PHW’s: are members of the health team who are professionals namely

1. Medical Officer (MO)-Physician------------------------ has immediate
2. Public Health Nurse (PHN)-Registered Nurse → responsibility to
3. Rural Health Midwife (RHM)-Registered Midwife-- implement r.a. 3573
4. Dentist
5. Nutritionist
6. Medical Technologist
7. Pharmacist
8. Rural Sanitary Inspector (RSI)-must be a sanitary engineer

2 Concepts of Communicable Disease:

1. Causative Agent-microorganism causing communicable disease
2. Transmission

5 Communicable Diseases to be reported weekly and monthly:

1. Rabies
2. Measles
3. Polio
4. Neonatal Tetanus-children delivered at home by midwives/”hilots”
5. Sexually Transmitted Disease (STD)-all forms
6. Diarrhea-not a disease but a symptom which should be reported by PHN monthly

Treatment of Communicable Diseases:

1. TB: Program of DOH for its treatment-DOTS
2. Pneumonia: Care & Control of Acute Respiratory Infection (CARI) for under 5 children
3. Leading Infections:
1. a. Pneumonia-a leading cause of morbidity & mortality of children under 5
2. b. Ear infection
3. c. Throat infection

Morbidity Report-report of diseases affecting the population group (BQ) while Mortality Report-reports of deaths

1. Diarrhea
2. Pneumonia
3. Bronchitis
4. Influenza
5. PTB
6. Hypertension

1. Preventive Program
1. Immunization-BCG
2. Strict isolation to prevent infection of the family
3. Health education
2. Case Finding/Surveillance

6 Concerns:

1. Disease
2. Other name
3. Causative Agents
4. Diagnostic Procedure
5. Signs and Symptoms
6. Treatment
3. Chemotherapy:
1. Multiple Drug Therapy (MDT)

Purpose:

1. To prevent drug resistance against 3 combined drugs
• if sensitive to one of the drugs, stop taking the identified drug but continue the other 2
2. To shorten the duration of treatment of TB
• Minimum of 6 months
• Maximum of 12 months
3. To eradicate the organism preventing relapse
2. Short Course Chemotherapy (SCC)
1. Intensive phase-2 months: RIP
2. Maintenance phase-4 months: RI
3. Extensive phase-2 months: RI

After 6 months of SCC:

• Do sputum examination to monitor the (+) tubercle bacilli:
• If (-), discontinue
• If (+), 2 months extension of RI then sputum culture recheck
• If (+), 2 months extension again of RI, the whole steps can be repeated
• for a total of 1 year treatment (from intensive to extensive phase)
• After 8 months of SCC: do sputum examination

After 8 months of SCC: do sputum examination

• If (-), stop medicines
• If (+), continue RI for 2 months

After 12 months of SCC, do sputum examination

• If still (+), do chest x-ray to determine the infiltration of MO to the lung lobes:
1. Extensive infiltration-diagnosed as Far Advanced Pulmonary TB (FAPTB) & treated with Parenteral Streptomycin
2. Minimal infiltration-diagnosed as Minimal Pulmonary TB (MPTB) & stay with SCC Program
3. Directly Observed Treatment for Short Course Chemotherapy (DOTS)
• Liberation of the Treatment of PTB wherein treatment is domiciliary (home setting)
• DOTS was 1st introduced by WHO on 1998 in China & Indonesia where PTB was #3 as morbidity.
• In the Philippines, WHO decided to include us in the program because PTB is #5 as morbidity and was implemented from 1998-2004.
• In October 2002, a pre-evaluation was done and showed that Category I & II patients responded to DOTS Program, however, Category III patients did not respond to DOTS after 4 months of treatment.
• DOTS was not terminated in 2004 but instead a replication was made known as Tuberculosis Incentives for Private Sectors (TIPS) which was funded by United States Agency International Development (USAID) and its beneficiary is the private sector.

5 Elements of DOTS:

1. Sputum Microscopy: to rule out TB, PHN is a microscopist
2. Training & Health Education of Health Workers: PHN keeps the key to Botika & distributes SCC to registered PTB patients
3. Appropriate Funding: DOTS is funded by WHO & beneficiary is DOH
4. Recording and Reporting (R/R) for proper documentation:
5. r.a. 3753: Vital Health Statistics-PHN reports the PTB patients so that WHO will prepare the medicines for those registered & serves as baseline information
6. Chemotherapy: based on the 3 Categories of WHO

1. Preventive-immunization (BCG)
2. Case Surveillance-health education
3. Chemotherapy-isolation
4. Rehabilitative-occupational therapy where P.P. #304 dictates non-discrimination, non segregation of leprosy victims Chemotherapy depending on the Category:

1. Pauci-bacillary: non-contagious type (6-9 months)
• Tuberculoid and Intermediate
• Treatment- Rifampicin once a month Diamino-diphenyl-sulfone (DDS) or Dapsone once a day
2. Multi-bacillary: contagious type (24-30 months)
• Lepromatous and Borderline
• Treatment- Rifampicin once a month→ bactericidal DDS 100 mg once a day→ bacteriostatic Clofazimine (Lamprene) 50 mg once a day→ bacteriostatic

1. Infants
1. BCG
2. DPT---
3. OPV → 1st dose given at 6 weeks; 2nd dose given a month after the 1st
4. HBV-- dose, 3rd dose given a month after the 2nd dose
5. Measles Vaccine- 9 or 12 months and earlier at 6 months when there is epidemic
6. School Entrants at age 6
1. BCG
2. DPT---
3. OPV → 1st dose given at 6 weeks; 2nd dose given a month after the 1st
4. HBV-- dose, 3rd dose given a month after the 2nd dose
5. Measles Vaccine- 9 or 12 months and earlier at 6 months when there is epidemic
2. Compulsory Immunization of All Children with HBV before the age 8 regulated under R.A. 7846
3. Universal Mother & Child Immunization Law regulated under P.P. # 6

2 Target Population:

1. Children: Infants and School Entrants→ 7 Immunizable Diseases
2. Pregnant Women: 5 doses of Tetanus Toxoid
4. AFP Elimination Program regulated under P.P. # 1064
1. Polio Eradication Program (PEP)
2. Knock Out Polio (KOP)
3. Door to door “patak” (Feb. 2002 & Mar. 2-8 2002)
5. A.C. 63A-include HBV in EPI Program
6. A.C. 242-Hepatitis B is one of the reportable & reported to be immunizable