases in the Philippines.
ROLE OF THE BHW: Under the Oral Health program, school children, adolescents and adults are also included. Adequately trained BHWs are expected to identify and record the eligible population of household catchment areas and assist the RHMs in providing the different services under this program. They are not expected to comprehensively discuss oral health diseases.
WHAT TO SAY: What are the causes of oral health diseases? Risk factors causing oral health diseases include the following: o Unhealthy diet o Poor oral hygiene o Tobacco use and alcohol, among adults How can oral health diseases be prevented? Healthy diet should start from birth up to 6 months through exclusive breastfeeding and continued with complementary feeding up to 2 years of age. Good oral hygiene should start as soon as the first tooth erupts at 5-6 months of age. It is important to visit the dentist as they are more knowledgeable to discuss good oral hygiene and have follow-up visits every 6 months thereafter. Low-grade fever (T = 37.80C to 38.50C) may still be due to tooth eruption among infants; diarrhea and moderate to high-grade fever are no longer due to tooth eruption. Advise patient to go to the nearest health facility for adequate management. Adequate tooth brushing techniques may also be already taught to children as early as 1 to 2 yrs of age.
WHAT TO DO: 1. Assist the mother to locate the nearest health facility with dental services. 2. Encourage members of the household to practice and train their children for good oral hygiene (e.g., tooth brushing after meals). 3. Encourage members of the household to return their children on the scheduled dental visit to ensure adequate oral examination. 4. Constantly remind members of the household that low-grade fever (T = 37.80C to 38.50C) may still be due to tooth eruptions among infants, but diarrhea and moderate to highgrade fever is no longer due to tooth eruption.
F. ADOLESCENT HEALTH The adolescent age group refers to young individuals between the ages of 10 to 19 years of age who are in transition from childhood to adulthood. It is also during this phase that risk-taking behaviours either due to peer pressure or simple curiosity are at its highest peak. Adolescent health refers to a state of complete physical, mental and social wellbeing of persons aged 10-19 years; thus, this section covers the different roles and responsibilities of BHWs in promoting Adolescent Health – particularly on Substance/Drug Abuse, Alcohol Abuse and STI-HIV programs of the DOH.
SUBSTANCE/DRUG ABUSE Risk-taking behaviours are at its peak at the adolescent phase and are usually secondary to peer pressure thus result to certain mental health conditions such as anxiety and depression.
ROLE OF THE BHW Under the Drug Abuse Program of the DOH, BHWs are expected to assist the RHMs in promoting essential information and education campaigns on abused substances. They are not expected to comprehensively discuss the effects of abused substances or its rehabilitative modalities.
WHAT TO SAY: What are the risk factors for drug abuse? Anxiety and depression are the most common factors that cause initial drug dependence and subsequent addiction. How can it be prevented? Parental supervision is most critical during this phase to prevent the adolescent from experimenting with drug use. Active community participation on the promotion of healthier activities (e.g., sportsfest) is also one of the practical ways to prevent adolescents from drug addiction. Family members or relatives are highly encouraged to immediately refer adolescents who are suspected for drug dependence and/or addiction, to the nearest drug rehabilitation or treatment facility to prevent further complications.
WHAT TO DO: Drug addiction is best evaluated and managed by an adequately trained health personnel for counselling and behaviour modification. It should be referred immediately to the appropriate authorities for prompt evaluation and management on the earliest sign of drug dependence to prevent subsequent addiction which is more difficult to manage. 1. Refer to the RHM or to the appropriate authorities if there are usual signs and symptoms of a drug addict (e.g., ecstasy) among members of the household catchment area: Nausea Chills Involuntary teeth clenching Cramped or tensed muscles Blurred vision Excitement and increased energy Confusion Profuse sweating Dry mouth Dilated pupils 2. Encourage members of the household to assist the adolescent to the nearest drug rehabilitation center if there are any of the usual signs and symptoms of drug addiction, for proper counselling. 3. Encourage members of the household to allow their children to actively participate in community activities such as sportsfest activities and minimize participation from activities that might encourage or promote drug use.
ALCOHOL ABUSE Alcohol abuse is characterized by a pattern of excessive drinking despite its negative effects on the physical, social and economic being of the individual.
ROLE OF THE BHW Under the Lifestyle Modification Program of the DOH, BHWs are expected to assist RHMs in promoting essential information and education campaigns on alcohol abuse. They are not expected to comprehensively discuss the effects of alcohol intoxication or its treatment and rehabilitative modalities.
WHAT TO SAY: What are the risk factors for alcohol abuse? It is caused by a complex group of genetic, psychological and environmental factors. Peer pressure is one of the causative factors for alcohol abuse among adolescents. How can it be prevented? Because alcohol abuse is multifactorial in nature, it is essential that there is active community participation for support, along with mutual family support and personal desire to achieve treatment and rehabilitation.
WHAT TO DO: Alcohol abuse is best evaluated and managed by adequately trained health personnel for counselling and behaviour modification. It should be referred immediately to the appropriate authorities for prompt evaluation and management at the earliest sign of alcohol dependence to prevent subsequent addiction which is more difficult to manage. 1. Refer to the RHM or to the appropriate authorities if there are usual signs and symptoms of alcohol abuse among members of the household catchment area: Alcohol breath or smell on skin Deterioration in person’s appearance or personal hygiene Decreased ability to pay attention 2. Encourage members of the household to assist the adolescent to the nearest alcohol rehabilitation center if there are any of the usual signs and symptoms of alcohol dependence, for proper counselling.
3. Encourage members of the household to allow their children to actively participate in community activities such as sportsfest activities and minimize activities that might encourage or promote alcohol abuse (e.g., bar-hopping).
SEXUALLY TRANSMITTED INFECTIONS (STI) Sexually transmitted infections are caused by a variety of microorganisms (e.g., gonorrhoea, hepatitis B or syphilis).
WHAT TO SAY: What is an STI? STIs are caused by a variety of bacteria, viruses and parasites that are spread primarily through sex. How are STIs transmitted? STIs (e.g., syphilis and Human Immunodeficiency Virus) are not only spread through person-to-person sexual contact but may also be transmitted through: o Infected blood products (e.g., single infected needle used by multiple drug addicts or infected needles used in unsterile body piercing or tattooing) o From mother to child during pregnancy and childbirth What are the usual signs and symptoms of STIs? There are some types of STIs which are asymptomatic, but the usual signs and symptoms include any of the following: o o o o o
Pain when urinating Unusual discharge from the genitals Itching Soreness Unusual lumps or sores
What is HIV? HIV stands for Human Immunodeficiency Virus. It attacks and weakens the immune system, making the body more susceptible to infections. HIV does not have specific signs and symptoms. A person living with HIV may look and feel healthy even if already infected with the virus. HIV infection is PREVENTABLE but it has NO CURE.
HIV is transmitted only through 4 body fluids namely: o o o o
blood semen vaginal fluid breast milk
ANY person can get HIV by: o o o o
having sex with a person who has HIV blood transfusion or organ transplant contaminated with HIV using or sharing contaminated needles and syringes mother to child transmission from an HIV-infected mother to her child through pregnancy, delivery and breastfeeding
What are the usual signs and symptoms of HIV infection? The usual signs and symptoms of HIV may include any of the following: o o o o o o
Fever Swollen lymph nodes Diarrhea Cough Weight loss Shortness of breath
If you know anyone within your HH who may have the signs and symptoms of STIs, do not hesitate to consult a health worker in the health facility for early detection and adequate management. ALL consultations in STI/HIV clinics are strictly confidential.
How can it be prevented or controlled? The best and practical way to prevent STI or HIV infection is to maintain mutually monogamous relationship between couples or practice safe sex (e.g., correct use of condoms among or those with multiple sex partners). Avoid sharing of needles or sharp objects which may have been contaminated.
ROLE OF THE BHW Under the STI-HIV Program of the DOH, BHWs are expected to assist the RHMs in promoting essential information and education campaigns on STI and HIV prevention. They are not expected to comprehensively discuss the different types of infections or its treatment modalities.
WHAT TO DO: STI/HIV infections should always be evaluated and managed by adequately trained health professionals in STI or HIV clinics. Encourage members of the HH to assist the adolescent or any individual suspected of having STI/HIV infection to the nearest health facility with an adequately trained health professional, if there are any of the usual signs and symptoms, for proper counselling and management. ALWAYS ENSURE confidentiality of information of any individual who is suspected/ confirmed of STI/HIV infection.
G. HEALTHCARE FOR ADULTS Adulthood starts from 20 yrs of age until 59 yrs of age. The adulthood phase of the life-cycle approach cover the different roles and responsibilities of BHWs in promoting and preventing common communicable and non-communicable disease programs of the DOH.
COMMUNICABLE DISEASESix Discussions on this section will only include common communicable diseases such as Dengue, Filariasis, Hepatitis A, B and C, Influenza, Leprosy, Leptospirosis, Malaria, Rabies, Schistosomiasis, Tuberculosis and Typhoid Fever.
ROLE OF THE BHW Adequately trained BHWs are expected to identify common types of communicable diseases within their HH catchment areas and assist the RHMs in providing adequate DOH-recognized first-aid management. They are not expected to comprehensively discuss the different types of communicable diseases and its treatment modalities.
DENGUE Dengue is transmitted through the bite of an infected Aedes aegypti mosquito affecting infants, children and adults; management/treatment of dengue DOES NOT require ANY type of antibiotics. In most instances, delayed recognition of the disease may lead to severe bleeding and death.
WHAT TO SAY: What is dengue infection? Dengue is a mosquito-borne viral infection that causes flu-like symptoms and occasionally develops into a potentially fatal complication such as dengue hemorrhagic fever. It may affect ANYONE in the community but seldom causes death if detected early. What are the usual signs and symptoms of Dengue? The usual signs and symptoms of dengue include the following: o High-grade fever o Joint and muscle pain o Skin rashes o Loss of appetite o Nausea/Vomiting Danger signs of possible bleeding from dengue infection may present with any of the following: o Nose bleeding usually when the fever subsides o Abdominal pain o Vomiting of coffee-ground vomitus o Dark-colored stools o Difficulty of breathing Go to the nearest health facility within the community if there are any of the signs and symptoms of dengue infection. How is dengue infection prevented or controlled? For prevention and control, follow the 4-S against dengue:
Search and Destroy Cover water containers which may serve as breeding sites of dengue mosquitoes Replace water of flower vases at least once a week Regularly clean gutters of leaves and debris Dispose all unused materials that can collect and hold water
Self-protection Use mosquito repellent or mosquito nets Wear long pants and a long-sleeved shirt
Seek early medical consultation if there is/are: Persistent fever for more than 2 days Rashes Any signs of possible internal bleeding: o Nose bleeding usually when the fever subsides o Abdominal pain o Vomiting of coffee-ground vomitus o Dark colored stools
Say yes to fogging ONLY WHEN there is an impending outbreak or hotspot Dengue fever may be supported with PARACETAMOL. DO NOT give Aspirin. Increase fluid intake to prevent dehydration from high-grade fever.
WHAT TO DO: 1.
Using the latest forms for Community Based Monitoring and Information System (CBMIS), gather the following data during your household visit: a. Name and age of members of the household b. Duration of high-grade fever, if any c. Note of the danger signs of bleeding from dengue infection, if any
2. Refer the members of the household within the catchment area to the RHM, if there is high-grade fever (T = > 390C) persisting for more than 2 days, despite increased oral fluid intake and treatment with Paracetamol. 3.
Immediately refer members of the household to the RHM or to the nearest health facility, if there are any of the danger signs of bleeding from dengue infection, namely: Nose bleeding usually when the fever subsides Abdominal pain Vomiting of coffee-ground vomitus Dark colored stools Difficulty of breathing
4. Regularly conduct community campaign drives to eliminate breeding sites of mosquitoes 5.
Regularly update the color coding signs of Dengue infection in the catchment area: White = no case of dengue Green = with > 2 cases of dengue Yellow = already considered a hot spot Red = there is already an outbreak
6. Explain to the community the meaning or significance of the color coding scheme for Dengue White = maintain Search and Destroy activities Green to Red = encourage intensified implementation of 4-S activities within the community against Dengue FILARIASIS Filariasis is a parasitic infestation that is transmitted through the bite of an infected mosquito. It is commonly known as elephantiasis.
WHAT TO SAY: What is a filarial infection? Filariasis is commonly known as elephantiasis, caused by parasitic worms such as Wuchereria bancrofti or Brugia malayi. It is transmitted to humans through the bite of an infected Aedes mosquito. What are the usual signs and symptoms of Filariasis? The usual signs and symptoms include any of the following: o Pain and swelling of the breast, vagina, scrotum, legs and arms o Fever o Cough o Chills o Noisy breathing Go to the nearest health facility within the community if there are any of the signs and symptoms of filariasis infection. How is filariasis prevented or controlled? Similar to dengue prevention, preventive measures include: wearing of long-sleeved shirt and long pants when working in areas where filariasis is endemic; and, use of mosquito repellants or mosquito nets. November is the declared month for Filariasis Treatment in endemic areas. NEVER self-medicate with antibiotics to prevent complications.
WHAT TO DO: 1. Using the latest forms for Filariasis Prevention and control, the BHWs should have a masterlist/record of the following within their designated HH catchment areas during their household visit: Name and age of the members of the household Signs and symptoms of possible filariasis infection, if any 2. Encourage members of the household to actively participate and be part of the Mid Sentinel Survey and Transmission Assessment Survey. 3. Immediately refer members of the household, suspected of having filariasis, to the RHMs or to the nearest health facility for adequate treatment. 4. Encourage patients with diagnosed filariasis to comply with the medications to prevent complications. 5. Assist patients during follow-up visits at the health center. HEPATITIS Hepatitis is a viral disease which may present with symptoms that may be so mild to be noticed, like jaundice (common yellowish discoloration of the eyes). There are 3 common types of Hepatitis in the Philippines: Hepatitis A, B and C.
WHAT TO SAY: What is a Hepatitis infection? Hepatitis A is a viral infection that is preventable and curable. It is transmitted through the feco-oral route (i.e., from ingestion of food contaminated with human waste or urine of persons who also have Hepatitis A infection). Hepatitis B is preventable but NOT curable. It is transmitted in various ways: o From mother to child during childbirth o Through blood transfusion o Through sharing of contaminated or infected sharp objects (e.g., needles) o Through sexual intercourse with an infected individual
Hepatitis C is also preventable but NOT curable. There is NO vaccine for Hepatitis C. It is transmitted through any of the following: o Through blood transfusion o Through sharing of contaminated or infected sharp objects (e.g., needles) o Through sexual intercourse with an infected individual Persons infected with Hepatitis B and Hepatitis C may become carriers for life, or may have liver cirrhosis, liver failure or liver cancer later in life. What are the usual signs and symptoms of Hepatitis? The usual signs and symptoms of Hepatitis A include any of the following: o o o o o o
Fever Flu-like symptoms (e.g., muscle and joint pains, loss of appetite) Fatigue or tiredness Abdominal discomfort Dark/brownish urine Yellowish discoloration of the eyes or jaundice
The usual signs and symptoms of Hepatitis B include any of the following: o o o o
Weakness Stomach upset Dark urine or very pale stools Yellowish discoloration of the eyes or jaundice
Hepatitis B carriers are asymptomatic. Infected individuals with Hepatitis C are usually asymptomatic but may also present with any of the following: o o o o o o
Headache Nausea and vomiting Abdominal pain Yellowish discoloration of the eyes or jaundice Weakness and fatigue Dark yellow urine, light-colored stools, and yellowish eyes
How can it be prevented or controlled? Proper handwashing techniques after using the toilet, before preparing food, and before eating is still the best and practical method to prevent the spread of Hepatitis A. Transmission of Hepatitis B infection from mother to child during childbirth can be prevented through complete (3 doses) immunization of HepaB vaccine. Hepatitis B immunoglobulin is also given in addition to the 3 doses of Hepatitis B vaccine for newborns who have mothers properly diagnosed with Hepatitis B. Mutual monogamous relationship between couples, consistent practice of safe sex among those with multiple partners, and avoiding use of any object that may be contaminated with the blood of an infected person are practical methods to prevent infection of both Hepatitis B and C. Hepatitis infections DO NOT require ANY type of antibiotic treatment.
WHAT TO DO: Immediately refer members of the HH who are suspected of having any of the 3 typesof Hepatitis to the RHM, or to the nearest facility for proper evaluation and management. Hepatitis infections are best evaluated by adequately trained health professionals. INFLUENZA Influenza is a highly contagious viral infection that is commonly known as the “flu”. Any person within the household or community who has a weakened immune system is susceptible.
WHAT TO SAY: What is influenza? Influenza is a viral infection commonly called “flu” and usually lasts from 1-3 days even without treatment. It is transmitted when an infected person coughs or sneezes or when there is direct contact with contaminated surfaces, material and clothing of an infected person.
What are the usual signs and symptoms of influenza? The usual signs and symptoms include any of the following: o Fever with or without joint pains o Headache o Runny nose o Sore throat o Cough Go to the nearest BHW or RHM or health facility if cough and fever persists for more than 2 days despite increased oral fluid intake and eating of nutrient-rich foods (e.g., citrus fruits), for proper evaluation and management. How can it be prevented or controlled? Adequate cough manners is one of the best and practical method to prevent its spread. Proper handwashing techniques are also a practical methods of preventing contamination of surfaces or clothing in the household. It is a self-limiting disease that does not usually require treatment and may only be treated with rest, increased oral fluid intake, and eating nutrient-rich foods (e.g., fruits).
WHAT TO DO: 1. Refer and assist members suspected with influenza, to the RHM if there are any complications such as pneumonia or ear infection. 2. Refer to the RHM immediately when pneumonia is accompanied by any of the following: Short rapid breathing Fever Difficulty of breathing Loss of appetite or poor suck among neonates 3. For ear infection, refer to the RHM immediately when any of the following are seen: Foul-smelling ear discharge Ear pain Fever Impaired hearing with the affected ear
LEPROSY Leprosy is caused by a bacteria called Mycobacterium Leprae which is both preventable and curable. It is transmitted by prolonged close contact through the respiratory tract (inhalation of the bacteria) from an infected person who is not treated.
WHAT TO SAY: What is Leprosy? Leprosy is caused by bacteria called Mycobacterium Leprae that affects the skin and peripheral nerves. How is it transmitted? It is transmitted by prolonged close contact through the respiratory tract (inhalation of the bacteria) from an infected person who is not treated. What are the usual signs and symptoms of Leprosy? The usual presenting signs of leprosy include any of the following: o Single or multiple whitish or reddish patches of skin with loss of feeling (e.g., does not hurt or does not itch) o Loss of sensation to heat, touch or pain of the affected area accompanied by weakness of the muscles of the hands and eyes If you know anyone within your community who may have the signs and symptoms of leprosy, do not hesitate to consult any health worker in the health facility to prevent its continuing spread. How can it be prevented and controlled? Preventive measures include the following: o Regularly practice good personal hygiene (e.g., proper handwashing techniques and cough manners) o Avoid smoking and excessive alcohol intake o Have enough rest and regularly exercise o Eat nutrient-rich foods (e.g., vegetables and fruits) to maintain increased resistance against infections o For households who have a patient with confirmed leprosy, regularly practice cough manners; DO NOT USE your hands when covering your mouth to prevent the spread of infection on surfaces
How can it be cured? 1. The duration of treatment depends on the classification of the leprosy. If classified as paucibacillary, treatment may last from 6-9 months depending on the response of your body to the medications prescribed. If classified as multibacillary, treatment may last from 24-30 months. 2. It is very important to religiously take your medications and follow-up as scheduled at the health facility, regularly exercise, and eat nutrient-rich foods to improve one’s health and early recovery. 3. Regularly coordinate with your BHWs for any adverse reactions noted at home while on treatment.
WHAT TO DO: 1. Using the latest family profiling form for leprosy, gather the following data: Name and age of the suspected Leprosy patient Number of members in the household Past medical history of leprosy infection among members of the household, if any Previous history of compliance on leprosy medications, if any 2. Refer suspected leprosy patients to the RHM or nearest health facility for proper evaluation and management if there are any of the following: Single or multiple whitish or reddish patches of skin with loss of feeling (i.e., does not hurt or does not itch) Loss of sensation to heat, touch or pain of the affected area accompanied by weakness of the muscles of the hands and eyes 3. For BHWs who already have Leprosy patients within their catchment areas, they should do the following: Regularly follow-up leprosy patients to ensure their intake of anti-leprosy medicines regularly and at the right dose Refer the patient for any adverse reactions, if any Constantly remind patients of their scheduled follow-up and assist, if necessary Encourage family members to support the patient with leprosy to ensure completion of treatment modality required Constantly provide health education to family members and the patient (e.g., stop smoking; cover mouth when coughing and sneezing to ensure control on the spread of infection)
4. Regularly update the members of your household catchment area of any health-related activities on the following health calendars: Leprosy Week as a reminder to the public (February) World Leprosy Day (January 29) National Skin Awareness Month (November) LEPTOSPIROSIS Leptospirosis is a bacterial infection most commonly transmitted by urine and semen of infected animals in flood waters, or muddy farms and in areas where there is a livestock.xx
WHAT TO SAY: What is Leptospirosis infection? Leptospirosis is a bacterial infection caused by Leptospira spirochetes. It is transmitted through ingestion of contaminated food or water or through broken skin or open wounds which come in contact with the contaminated water. What are the usual signs and symptoms of Leptospirosis? The usual signs and symptoms include any of the following: o Fever o Calf-muscle pain Immediately consult the nearest RHM or health facility if one suspects the possibility of leptospirosis infection, for prompt evaluation and management. NEVER self-medicate with antibiotics to prevent undetected complications such as liver or kidney failure. How can it be prevented? Use personal protective equipments such as boots and gloves when work requires exposure to potentially contaminated water.
WHAT TO DO: 1. Encourage members of the household within the catchment area located in floodprone areas to avoid swimming or wading in potentially contaminated waters. 2. Encourage members of the household within the catchment area to maintain good environmental sanitation through regular cleaning and drainage of potentially contaminated waters.
3. Immediately refer to the RHM or nearest facility if there are any of the danger signs of severe leptospirosis infection: Yellowish body discoloration Dark-colored urine and light stools Low urine output Severe headache MALARIA Malaria is a communicable disease caused by a protozoan parasite called Plasmodium which is both preventable and curable. It is transmitted through the bite of an infected Anopheles sp. mosquito.
WHAT TO SAY: What is malaria? Malaria is sometimes a fatal communicable disease, caused by a protozoan parasite called Plasmodium. It is transmitted through the bite of an infected Anopheles sp. mosquito. What are the usual signs and symptoms of malaria? The usual signs and symptoms include any of the following: o o o o o o
Chills High-grade fever with or without joint pains Severe headache Vomiting Body malaise Profuse sweating
Consult the nearest RHM or health facility if there are any of the signs of possible malaria infection as soon as possible. How can it be prevented or controlled? Malaria can be prevented through any of the following: o Use mosquito nets that are preferably treated with long-lasting insecticide o Wear protective clothing such as long sleeves and long pants if staying outdoors at night in endemic areas (e.g., Palawan) o Regularly search and destroy potential breeding sites of Anopheles mosquitoes (e.g., old tires) o Place screens on doors and windows
Local or international travellers should take prophylactic anti-malarial drugs when travelling to endemic areas and use insect repellents or lotion.
WHAT TO DO: 1.
Encourage members of the household within the catchment area to maintain good environmental sanitation through regular cleaning and drainage of potential breeding sites of Anopheles sp. mosquitoes.
2.
Encourage and assist members of the household suspected of having malaria to seek medical consultation, as early as possible, when there are any of the signs and symptoms of malaria: Chills High-grade fever with or without joint pains Severe headache Vomiting Body malaise Profuse sweating
3.
Conduct follow-up visits to those who have been adequately diagnosed to have malaria to ensure good compliance to prescribed medications.
RABIES Rabies is a deadly viral infection that is PREVENTABLE but NOT CURABLE once symptoms have already started.
WHAT TO SAY: What is Rabies? Rabies is a deadly viral infection that is spread by infected animals such as dogs, cats, or bats. It is transmitted through direct contact with infected saliva of a rabid animal from bites or scratches. What are the usual signs and symptoms of Rabies? The usual signs and symptoms include any of the following: o Fever and headache o Pain or numbness of bite site o Pain or difficulty in swallowing o Fear of looking at water (hydrophobia) o Fear of air (aerophobia) o A lot of thick, sticky saliva dripping from the mouth o Delirium and paralysis in severe cases
Rabies cannot be treated. How can it be prevented? The only way to prevent rabies infection is to be vaccinated. Post-exposure prophylaxis (PEP) must begin immediately after the biting incident to prevent the onset of symptoms and death. PEP consists of local treatment of: the wound right after rabies exposure; a course of potent and effective rabies vaccine; and, the administration of rabies immunoglobulin, if indicated. Pre-exposure and post-exposure anti-rabies vaccines are available at the animal bite treatment centers. What is the first-aid management for animal bites? For any incidence of animal bites, wash the wound immediately with soap and running water for at least 10 minutes. DO NOT apply garlic or tandok on the site of bite to avoid contamination and further complications. DO NOT bleed the area of the wound. Go to the nearest animal bite treatment center or health facility for proper management. What should pet owners do? For pet owners: o Have your pet vaccinated by a veterinarian at 3 months old and every year thereafter, or during mass vaccination of pets scheduled in your community o If your pet has bitten any person: Leash your pet or put it in its cage Observe for 14 days for possible signs of rabies DO NOT kill or eat the dog Assist the bitten victim to the nearest animal bite and treatment center for proper post-exposure anti-rabies vaccination Report to the animal bite treatment center or health facility where the postexposure anti-rabies vaccination was given when: - Pet becomes wild - Pet drools - Pet bites any moving or non-moving objects - Pet does not eat or drink - Pet dies within the observation period
WHAT TO DO: 1. When presented with patients with animal bites, advise family members to: Go to the nearest health facility or animal bite treatment center to have the victim vaccinated against rabies immediately Wash the wound with clean soap and water only Not bleed the area of the wound Observe the biting animal for 14 days NEVER kill or eat the biting animal 2. Update and inform the community if there are any mass vaccination activities for animals against anti-rabies. SCHISTOSOMIASIS Schistosomiasis is a parasitic infestation that affects the liver, central nervous system, or other organs where eggs of Schistosoma japonicum get lodged. Its symptoms depend on the type of species the person is infected with.
WHAT TO SAY: What is schistosomiasis? Schistosomiasis is a disease caused by a blood fluke/parasite called Schistosoma japonicum. It is transmitted through skin penetration while bathing or swimming in freshwater, infested with an infected snail; the snail serves as the intermediate host of schistosomiasis. Freshwater is contaminated when an infected person either urinates or defecates in the water. What are the usual signs and symptoms of schistosomiasis? The usual signs and symptoms include any of the following: o o o o o
Abdominal pain Fever Loose bowel movement Bloody stool Bulging of the abdomen
Go to the nearest RHM or health facility if there are any of the usual signs and symptoms of schistosomiasis. NEVER self-medicate with antibiotics, to prevent complications.
How can it be prevented or controlled? Personal protective equipments such as boots and gloves should be used by farmers or other workers whose work requires exposure to freshwater areas. Proper environmental sanitation (e.g., use of sanitary toilets) is still the most practical method to prevent its spread.
WHAT TO DO: 1. Using the latest forms for environmental sanitation, gather the following data within your designated household catchment areas: a. Name of members of the household catchment area b. Presence and use of sanitary toilets, if any 2. Refer and assist members of the household catchment area who are suspected to have schistosomiasis infection to the RHM, or nearest health facility, for proper evaluation and management. 3. Encourage members of the HH to regularly practice proper environmental sanitation (e.g., use of sanitary toilets, proper waste disposal). 4. Conduct regular follow-up visits to patients who are properly diagnosed to have schistosomiasis to ensure their compliance to prescribed medications. TUBERCULOSIS (TB) TB is an infectious disease that primarily affects the lungs; this is commonly known as pulmonary TB. TB may also affect other parts of the body such as the bones, brain; in such cases, this is referred to as extra-pulmonary TB. It is curable AND preventable.
ROLE OF THE BHW: Under the National Tuberculosis Program (NTP), adequately trained BHWs are expected to identify and record presumptive TB patients within their household catchment areas and act as treatment partners. They are not expected to comprehensively discuss tuberculosis and its treatment modalities.
WHAT TO SAY: What is TB? TB is a disease caused by Mycobacterium bacilli acquired through inhalation of the air droplets when an infected person coughs, sneezes, or spits in public areas. What are the usual signs and symptoms of TB? The usual signs and symptoms of presumptive TB patients include the following: o Cough for 2 weeks or more o Afternoon Fever o Chest or back pain not referable to other diseases o Loss of weight o Lack of appetite o Blood-streaked sputum How can it be prevented or controlled? Continuing spread of TB may be controlled through: o BCG vaccination of newborns o Active community participation: Avoid spitting in public areas Cover mouth when sneezing or coughing within or outside their household Referral of presumptive TB patients to trained health workers o Completion of treatment modality
WHAT TO DO: 1.
Using the latest family profiling form for TB, gather the following data: a. b. c. d.
2.
Name and age of the presumptive TB patient Number of members in the household Past medical history of TB infection, if any Previous history of compliance on TB medications, if any
Refer presumptive TB patients to the RHM or nearest health facility for proper evaluation and management if there is note of any of the following: a. b. c. d. e.
Cough for 2 weeks or more Fever Chest or back pain not referable to other diseases Loss of weight Blood-streaked sputum
3. Presumptive TB is a condition in a patient who presents with symptoms or signs suggestive of TB (previously called a TB suspect). 4.
Ideally, there should be 3 sputum specimens collected (on the spot, early morning and another on the spot). However, if the presumptive TB patient resides in geographically isolated and depressed areas, the BHW should collect an early morning sputum, label its container with name, age, address and date, and submit to the RHM or health center if feasible, at the earliest possible time.
5.
For those BHWs who already have confirmed TB patients within their catchment areas, they should: As a treatment partner, fill-up the NTP ID card and regularly visit the TB patient to ensure compliance with medications Refer the TB patient for any adverse reactions, if any (e.g., joint pains) Constantly remind patient of his/her scheduled sputum follow-up and assist, if necessary Encourage family members to support the TB patient to ensure completion of treatment modality required Constantly provide health education to family members and the TB patient himself/herself (e.g., stop smoking; cover mouth when coughing and sneezing) If there are family members who are less than 5 yrs of age, encourage the family to have newborns vaccinated with, or have children < 5 yrs old tested with PPD
6.
ALWAYS ENSURE confidentiality of information of your TB patients, whether they are presumptive or confirmed cases.
TYPHOID FEVER Typhoid fever is a water and food-borne disease that is also known as enteric fever. It can only spread in environments where human feces and urine can come in contact with food or drinking water.x
WHAT TO SAY: What is typhoid fever? Typhoid fever is a bacterial infection caused by Salmonella typhi. It is transmitted through ingestion of contaminated food and water.
What are the usual signs and symptoms of typhoid? The usual signs and symptoms may include any of the following: o o o o o o
High-grade fever Headache Body malaise Loss of appetite Either diarrhea or constipation Abdominal discomfort
Go to the RHM or nearest health facility if high-grade fever is persistent despite increased oral fluid intake and Paracetamol intake. NEVER self-medicate with antibiotics to prevent complications. How can it be prevented or controlled? Proper hand washing technique is still the best form of preventing its spread.
WHAT TO DO: 1. Using the latest forms for environmental sanitation, gather the following data within your designated household catchment areas: Name of members of the household catchment area Presence and use of sanitary toilets, if any 2. Refer and assist members of the household catchment area to the RHM or nearest health facility when there are any of the signs and symptoms of typhoid infection. 3. Encourage members of the household to regularly practice proper environmental sanitation (e.g., use of sanitary toilets, proper waste disposal and proper handwashing after using the toilet), before preparing or cooking food and before eating.
NON-COMMUNICABLE DISEASES Lifestyle related or non-communicable diseases (NCDs) are considered a major public health concern worldwide. Discussions on this section will only include common noncommunicable diseases such as Breast Cancer, Cervical Cancer, Lung Cancer, Prostate Cancer, Chronic Obstructive Pulmonary Disease (COPD), Diabetes and Hypertension.
ROLE OF THE BHW Under the NCD program of the DOH, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who are at risk against the common types of NCDs. They are also expected to assist the RHMs in providing adequate information and education campaigns on lifestyle-related diseases. They are not expected to comprehensively discuss the different types of NCDs and its treatment modalities.
BREAST CANCER Breast cancer is multifactorial in nature. Men can also develop breast cancer.
WHAT TO SAY: What is Breast Cancer?ix Breast Cancer is a cancer that starts from the cells of the breast. What are the risk factors for Breast Cancer? Risk factors include any of the following: o o o o o
Family history of cancer Obesity High fat diet Smoking and drinking Women who are > 30 yrs old and above during their first pregnancy or those who never had any children
What are the usual signs and symptoms of breast cancer? The usual signs and symptoms include any of the following: o o o o
Lump or swelling of the breast Skin dimpling on the area of the breast Retraction of the nipple A sore or wound in the nipple
Go to the nearest RHM or health facility for proper evaluation and management of any lump or swelling or discharge in the nipple.
How can it be prevented or controlled? Regular breast self-examination after menstruation is one of the key factors for early detection of breast cancer. These are few steps you can follow to perform a basic self – examination (See Fig. 6): a. In a clockwise direction, move 3 fingers of your left hand in a downward and upward motion over your right breast while the right arm is raised over your head b. Check for any lump or thickening around your breast c. Repeat the cycle in three circles and then check the other breast in the same manner d. Gently press your nipple and note if there is any pus or discharge e. Other techniques may also be performed (See Fig. 6) Regular exercise and healthy eating habits rich in fiber minimizes the risk for breast cancer.
Source: magazine.raghunter.com Source: magazine.raghunter.com
Figure 6. Self-Breast Examination
WHAT TO DO: 1. Using the latest family profiling form for Reproductive Health, gather the following data within your designated household catchment areas: a. Name and age of Women of Reproductive Age (WRA) b. Age of menarche c. Family history of breast cancer 2. Encourage members of the household in the eligible population to regularly conduct breast self-examination either while taking a shower, lying-down or sitting 3. Encourage members of the household 30 yrs or older to undergo mammography when there are any lumps in the breast CERVICAL CANCER ROLE OF THE BHW: Under the Cervical Screening Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who belong to WRA, at risk of cervical cancer. They are not expected to be able to comprehensively discuss cervical cancer to the eligible population.
WHAT TO SAY: Using the latest IEC materials for Cervical Cancer Screening, the BHWs may discuss the following: 1. Cervical cancer is the second leading cause of death among WRA but can be cured as long as it is detected early. 2. It is caused by an infectious agent, known as human papillomavirus (HPV), usually transmitted through sexual intercourse with multiple sexual partners or whose sexual partners have several sexual partners or among those who have had sexual intercourse at an early age (15 or 16 yrs old). 3. The signs and symptoms of cervical cancer usually manifest only during the advance stage of the disease. It is generally asymptomatic.
4. The most reliable and practical way to detect cervical cancer is through a Pap smear which should regularly be done among: a. Those who have their first intercourse at an early age (3 yrs after the first vaginal intercourse – but not done among those less than 21 yrs old) b. Those who have multiple sex partners or whose partners have multiple sexual partners c. Those who have been in long-term use of oral contraceptives d. Smokers e. WRA with HIV infection f. WRA 35 yrs old and above with or without sexual intercourse 5. If the Pap smear is negative for 3 consecutive years, it is advised that it should be repeated after every 2 or 3 years.
WHAT TO DO: 1. Using the latest family profiling form for Cervical Cancer Screening, the BHWs should have a masterlist/record of the ff. within their designated household catchment areas: a. Name and age of all WRA in the household b. Number of pregnancies, if any c. FP method practiced, if any, and for how long
Sexual history is a sensitive topic and is best discussed during FP or STI-HIV counselling by adequately trained health personnel.
2. Refer WRA who present with signs and symptoms of unusual vaginal bleeding, with or without unpleasant vaginal discharge, to the RHMs or the nearest health facility for further evaluation and management. LUNG CANCER Lung cancer is almost always due to the delayed effect of smoking. It is still the top leading cancer among men and ranks 3rd among women.
WHAT TO SAY: What is lung cancer? Lung cancer is one of the common health risks associated with smoking, whether voluntarily or involuntarily (e.g., second hand smoke).
What are the risk factors for lung cancer? Risk factors may include any of the following: o Smoking o Second hand smoking or passive smoking o Air pollution What are the usual signs and symptoms of lung cancer? The usual signs and symptoms include any of the following: o o o o o o
Persistent dry cough that gets worse over time Constant chest pain Shortness of breath, wheezing or hoarseness Difficulty of breathing Weight loss Easy fatigability
Go to the nearest RHM or health facility when there are any of the signs and symptoms of lung cancer, for proper evaluation and management How can it be prevented or controlled? Best and only way to prevent lung cancer is to stop smoking or avoid second hand smoke. Regular exercise and healthy eating habits minimizes the risk for lung cancer.
WHAT TO DO: 1. Using the latest family profiling form for non-communicable diseases, gather the following data within your designated household catchment areas: a. Name and age of household members b. Family history of lung cancer, if any c. Note of any of the signs and symptoms of lung cancer, if any 2. Encourage members to exercise regularly, avoid smoking and intake of alcoholic beverages, and eat nutrient-rich foods to minimize the risk for lung cancer 3. For BHWs who already have patients properly diagnosed with lung cancer within their catchment areas, they should: Constantly remind patients to have regular follow-up check-up Constantly remind patients to comply with medications given NEVER self-medicate
PROSTATE CANCER Prostate cancer is the 4th leading cancer in men, but the cause is still unknown.ix
WHAT TO SAY: What is Prostate Cancer? Prostate cancer is the most common type of cancer among Filipino men > 50 yrs old. It is multifactorial in nature. What are the risk factors for prostate cancer? Risk factors may include any of the following: o o o o
Age > 50 Family history of prostate cancer High fat diet High intake of calcium
What are the usual signs and symptoms of Prostate Cancer? The usual signs and symptoms may include any of the following: o o o o
Difficulty in urinating Blood in the urine Blood in the semen Discomfort in the pelvic area Go to the nearest RHM or health facility when there is note of any of the signs and symptoms of prostate cancer, for proper evaluation and management.
How can it be prevented or controlled? Eat a balanced diet and avoid too much alcohol intake. NEVER self-medicate to avoid possibility of missing early detection of prostate cancer among high-risk individuals. Regular exercise and healthy eating habits minimize the risk for prostate cancer.
WHAT TO DO: 1. Using the latest family profiling form for non-communicable diseases, gather the following data within your designated household catchment areas: a. Name and age of household members b. Family history of prostate cancer, if any c. Note of any of the signs and symptoms of prostate cancer, if any 2. Encourage members to exercise regularly, avoid smoking and intake of alcoholic beverages and eat nutrient-rich foods to minimize risk for prostate cancer. 3. For those BHWs who already have patients properly diagnosed with prostate cancer within their catchment areas, they should: Constantly remind patient to have a regular follow-up check-ups Constantly remind patient to religiously comply with medications given NEVER self-medicate
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) COPD is a life-threatening lung disease that leads to breathing-related problems. It is NOT curable. Current medications available can only control its symptoms and improve quality of life.
ROLE OF THE BHW: Under the Lifestyle Related Program, adequately trained BHWs are expected to identify and record the eligible population of their household catchment areas who are at higher risk of having COPD. They are not expected to comprehensively discuss the disease to the eligible population.
WHAT TO SAY: What is COPD?ix COPD is a life-threatening lung disease, usually affecting those who are > 40 yrs old, that is NON-INFECTIOUS. The 2 most common types are emphysema and chronic bronchitis.
What are the risk factors for COPD? Risk factors include any of the following: o Tobacco smoking o Indoor and outdoor air pollution o Occupational dusts and chemicals What are the usual signs and symptoms of COPD? Both emphysema and chronic bronchitis have symptoms of breathlessness and chronic cough. Cough with phlegm is more commonly seen in chronic bronchitis, while wheezing is more prominent in emphysema. Not all wheezing is caused by asthma. How can it be prevented or controlled? Quit smoking or avoid second-hand smoke. Wear proper face masks if your work will require exposure to dusts and chemicals. Influenza and pneumococcal vaccination will help in decreasing the risk of acquiring respiratory infections. NEVER self-medicate with antibiotics to prevent further complications.
WHAT TO DO: 1. Using the latest family profiling form for lung diseases (e.g., TB and asthma), gather the following data within your designated household catchment areas: a. Name and age of all members in the household b. History of tobacco smoking or exposure c. Exposure to indoor air pollution d. History of exposure to occupational dusts and chemicals 2. For those BHWs who already have COPD patients within their catchment areas, they should: Encourage the patient and household members to stop smoking. Encourage the patient and household members to lessen or minimize indoor air pollution (e.g., use indoor plants that absorb carbon monoxide or avoid burning of solid fuels for indoor heating).
3. Refer household members who present with cough for more than 2 weeks to the RHMs or the nearest health facility for further evaluation and adequate management. DIABETES Diabetes is a group of metabolic disorders characterized by high blood sugar levels on 2 separate occasions.xi
WHAT TO SAY: What is diabetes? Diabetes results when the body cannot properly regulate the amount of sugar (e.g., glucose in the blood). There are 4 clinical types of diabetesxii o Type 1 these refer to insulin dependent diabetics. o Type 2 these refer to those who can be managed through oral anti-diabetic medications but may eventually also require insulin treatment to attain good blood glucose control. o Gestational diabetes refer to diabetics who were first diagnosed to have diabetes during pregnancy. o Secondary diabetes refer to those who have acquired diabetes that may be drug or chemical-induced such as those who are being treated for AIDS; or from other endocrine diseases such as hyperthyroidism. What are the risk factors for diabetes? High blood pressure High triglyceride levels Giving birth to an 8-lb baby Sedentary lifestyle Obesity Family history of type 2 diabetes mellitus among first degree relatives What are the usual signs and symptoms of diabetes? Fatigue Unexplained weight loss Excessive thirst Excessive hunger
Excessive urination Poor wound healing If you know anyone within your household who may have the signs and symptoms of diabetes, do not hesitate to consult anyone of us in the health facility. Early detection is an important factor for preventing further complications. How can it be prevented? Diabetes is a lifestyle-related disease which can be prevented through regular exercise (at least 30 minutes every other day) and eating a “heart healthy” diet (i.e., low-salt, low-fat diet). Excessive alcohol consumption and cigarette smoking also increases the likelihood of diabetes.
WHAT TO DO: 1. Using the latest Non-Communicable Disease Risk Assessment Form for noncommunicable diseases, gather the following data: a. b. c. d.
Name and age of household members Past medical history of diabetes, if any Family history of diabetes, if any Personal and social history of tobacco smoking; alcohol intake; high-fat, high-salt intake and physical activity, if any e. Any of the signs and symptoms of diabetes 2. Refer members of the household catchment area who is suspected of having diabetes when there are any of the following signs and symptoms: o o o o o o
Fatigue Unexplained weight loss Excessive thirst Excessive hunger Excessive urination Poor wound healing
All pregnant women are advised to undergo screening for gestational diabetes at their first prenatal visit.
3. Encourage members to exercise regularly and eat nutrient-rich foods to minimize risk for diabetes. 4. For those BHWs who already have diabetic patients within their catchment areas, they should: Constantly remind patient to have a regular follow-up check-ups and monitoring of glucose levels Constantly remind patient to religiously comply with medications given to prevent complications NEVER self-medicate Constantly remind patient to regularly inspect both feet to immediately identify any ulcers or wounds which may not have been felt (because there is loss of sensation) Regularly exercise and eat nutrient-rich foods 5. Assist in the risk assessment of clients using the Philippine package of essential noncommunicable disease intervention for primary care. HYPERTENSION Hypertension is an increase in blood pressure > 140/90mmHgxiii in 2 or more occasions. It is one of the leading causes of disability among Filipinos due to stroke.
WHAT TO SAY: What is hypertension? Hypertension is an increase in blood pressure > 140/90mmHg in two (2) or more separate occasions. It is one of the leading causes of disability among Filipinos due to stroke. Table 5. Classification of blood pressure for adultsxiii
BLOOD PRESSURE CLASSIFICATION
SYSTOLIC BP
DIASTOLIC BP
Normal
Less than 120 mmHg
Less than 80 mmHg
Prehypertension
120-139 mmHg
80-89 mmHg
Stage 1 Hypertension
140-159 mmHg
90-99 mmHg
Stage 2 Hypertension
160 mmHg or higher
100 mmHg or higher
What are the risk factors for hypertension? Smoking Excessive alcohol consumption Overweight Family history of hypertension, heart disease, diabetes and kidney disease Sedentary lifestyle Chronic stress Advancing age What are the usual signs and symptoms of hypertension? Not all hypertensive patients have symptoms, but the usual signs and symptoms are: o Headache o Dizziness o Blurring of vision o Nape/neck discomfort If you know anyone within your household who may have the signs and symptoms of hypertension, do not hesitate to consult anyone of us in the health facility. Early detection is an important factor for preventing further complications. What are the possible complications of hypertension? Chronic, undiagnosed and untreated hypertension may result to: o Heart attack o Stroke o Kidney failure o Loss of vision How can it be prevented? o Hypertension is a lifestyle-related disease which can be prevented through regular exercise and eating a “heart healthy” diet (i.e., low-salt, low-fat diet). Excessive alcohol consumption and cigarette smoking also increases the likelihood of hypertension.
WHAT TO DO: 1.
Using the latest Non–Communicable Disease Risk Assessment Form for noncommunicable diseases, gather the following data: a. b. c. d.
Name and age of household members Past medical history of hypertension, if any Family history of hypertension, if any Personal and social history of tobacco smoking, alcohol intake, high-fat, high-salt intake and physical activity, if any e. Any of the signs and symptoms of hypertension 2.
Not all hypertensive patients have symptoms, but refer members of the household catchment area who are suspected of having hypertension (BP is 140/90 mmHg or higher) PLUS any of the following signs and symptoms: Headache Dizziness Blurring of vision Nape/neck discomfort
3.
Encourage members to exercise regularly, avoid smoking and excessive intake of alcoholic beverages, and eat nutrient-rich foods, to minimize risk for hypertension.
4.
Encourage lifestyle modification techniques to prevent and manage hypertension.
Table 6. Lifestyle modifications to prevent and manage hypertensionxiii LIFESTYLE RECOMMENDATION MODIFICATIONS
5.
APPROXIMATE SYSTOLIC BP REDUCTION
Weight reduction
Maintain normal body weight
5-20 mmHg
Adopt DASH* eating plan (Dietary Approach to Stop Hypertension)
Consume a diet rich in fruits, vegetables and low fat dairy products
8-14 mmHg
Dietary sodium (salt) restriction
Reduce dietary sodium intake
2-8 mmHg
4-9 mmHg
Physical activity
Engage in regular aerobic physical activity such as brisk walking (at least 30 min per day, most days of the week)
Moderation of alcohol consumption
Limit consumption to no more than 2 drinks per day in most men, and not more than 1 drink per day in women and lighter weight persons
2-4 mmHg
For BHWs who already have hypertensive patients within their catchment areas, they should: a. Constantly remind patient to have a regular follow-up check-ups and monitoring of blood pressure levels b. For adequately trained BHWs, take the blood pressure of hypertensive patients during your household visits c. Constantly remind patient to religiously comply with medications given to prevent complications d. NEVER take anti-hypertensive drugs without a doctor’s prescription e. Regularly exercise and eat nutrient-rich foods
6. Refer and assist the patient with high blood pressure (140/90mmHg or higher) to the nearest RHM or health facility for proper evaluation and management. 7.
Assist in the risk assessment of clients using the Philippine package of essential noncommunicable disease intervention for primary care.
H. ELDERLY This phase of the life-cycle approach cover some DOH programs that the elderly (60 yrs of age or older) can avail, particularly on the following: a) vaccines for the senior citizens/elderly; and, b) 20% discount for senior citizens on health related goods.
VACCINES FOR THE ELDERLY Vaccines among those who are 60 years old and above are available in private clinics, government and private hospitals. Discussions in this section include Influenza vaccine and Pneumococcal vaccinations.
ROLE OF THE BHW: As part of the BHW’s role as an educator, linker and record keeper, they are expected to assist RHMs in educating their respective HH catchment areas on the importance of vaccines for the elderly and where it can be availed. They are not expected to be able to comprehensively discuss the different types of adult immunization among the elderly.
WHAT TO SAY: What are the DOH vaccines available for the elderly?xiv Pneumococcal vaccines and influenza vaccines are given FOR FREE AS SINGLE DOSE to all indigent senior citizens Who are qualified to avail of these vaccines? These vaccines shall cover all indigent senior citizens 60 years old and above, living in: o RESIDENTIAL CARE FACILITIES for INDIGENT senior citizens o In the community BASED ON THE NATIONAL HOUSEHOLD TARGETING SYSTEM FOR POVERTY REDUCTION list of the DSWD
An indigent senior citizen who has received a PNEUMOCOCCAL vaccine in the LAST 5 YEARS and was less than 60 years of age at the time of immunization should receive another dose of pneumococcal vaccine.
An indigent senior citizen who has received a pneumococcal vaccine when he/she was 60 years old and above at the time of immunization is NOT required to receive another dose of pneumococcal vaccine.
What is meant by a “residential care facility”? It refers to a DSWD accredited-facility that provides 24-hour residential care services operated for the purpose of promoting the well-being of abandoned, neglected, unattached or homeless senior citizens. Where are these vaccines available? It is available in designated city/municipal health centers, government run residential facilities and DSWD-accredited non-governmental home care facilities for senior citizens.
Only health workers trained and skilled at adjusting vaccines are authorized by the DOH to give immunizations.
WHAT TO DO: 1.
Using the latest masterlist of Indigent Senior Citizens 60 years old and above, assist the RHMs in annually updating the following data in your designated HH catchment area: a. Name, sex, address and date of birth of the senior citizen b. Office for Senior Citizens Affair ID and date of registration c. Pneumococcal and Influenza vaccine received, if any
2.
Regularly update the target beneficiaries when, where, and what to do for the scheduled immunization activity.
20% SENIOR CITIZEN DISCOUNT ON HEALTH RELATED GOODS AND SERVICES The Expanded Senior Citizens Act of 2010 apply to ALL hospitals and health-related facilities from the government and private sectors, the health care professionals and other related health care facilities and services and drug stores, hospital pharmacies and similar establishment dispensing medicines and medical devices.xv
ROLE OF THE BHW: As a linker to all health-related services provided within their community, BHWs are expected to discuss the basic concepts in availing the 20% senior citizens discount on health related goods and services. They are not expected to comprehensively discuss the entire Expanded Senior Citizens Act, which is already a function of the point person in their respective Senior Citizens Association.
WHAT TO SAY: Who are qualified to avail of the 20% senior citizens discount? All Filipino citizens who are residents of the Philippines and 60 years old and above All senior citizens with “dual citizenship”, provided they prove their Filipino citizenship AND they have been residents for at least 6 months in the Philippines All senior citizens who are recipients of the DSWD NHTS-PR program
What are the necessary documents needed to avail of the 20% discount? 1. Any document or proof of being a senior citizen shall suffice, namely: ID issued by the city or municipal mayor or Office of Senior Citizens Affairs or of the barangay captain of the place where the senior citizen or the elderly resides; The passport of the elderly person or senior citizen concerned; and, Other government issued certificates which may include any of the following: o Birth certificate o Voter’s ID 2. EXCEPT for over the counter drugs such as paracetamol, a doctor’s prescription shall be presented having the following information: Name, age, sex, and address of the senior citizen Date of consultation Generic name of the medicine, dosage form, dosage strength, quantity Name and signature, address, professional license number and S2 license number, if applicable, of the prescribing physician 3. Purchase slip booklets
What are the health-related goods and services that are included? 1. Medical and dental services 2. Diagnostic and laboratory services (e.g., x-rays, CT scan, blood tests, hemodialysis) 3. Professional fees of attending physicians and other health professionals confined in pay sections provided the confinement are in accordance with available clinical practice guidelines or hospital treatment protocols 4. All medical devices (e.g., supplies, kits used or consumed during check-up or confinement) regardless of the number of days 5. All medical devices to be used during the recovery at home, or for monitoring of a particular ailment or disease (e.g., glucometer set including lancets and test strips, insulin syringe and needle, blood pressure apparatus, wheelchair) provided that the prescription for the use of a particular medical device shall be provided by the physician
The 20 % discount and VAT exemption shall apply only once for personal use of senior citizen of non-disposable medical devices such as glucometer, blood pressure apparatus, weighing scale.
What are NOT included? Services that are not medically necessary for treatment and diagnosis. these include: o Cosmetic surgery procedures o Executive check-up packages
SPECIAL HEALTH CONCERNS
IN THE COMMUNITY
A. ENVIRONMENTAL HEALTH Climate change is a global concern because it causes flash floods, earthquakes and super typhoons. Along with these effects are the continuing spread of diseases that arise from contaminated air, soil and water. The climate changes because of our disregard of environmental health. Environmental health is the process of ensuring the health and safety of the community through safe and accessible drinking water, clean toilets, proper waste disposal, and food safety. Ensuring adequate environmental protection requires proper waste disposal to prevent air and water pollution; provision of safe drinking water to prevent the spread of water-borne diseases; construction of sanitary toilets to prevent the spread of diseases transmitted, and food safety measures to avoid contamination and food poisoning. BHWs play a significant role in promoting environmental health by constantly reminding members of his/her HH catchment areas of the importance of proper waste disposal, provision of safe-drinking water, construction and use of sanitary toilets and food safety.
PROPER WASTE DISPOSAL Improper disposal of garbage in rivers, “sapa”, and canals can cause clogging and encourages rats and insects that carry diseases. This can further lead to flooding and can result to water contamination which can cause diarrhea, leptospirosis and amoebiasis.
WHAT TO DO: 1.
Using the latest forms for environmental sanitation, gather the following data from your designated household catchment areas: a. b. c.
2.
Name of members of the HH catchment area What type of garbage materials are disposed How are these garbage materials disposed
Encourage members of the HH to regularly practice proper waste disposal: Throw garbage only on designated pick-up points/storage in the community for garbage collection. DO NOT burn waste products to prevent further damage to the ozone layer. Burying biodegradable waste products within the backyard is an alternative way of disposing garbage. It will at the same time serve as a fertilizer for organic gardening.
Recycle non-biodegradable products such as plastic bottles, or sell them to junk shops within the community. DO NOT throw garbage in rivers or canals to prevent contamination of water. 3.
Coordinate with barangay officials and local sanitary officer in promoting proper waste disposal and to facilitate identification of HH without sanitary toilets, or if there is possible water contamination within the HH catchment area.
PROVISION OF SAFE DRINKING WATER: Safe water supply is important in disease prevention and for maintaining the health of the community. Water sources and distribution must be protected to prevent contamination through: a) leaking water pipes that are submerged in canals or stagnant water; b) toilets built near the water sources; and, c) unclean water containers.
WHAT TO DO: 1.
Using the latest forms for environmental sanitation, gather the following data within your designated household catchment areas: a. b.
2.
Name of members of the household catchment area Source of drinking water
Encourage members of the household and barangay officials to regularly promote safe water handling practices: Regularly clean water containers at least once a week Regularly clean water source at least every 6 months Drink chlorinated/treated/boiled water only Make sure that the water for drinking is safe: a. Boil water from unsafe or doubtful sources o Spring o Rain water o Other surfaces of water o Unprotected wells o Unprotected springs b. Use clean, covered containers when collecting and transporting water from source c. If the container does not have any faucet, use a clean dipper to get water d. DO NOT put hands or dirty cups into the water
3.
Coordinate with barangay officials and the local sanitary officer to facilitate identification of household with potentially contaminated water source, or if there is possible water contamination within the household catchment area.
CONSTRUCTION AND USE OF SANITARY TOILETS: Parasitism is common in communities with no toilet facilities. Construction and use of sanitary toilets will minimize or address such problem.
WHAT TO DO: 1.
Using the latest forms for environmental sanitation, gather the following data within your designated household catchment areas: a. Name of members of the household catchment area b. Presence and use of sanitary toilets, if any
2.
Encourage members of the household to regularly use sanitary toilets to prevent parasitism which will aggravate malnutrition among children who are the most vulnerable groups affected.
3.
People should dispose their feces properly to prevent the spread of germs and parasites that can cause diseases such as cholera, parasitism, and typhoid fever.
4.
Unclean public toilets will also affect the entire community since it may potentially contaminate nearby water sources. Its maintenance should therefore be considered as a public health concern by the entire community.
5.
Coordinate with barangay officials and local sanitary officer to facilitate identification of household without sanitary toilets.
FOOD SAFETY To prevent food and water-borne diseases, the following guidelines should be considered: 1.
Meat (pork, beef and chicken) must come from healthy animals and must have been approved by the meat inspector
2.
Fruits and vegetables must be fresh and washed with clean water
3.
Fresh milk from cows, carabaos and other animals must be boiled before drinking
4.
Fish and shellfish (oysters, mussels, clams) must come from clean sources
5.
Food in plastic wrappers must be dry
6.
Food must be carried in clean container and covered
7.
Always take note of the expiry date when buying any type of food products
B. VIOLENCE AGAINST WOMEN AND CHILDREN Reproductive health care also includes elimination of violence against women and children and other forms of sexual and gender-based violencexvi which is currently considered as the 5th leading cause of death among women of reproductive age; this is secondary to unintended pregnancies, abortions and mental ill-health. xvi Violence Against Women or Gender-Based Violence refers to all forms of violence, whether mental, physical, or sexual.xvi
ROLE OF THE BHW: Under the Anti-Violence against Women and Children Act, adequately trained BHWs are expected to assist WRA who experience any form of violence. They are not expected to be able to comprehensively discuss the different concepts on Violence against Women and their Children.
WHAT TO SAY: What are the different types of gender-based violence? Violence against women does not only refer to physical or sexual violence. Acts of withdrawing financial support to children or preventing women from engaging in a legitimate profession is considered an economic abuse which is also a form of violence against women. Stalking, public ridicule or humiliation is considered psychological violence which is another form of violence against women. If there is anyone among the community, who knows someone who may be a victim of violence against women and their children, it is best that they go to the nearest women and child protection unit for proper counselling, or approach anyone among the health facility who can assist you.
WHAT TO DO: Whenever a BHW is approached by a victim of violence, domestic or non-domestic in nature, it is best that the BHW assist the victim to the nearest women and child protection unit within the community or municipality. If there is none available, referral and assistance to the DSWD is also appropriate. Medical and psychological treatment is best given by adequately trained professionals on anti-Violence Against Women and their Children.
C. DISASTER RISK REDUCTION AND MANAGEMENT Disasters refer to situations brought about by flood, earthquake, typhoons, fire, or armed conflict that may cause destruction of properties and loss of lives. In most cases, national and local authorities will require mass evacuation and relief operations. Disaster preparedness minimizes and effectively reduces destruction of properties and loss of lives as well as prevent or control spread of contagious diseases commonly seen in overcrowded and congested places. This chapter only discusses the general information on what the BHWs should advocate during and after any disaster. For a more detailed discussion on disaster risk reduction and management, please refer to Guide for Community-Based Health Emergency Management Manual of DOH.
WHAT TO DO: 1.
Using the latest family profiling forms and risk assessment forms for disaster preparedness and management, gather the following data within your designated household catchment areas: a. Name of members of the household catchment area b. Proximity to identified disaster prone areas within the community such as: Low lying areas below sea level Households near denuded mountains or garbage dumpsite Households inside or near the earthquake fault line Areas frequently visited by typhoons
2.
Regularly coordinate with local officials to facilitate identification of potential evacuation site/s of members of the household catchment area for ease of referral and management once a disaster occurs. Include emergency hotline numbers and point persons to contact
3.
Regularly remind household members within your catchment areas what to do, for incoming typhoons which will potentially affect the community: Multimedia services (e.g., radio, television, internet) can be utilized for announcements or news update Prepare set of clothing’s, canned goods, rice, flashlight, fully charged batteries for cellphones or emergency lights or radio and bottled drinking water Prepare set of first-aid kit and medicines for fever, colds, wounds and diarrhea Never panic. Anxiety and panic only adds problem to the current situation. It does not provide any benefit Go to the nearest BHW or other local officials designated to the household for information on evacuation procedures, if necessary
4.
Educate and regularly update the community on the following: What to do during emergencies based on type of hazard How, when and where to evacuate What should be included in the family/household emergency kit
5.
Advocate active community participation on drills and exercises like earthquake drills, or fire drills
6.
Advocate active community participation among HH heads on attending training on Basic Life Support
7.
Assist health workers at the evacuation center in the provision of public health care and proper referral of patients
8.
Act as Surveillance in Post Extreme Emergencies and Disasters reporter by reporting diseases, injuries and other health trends through the Surveillance in Post Extreme Emergencies and Disasters system, if applicable
FIRST-AID TECHNIQUES FOR
COMMON INJURIES AND ILLNESSES
INTRODUCTION TO FIRST AID TECHNIQUES FOR COMMON INJURIES AND ILLNESSES As part of the community health team, adequately trained BHWs are also expected to provide DOH-recognized first aid techniques within their respective HH catchment areas. This chapter covers discussions on the first-aid methods that a BHW can provide while waiting for health personnel or professionals to arrive or while in transit during actual referral. Common injuries and illnesses discussed are the following: benign febrile convulsion, shock, loss of consciousness, drowning, poisoning, wounds, bleeding, suspected fractures and dislocations, insect bites and stings, snake bites and the essential contents of a first aid kit. In all emergencies, always call for help or ask a bystander to call for help before starting first aid measures. Some of the fist aid measures require separate training such as CPR or Cardiopulmonary Resuscitation given by trained licensed professionals.
A. BENIGN FEBRILE CONVULSION Benign febrile convulsion present as generalized seizures secondary to high-grade fever common among children < 6 yrs old. Persistent or recurrent seizure with or without fever is no longer considered as benign febrile convulsion.
WHAT TO DO: 1. NEVER wrap a person with fever in several blankets since it will only increase his/her body temperature and may result to convulsion. 2. NEVER attempt to stop or control the shaking movements. 3. Give a sponge bath by alternating use of clean cloth with cool water and dry clean cloth, to prevent subsequent chilling episodes, until the temperature goes down to normal. 4. Regularly check the body temperature of the patient while providing sponge bath to monitor response to the sponge bath. 5. Encourage and assist family members to bring the patient to the nearest health facility for adequate evaluation and management, most specially if the patient is a child.
B. SHOCK Shock is a serious and sometimes fatal condition where the blood circulating in the body is not enough to meet the demands of the entire body.
WHAT TO DO: 1. Check the level of consciousness of the victim or patient a. If the victim or patient is conscious, lay the patient or victim on his/her back with his/her legs placed higher than the rest of his/her body; cover him/her with blanket for comfort and check for other injuries. b. If the victim or patient is unconscious, check for presence of heartbeat; If present, lay the patient or victim on his/her back with his/her legs placed higher than the rest of his/her body and check for other injuries If there is no heartbeat, perform CPR only if you are properly trained 2. Check the blood pressure a. Maintain the position of the victim if BP is > 90/60mmHg b. If BP continues to go down, check for possible sites of bleeding. If victim is bleeding, place direct pressure on the wound 3. Take an initial history to assist the health professionals in further assessing areas of potential injuries.
C. LOSS OF CONSCIOUSNESS Loss of consciousness is caused by a range of factors from injuries to the brain, to injuries to the heart.
WHAT TO DO: 1. Remember to follow this sequence: C – A – B: C – for circulation Are there any signs of bleeding? o Apply direct pressure on the bleeding site, if any Check the blood pressure o If the BP is less than 90/60 mmHg, elevate the legs higher than the other parts of the body and recheck BP
A – for airway Is the person breathing? o Check for possible obstruction of airway from foreign objects and gently remove, if there is any B - for breathing If the person is not breathing, perform CPR only if properly trained
D. DROWNING Death caused by drowning is always due to lack of oxygen.
WHAT TO DO: 1. Check if the victim is breathing If not, start mouth-to-mouth resuscitation, if properly trained, as soon as possible. If mouth-to-mouth resuscitation is not possible, place the victim on his/her side with the head lower than the body and push the belly upwards to force the water out . 2. Check if the victim has a heartbeat If none, perform CPR if properly trained 3. Check for any other injuries
E. POISONING Poisoning may either be voluntary (e.g., suicide attempts) or involuntary (e.g., inhalation of poisonous substances).
WHAT TO DO: 1. In all types of poisoning AND if the patient is conscious, give lots of water to drink. 2. Never ask the patient or victim to vomit if the suspected poison is a chemical substance such as Lysol or ammonia, or when there are burn marks on the lips or mouth. 3. Check for level of consciousness and vital signs. 4. Pesticide poisoning may present with frequent dizziness, headache and severe anemia. 5. Lead poisoning may present with loss of appetite and numbness.
F. WOUNDS All types of wounds are potential entry points for infection. It is very important to wash all types of wounds no matter how small its physical appearance may be, to prevent infection.
WHAT TO DO: 1. Wash your own hands first with soap and water before touching the wound. 2. Clean the wound and the skin around it with bath soap and water to remove dirt, sand or dried blood then apply betadine in a clockwise motion from the center of the wound going out. 3. Cover the wound with a clean gauze or cloth. 4. If there are signs of infection (e.g., swelling, redness or heat), wash the wound with warm water and guava decoction, a DOH-recognized medicinal plant for wounds, gently removing the pus, if there is any. 5. Cover the wound with a loose bandage and refer immediately to the RHM or nearest health facility for adequate management. 6. Wash your own hands again after providing first-aid.
G. BLEEDING There are two types of bleeding which may be fatal because of too much blood loss. 1. External bleeding are those that can be seen from a wound or open fractures 2. Internal bleeding are those that can present as bloody discharge from the nose, ear, vagina or anus, or may also present as dark, black (tarry) stools or dark brown vomitus and requires immediate referral to the nearest hospital
WHAT TO DO: 1. Check the blood pressure (normal: from > 90/60 mmHg up to < 130/80 mmHg), pulse rate (normal: 60-100 beats per minute) and respiratory rate (normal: 16-20 breaths per minute) to immediately assess the possibility of shock. Cold, clammy perspiration and changing levels of consciousness are indicative of an impending shock. 2. For external bleeding, elevate the area of the wound from the rest of the body and apply direct pressure with a clean cloth or the palm of your hand on the wound until the bleeding stops.
3. If the cloth is already soaked with blood, simply add another cloth on top of it. DO NOT remove the soaked cloth. 4. If there is still bleeding, apply pressure on the pulse point above the wound. Pulse points can be found in any of the following areas: Neck Armpit Wrist Groin Leg Foot
H. SUSPECTED FRACTURES AND DISLOCATIONS Fractures refer to a break in any bone in the body, while dislocations refer to displaced bones at a joint.
WHAT TO DO: 1. Apply a splint to keep joints above and below the fracture/dislocation site from moving or stabilized. Apply the splint on the site of injury Do not move the fractured or dislocated limb while applying the splint Any stick-like object or material can be used for splinting 2. If you suspect that there may be an injury to the back, neck, chest or pelvis, DO NOT attempt to move the person. 3. A person who is suspected to have a fracture or dislocation must be brought as soon as possible to the nearest health facility for proper evaluation and management. The longer the delay in consultation, the more difficult it is to correct the injury. 4. NEVER massage any part of the body that is suspected to have a dislocation or fracture to prevent further harm. 5. Follow-up visit to a patient with fracture or dislocation is important to ensure compliance with prescribed medications and evaluate possible secondary infections or complications. 6. Immediately refer the post-treated patient to the RHM or to the nearest health facility when he/she complains of any of the following: Inability to move fingers or toes Bluish discoloration of fingers or toes Foul-smelling discharge on the area of the fracture or dislocation
I. INSECT BITES AND STINGS Bites from mosquitoes, ants and ticks may cause mild skin reactions, while bites from bees may cause allergic responses.
WHAT TO DO: 1. Wash area with soap and water 2. Apply cold pack on the affected area to reduce pain and swelling 3. Refer the victim to the nearest health facility if there are signs and symptoms of allergic reactions such as mild nausea, diarrhea or swelling larger than 2 inches in diameter, for prompt evaluation and management
J. SNAKE BITES Majority of snakes are NOT poisonous.
WHAT TO DO: 1. Lay the victim in a comfortable position 2. Immobilize the bitten limb with a splint 3. Reassure the victim who may be very anxious; anxiety hastens absorption of the venom 4. Assist the victim to the nearest health facility for proper evaluation and management or antivenom treatment if needed DO NOT: 1.
Use tourniquet
2.
Use ice pack
3.
Puncture, pinch, or scrape bitten area
4.
Suck venom from the patient’s open wound
5.
Elevate the wound at the same level or higher than the chest/heart area
K. BURN INJURIES Burns are classified into first-degree, second-degree or third-degree. Only first degree burns can be treated at home, EXCEPT if the victim is an infant or an elderly. Second-degree and third-degree burns ALWAYS require medical attention of a trained health personnel. The usual signs and symptoms of First degree burns are: Reddish, painful discoloration of skin With or without mild swelling Second degree burns present with: Deep reddening of skin Painful, with blisters Glossy appearance from leaking fluid and possible loss of some skin Third degree burns are often painless and possibly charred with patches that appear white, brown, or black.
WHAT TO DO for FIRST-DEGREE burns: a. Apply cool, wet compresses, or immerse in cool, fresh water. Continue until pain subsides. b. Cover with a sterile, non-adhesive bandage or clean cloth. DO NOT apply any ointment or butter to prevent secondary forms of infection. c. Over the counter pain medications (e.g., Paracetamol) may be used to relieve pain and reduce inflammation.
L. ESSENTIAL CONTENTS OF THE FIRST AID KIT
Supplies/equipment o o o o o o
Cotton Gauze Elastic bandage Adhesive tape 2 forceps Scissor
Medicines o Ammonia o Antiseptic solution Hydrogen peroxide Povidone iodine 70% alcohol o For pain and fever Paracetamol o Oresol packs
o o o o o
Bulb syringe Thermometer Penlight Stethoscope Blood pressure apparatus
HERBAL MEDICINES
Medicinal plants are an essential component of first-aid management most especially among those who are located in geographically isolated and depressed areas. This chapter covers discussions on the 10 medicinal plants recommended by the DOH namely: Lagundi; Yerba Buena; Sambong; Tsaang Gubat; Ulasimang Bato or Pansit-pansitan; Garlic, Niyog-niyogan; Guava; Akapulko; and, Ampalaya.
ROLE OF THE BHW BHWs are expected to at least know the use of the medicinal plant and its right dosing for the different age groups.
A. LAGUNDI Lagundi is a shrub approximately 5 meters in height which is used for cough. How to prepare lagundi decoction: Chop the leaves and place them in an earthen jar according to the following amounts corresponding to the age: Figure 7. Lagundi
Table 6. Quantity of Lagundi for preparation of decoction: AGE GROUP
IF DRIED LEAVES
IF FRESH LEAVES
Adult
4 tbsp
6 tbsp
7-12 yrs
2 tbsp
3 tbsp
2-6 yrs
1 tbsp
1 ½ tbsp
* tbsp - tablespoon
Pour in 2 glasses of water and cover Bring the mixture to a boil Remove the cover and let it continue to boil for 15 minutes or until one glass of decoction is left Let it cool, and then strain the mixture Divide the decoction into 3 parts: o For cough, drink 1 part 3 times a day
B. YERBA BUENA Yerba buena is a creeping plant with rough and wrinkled leaves. It is used to treat body pains as a decoction (similar in preparation to Lagundi decoction), or as crushed the fresh leaves placed directly over the affected site. DO NOT give to children less than 7 yrs of age.
Figure 8. Yerba Buena
How to prepare yerba buena decoction: Chop the leaves and place them in an earthen jar according to the following amounts corresponding to the age:
Table 7. Quantity of Yerba Buena for preparation of decoction: AGE GROUP
IF DRIED LEAVES
IF FRESH LEAVES
Adult
4 tbsp
6 tbsp
7-12 yrs
2 tbsp
3 tbsp
Pour in 2 glasses of water and cover Bring the mixture to a boil Remove the cover and let it continue to boil for - 15 minutes Let it cool, and then strain the mixture Divide the decoction into 2 parts and drink 1 part 3 times a day
C. SAMBONG Sambong has rough leaves and grows 2 to 3 meters in height. It is used for kidney stones as a decoction (similar in preparation to Lagundi decoction). DO NOT give to children less than 7 yrs of age.
Figure 9. Sambong
How to prepare sambong decoction: Chop the leaves and place them in an earthen jar according to the following amounts corresponding to the age: Table 8. Quantity of Sambong for preparation of decoction: AGE GROUP
IF DRIED LEAVES
IF FRESH LEAVES
Adult
4 tablespoon (tbsp)
6 tbsp
7-12 yrs
2 tbsp
3 tbsp
2-6 yrs
1 tbsp
1 ½ tbsp
Pour in 2 glasses of water and cover Bring the mixture to a boil Remove the cover and let it continue to boil for 15 minutes or until 1 glass of decoction is left Let it cool, and then strain the mixture Divide the decoction into 3 parts and drink 1 part 3 times a day
D. TSAANG GUBAT Tsaang gubat is a shrub about 5 meters in height. It is used for stomach ache as a decoction. DO NOT give to children less than 7 yrs of age.
How to prepare tsaang gubat decoction: Chop the leaves and place them in an earthen jar according to the following amounts corresponding to the age:
Figure 10. Tsaang Gubat
Table 9. Quantity of Tsaang Gubat for preparation of decoction: AGE GROUP
IF DRIED LEAVES
IF FRESH LEAVES
Adult
2 tbsp
3 tbsp
7-12 yrs
1 tbsp
1 tbsp
Pour in 1 glass of water and cover Bring the mixture to a boil Remove the cover and let it continue to boil for 15 minutes or until ½ glass decoction is left Let it cool, and then strain the mixture Take the decoction
E. ULASIMANG BATO or PANSIT-PANSITAN:
Ulasimang Bato is a plant that grows 40 centimeters in height and is usually seen during rainy seasons. It is used to lower uric acid level.
There are 2 ways to prepare and take it: Prepare 1-2 cups of fresh leaves and chew 3 times a day; or Prepare and take a decoction: o o o o o
Figure 11. Ulasimang Bato leaves
Put 1-2 cups of fresh leaves in an earthen jar Pour in 2 glasses of water and cover Bring the mixture to a boil Remove the cover and let it continue to boil until the 2 glassfuls of water originally poured has been reduced to 1 glassful Let it cool, and strain the mixture Divide the decoction into 3 parts and drink 1 part 3 times a day, after meals
F. GARLIC Garlic is a popular medicinal plant to help control and decrease cholesterol level. Eat 2 cloves of garlic together with each meal.
Figure 12. Garlic cloves
G. NIYOG-NIYOGAN
Niyog-niyogan is a shrub about 8 meters in height with hairy leaves that give a rusty color. It is used for deworming ascaris. DO NOT give to children less than 4 yrs of age. 2 hours after dinner, chew and swallow only dried seeds according to the following measurement, then drink water. Figure 13. Niyog-niyogan leaves
Table 10. Quantity of Niyog-niyogan seeds for consumption: AGE GROUP
DRIED SEEDS
Adults
8-10
9-12 yrs
6-7
6-8 yrs
5-6
4-5 yrs
4-5
H. GUAVA
Guava is a popular medicinal plant for cleansing wounds. It is also used as mouth wash for mouth infection and sore gums or tooth decay.
How to prepare and take guava decoction: Wash the leaves very well Put 2 handfuls of chopped leaves in an earthen jar Pour in 4 glassfuls of water Boil for 5 minutes and let it cool and strain Use as mouth wash or gargle
Figure 14. Guava leaves
I. AKAPULKO Akapulko is a shrub with oblong-shaped leaf and has yellow flowers at the tip of its branches. It is used to treat ringworm and athlete’s foot. Pound sufficient amount of fresh leaves and apply the juice on the affected area 1 to 2 times a day for 3 weeks.
Figure 15. Akapulko leaves
J. AMPALAYA Ampalaya is popular medicinal plant to help control blood sugar level.
There are 2 ways to prepare ampalaya leaves to be used as adjunct treatment for persons with diabetes: Eaten as a salad: Measure ½ cup of packed leaves and steam Taken as a decoction: 1. Wash young leaves very well 2. Put 6 tablespoonfuls of chopped leaves in an earthen jar 3. Pour 2 glasses of water and cover 4. Boil the mixture for 15 minutes 5. Strain the mixture 6. Divide decoction into 3 parts and drink 1 part 3 times a day, after meals
REFERENCES i.
Department Memorandum 2009-0302 Reiteration of DOH Support for the Continuing Development of BHWs ii. DOH Administrative Order 50-A s. 2001 National Family Planning Policy iii. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012 iv. DOH MNCHN Strategy Manual of Operation 2011 v. Basic Information about NB Screening, accessed at www.newbornscreening.ph vi. DOH Administrative Order 2006-0012 Revised IRR of Executive Order 51 (Milk Code) vii. IYCF Guidelines viii. DOH Administrative Order 2010-0023 Guidelines on Deworming Drug Administration and the Management of Adverse Events Following Deworming ix. 2012 Philippine Health Advisories x. 2014 DOH HEMS Guide for Community-Based Health Emergency Management xi. DOH Administrative Order 2012-0029 Implementing Guidelines on the Institutionalization of Philippine Package of Essential Non-Communicable Disease Interventions (PHILPEN) on the Integrated Management of Hypertension and Diabetes Milletus for Primary Health Care Facilities xii. 2014 UNITE for Diabetes: Philippine Practice Guidelines for Diabetes Mellitus xiii. 7TH Joint National Committee Classification for Hypertension xiv. DOH Administrative Order 2011-0018 Implementing Guidelines on Influenza and Pneumococcal xv. DOH Administrative Order 2012-0007 Guidelines on the Grant of 20% discount to Senior Citizens on Health-Related Goods and Services and for other Purposes xvi. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012 xvi. Philippine Health Advisories (DOH 2012) xvi. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012
NOTES
