IMCI-INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS-1992-2 Pilot areas are in zamboanga del norte and sarangani-strategy in reducing mortality and morbidity rate caused by a common childhood illness .PneumoniaDiarrheaDengueMalariaMeaslesMalnutrition/AnemiaEar Problems

Objectives of IMCI strategies:1. To reduce death2. To reduce severity and frequency of illness disabilities3. to contribute in the improvement of growth and development of a child.

Major Components of IMCI:1.Improve case management skills of Healthcare provider2.Improving the health system to deliver IMCI3.Improving the family and the community health practice.

Target Age:1wk old age – 5y/o

Young Infant – 1 wk old - <2mos oldCommon illness/Problem:1.Possible serious bacterial Infection/ Local bacterial Infection2.Diarrhea – Dehydration3.Feeding Problems- death/low wt.

Young Child – 2 mos old – 5 y/oCommon illness:PneumoniaDiarrheaDengueMalariaMeaslesMalnutrition/AnemiaEar Problems

8 Important Guidelines base on the following Principles:***before the IMCI strategy you have to ask the mother what is the problem of the child?” IMCI case also called SICK CHILD.1. All sick children must be examined for General Danger Sign:C-onvulsion (fits,jerky movements,spasm)U-nable to drink/breast feed (unable to swallow but not unable to eat) To verify: offering a fluid or observe the mother to breastfeed her child.V-omits everything A-bnormally sleepy(difficulty to awaken,unconscious,lethargy)

2.Assess the childs main symptoms: Breathing difficulty Coughing Diarrhea Fever Ear problems

3.Assess Nutritional status Malnutrition and AnemiaAssess Immunization statusAssess vitamin A statusAssess feeding problemAssess other potential problems (ex.allergy)

4.Only a limited number of selected clinical signs are usedReadings: ASK, LOOK,LISTEN and FEELAsk: mouth; EBSA-Evidenced base syndromic approach supports the rational and effective and affordable use of drugs and diagnostic tools.It is also serve as a clinical sign.LOOK:eyesLISTEN:earsFEEL:hands

5.A combination of individual signs leads to childs classification and not for diagnosis.***classify illness is classification right!!!But identify illness is diagnosis its wrong!!

6.IMCI management procedures use limited essential drugs means low cost but high effective and we need active participation of care takes is needed.a.Antibiotics (PO,IM,APPLIED)b.Anti malarial (PO,IM)c.Anti Helmentics (PO)

7.The guidelines do not describe the management of trauma and other emergency.

8.An essential component of IMCI is counseling the caretaker about recommended treatment,feeding,play and communication skills.

DRUGS USE IN IMCI:ANTIBIOTICSPer orem/PO 1st line:Cotrimoxazole ***except in CHOLERA 1st line is tetracycline 2nd line cotrimoxazole 3rd line amoxicillin 2nd line:Amoxicillin *** except in Dysentery 1st line is cotrimoxazole 2nd lineis Nalidixic

Intramascular/IM1st line:chlorampenicol2nd line:Benzylpenicillin (Procaine penicillin)

Applied: Eyes: Tetracycline ointmentSkin, mouth and umbilicus: Gentian violetHalf strength of Gentian Violet.25% concentration1 ml GV + 3 mil distilled water

Full strength of Gentian Violet.5% concentration1 ml GV + 1ml distilled water

How to apply Gentian Violet:Mouth Ulcers/Oral trush Skin Infection Umbilical InfectionHalf strength1.Wash Hands2.Clean affecting area using soft cloth dipped in salt water3.Paint Gentian4.Wash Hands

Full strength1.Wash Hands2. Clean affecting area using soft cloth soaked in soap and water.3.Paint Gentian4.Wash Hands

Full strength1.Wash Hands2. Clean affecting area using soft cloth using 70% alcohol.3.Paint Gentian4.Wash Hands

ANTI MALARIALSPER OREM/PO1ST line: Sulfadoxine(pyrimethamine), Chloroquine, Primaquine2nd line: Arthemeter (Lumefantrine)Intramascular/IMQuinine- use for severe cases of malaria

ANTI HELMENTICSPER OREM/POAlbendazoleMebendazoleReminders in giving anti helmentics:Only 12mos age and aboveWith 6 months interval after the last deworming

STEP BY STEP PROCESS: INTEGRATED CASE MANAGEMENT PROCESS1.Assess s/s2.Classify illness: Severe- pink

Moderate – yellowMild – green

3.Identify treatment- color code treatment:Pink: referral or admission but with pre referral management or treatment in Health Center.Yellow: well enough to go home but with specific management/treatments like antibioticspo, anti malaria poGreen: well enough to go home but with simple home care or home management like safe remedies,TSB, paracetamol 4.Treat the child –the first dose of any drugs is given in health center5.Counsel the mother6.Give follow care commonly 2 days, 5 days, 14 days or 30 days.

Assess and classify the chart:use to sick child onlyChart should not use to children brought at the health center d/t immunization and emergency conditions.-for immunization use Growth Monitoring Chart -for emergency use first aid chart like trauma, injury, fracture, burn.

Good Communication skills:L-istening attentivelyU-se understandable wordsG-ive time to answer questionsA-sk additional questionsW-ag!!! Or don’t use checking question only if the counseling was done to verify.

How to treat the child in lowering of blood sugar:1.If child is able to breastfeed: Breastfeed the child2.If child is unable to breastfeed but can swallow: give 30-50cc of express breastmilk or sugar water by mouth.Sugar water = 4 tsp sugar in 200cc of water3.I child is unable to Breastfeed and unable to swallow but conscious: give 50 ml express breastmilk or sugar water through NGT.4. I child is unable to Breastfeed and unable to swallow but unconscious:Insert IVF (d10w-KVO)

PNEUMONIA2 Common virus:1.Streptoccocus Pneumoniae2.Haemophilus InfluenzaeP-neumoniaB-ronchitisA-sthmaP-ertussisO-her upper and LRI ProgramExcept TB bec of separate program: NTCP or National Tuberculosis Control ProgramAn d DOTS or tutok gamutan is their treatments partners or strategies***review for CARIMain Focus: To reduce Mortality rate through early detectionContributory factors:Mainor priority factor:Mother’s failure to recognized s/s of pneumoniaIndescriminate use of antibioticsNot standardized management to pneumonia by HC providers.Primary Role:-to reduce morbidity d/t pneumonia-teaching the parents and also the community members on how to recognize s/s of pneumonia.Important responsibility of CHN-prevention of unnecessary deaths d/t pneumonia-probation of careful assessment

PNEUMONIA PINK YELLOW GREENAssess:1.acute - <30 days chronic- >30 days

2.Count RR for FB <2mos =602 mos – 12 mos =5012 mos – 5 y/o =40

3.Look for chest Indrawing – IN-IN-IN-when the lower chest wall goes IN during breaths IN lead to INdrawing d/t stiffness of lungs

4.Look for Stridor-harsh noise during breaths in.severe pneumonia but ifWheezing- harsh noise during breaths out is for asthma

Severe Pneumonia or Very Severe Disease

Signs & Symptoms:Any of theseC-onvulsionU-nable to drinkV-omittingA-bnormally sleepC-hest IndrawingS-tridor

Treatment:Pre referral….1.1st dose of antibioticGive Vitamin A<6mos -50,000 IU6 mos-12mos-100,000 IU blue12 mos-5y/o -200,000 IU red3.Treat child to prevent lowering of blood sugar.4.REFER!!!

Pneumonia

Signs & symptoms:(+) Fast Breathing

Treatment:1.Give 5 days of antibioticCotri BIDAmox TID2.Give safe remediesTamarind juiceLuya juiceCalamansi juice***never give antitussive because of sedative effect like decongestant,mucolytic,cough syrup.3.Advise to return immediately4.follow up 2 daysRe-assessment:1.CUVACS is (+) the REFER2.same FB- change antibiotic3.im improving-continue

No Pneumonia

Signs & symptoms:Cough/Colds

Treatment:1.Give safe remediesTLC Juice2.Advise when to return3.follow up 5 days.

DENGUE-By temperature: Axilla-37.5 C Rectal- 38 C-By touch/feel: abdomen or axilla (warm to touch or feels hot)-By history within 72 hours or 2-3 days fever

Dengue celebrated every juneMOT: bite of a mosquitoSources of Infection: Aedes AegyptiCharacteristic: Tiger mosquito because of white patches at the legs and back.D-ay bitingL-ow flyingS-tagnant waterU-rban areasImportant responsibilities of a CHN-Explaining to individual-Family and Community the Nature of the disease and its causation.

DENGUE PINK YELLOW GREENAssess:1.Travel, living or visit dengue endemic area?If YES!!!

Checking Capilliary Refill:1.apply 2 sec pressure on the nailbed.

2.Then release.

3.If it takes < 3sec adequate but if >3seconds means (+)circulatory failure

Reminders!!!1.truly (+) signs of dengue:Increase bleeding timeIncrease hct countDecrease platelet count

2.Immediate control of bleeding by:-keeping the patient at rest.

3.To determine shock: vital signs

SEVERE DENGUE HEMORRHAGIC FEVERS/SB-leedingC-old clammyC-appiliary refillA-bdominal pain persistentP-ersistent headacheP-ersistent vomitingP-ositive tourniquet testS-kin petichae >20TREATMENT:

1.Rapid Fluid Replacement-the most important tx.a.PlanC if child has any of the ffng signs:BCC give IVF

b.PlanB if child has any of the ffng signs:APPPS give ORS

2.Give Paracetamol w/o aspirin if temp is 38.5 C

3. Treat child to prevent lowering of blood sugar.

4.REFER!!!

FEVER:DENGUE UNLIKELY

S/SFever only

TREATMENT:

1.Give paracetamol w/o aspirin or TSB only

2.Advise when to return immediately.

DIARRHEA-occurs when stool contains more water than normal-consistensy of stool: watery loose stool.-frequency of bowel movement: 3 or more within a day-Clinical Manifestation: 3 or more of loose/watery stool within a day according to WHO and DOH.Program:CDD (Control of diarrheal disease) Main objective:to reduce mortality rate d/t diarrhea among children 5years of age through extensive care management.Extensive care management: Oresol rehydration TherapyORS:1.oresol pocket/hydrite 2.home made ORS 3. AM- Rice water

DIARRHEA PINK YELLOW GREENAssess:1.For how long?Acute <14 daysPersistent >14 days

2.Blood on stool?

3.Assess signs of Dehydration/DHN

***1st sign of DHNThirs,irritable and drinks eagerly

SEVERE DHNS/SC-T-E-S-T2 signs of DHN or above

TREATMENT:PLAN C1.IVF=D5LRExemption to the rule if no other severe disease and availability of resources.2. REFER!!!

SOME DHNS/SC-T-E-S-T1pink and other signs of yellow or above.TREATMENT:PLAN B1.Give ORS every 4 hours(wt by kg) x 75 = #cc <4mos = <4004mos-1y/o= 400-7001y/o-2y/o = 700-9002y/o-5y/o = >9004-1-2-5-4-7-9***after 4 hrs re-assess the child:Severe=plan C and refer!!!Same=repeat plan BNo DHN=shift to plan A2. 4 home rule managementa. continue feeding/BFb. give extra fluid(juices,soup)c.give zinc supplemet(10-14 days)d.Instruct the mother to s/s to know when to return the child3.Follow up 5 days

NO DHNS/SC-T-E-S-T

TREATMENT:PLAN A1.ORS given1wk old-2y/o=50cc-100cc2y/o-5y/o=100cc-200cc2. 4home rule mgt3.follow up 5 days

REMINDERS IN ORS!!!a.severe vomits- stop ORS then start IVFb.Mild Vomits – Stop ORS in 10 mins then continue slowlyc.Puffiness of eyelids – means overhydration give 1 milk or 1 glass of water.

SEVERE PERSISTENT (YC&YI)2 or more signs of DHN1.PLAN C (Same exemption)2. Vitamin A is given

PERSISTENT (YC)No signs of DHN1.Give Vit.A2.Proper feeding recommendationIf still BF:a.frequent BF day and nightIf milk supplement:a.replace milk supplement to breast milk.b.replace half of the milk with nutrient rich semi solid food.c.do not use condense or evaporated milk.3.Follow up 5 days

DYSENTERY (YI)No exemption referral is needed!!!

DYSENTERY (YC)1.5 days antibiotic1st line:Cotrimoxazole2nd line:nalidixic

2.follow up 2 days

C-T-E-S-T PINK YELLOW GREENC-ONDITION

T-ONGUE

E-YES

S-KIN

T-HIRST

ABNORMALLY SLEEP

VERY DRY

SUNKEN EYES

VERY SLOWLY> 2secondsDRINKS POORLY

RESTLESS/IRRITABLE

DRY

SUNKEN EYES

SLOWLY<2secondsDRINKS EAGERLY

WELL AND ALERT

MOIST

NORMAL EYES

QUICKLY1seconds or less thanDRINKS NORMALLY

How To Pinch in Abdomen:1.Lying on his back/supine2.use thumb and 1st finger3.do not use fingertips4.Location:halfway between umbilicus & side of abdomen.

Home made Oresol:– 1L of water 1 tsp salt 8 tsp sugar -1 glass of water 1pinch salt 2 tsp of sugar

Preventive measure:a. Breast feeding-effective and practical way.-Breastmilk includeLactalbumin(for easily digestion)b.Handwashingc.Measles vaccine that can reduce incidence of diarrhea to children.

Malaria-2 category: Malaria risk and non malaria riskProvinces with Malaria situation:Category A-no significant improvement in malaria case in the last 10 years.Category B-has improvement in the last 5 years.Category C-with significant reduction in malaria cases in the last 5 years.Category D- malaria free but still potentially malarious

Malaria Risk PINK YELLOW GREENAssess :1.Travel,visit or living?YES!!!

***Reminders 1.In giving Quinine:-use tuberculine syringe.2, .3, .7-s/e:dizziness or hypotension or sudden drop of BP-IM only never IV-Mgt: lying down for 1 hour if dizziness occur.

2.How to check stiff neck?-tickle his toe or umbilicus-shine flashlight on his toes or umbilicus.(+)pain – stiffneck(-)pain – no stiff neck-last option:Lie child on his back then flex his head toward chest.

3.Side effects of oral anti malarials-chloroquine-itchiness

Very severe febrile disease:Malarias/s:any of theseC-onvulsionU-nable to drinkV-omittingA-bnormally sleepS-tiff neck/Nuchal rigidity

treatment:a.Give IM quinineb.Give 1st dose of antibiotic because of prone infection.c.give paracetamol if with 38.5 C tempd.treat the child to prevent lowering of blood sugare.REFER!!!

Malaria

s/s:(+)Blood stream(-)runny nose(-)measles(-)other infection that may cause fever like wounds….

treatment:a.give antimalarial per orem: 1ST line:Sulfadoxine(pyrimethamine), Chloroquine, Primaquine2nd line: Arthemeter (Lumefantrine)b.give paracetamol or TSB onlyc.Advise when to return immediately.d.follow up 2 days.

Fever:malaria unlikely

s/s:(-)Blood stream(+)runny nose(+)measles(+)other infection that may cause fever like wounds….

treatment: a.give paracetamol or TSB onlyb.advise when to return immediatelyc.follow up 2 days

No Malaria Risk PINK YELLOW GREEN1.Travel,visit or living?NO!!!

.

Very severe febrile dses/s:any of theseC-onvulsionU-nable to drinkV-omittingA-bnormally sleepS-tiff neck/Nuchal rigidity

treatment:a.Give 1st dose of antibiotic because of prone infection.b.give paracetamol if with 38.5 C tempc.treat the child to prevent lowering of blood sugard.REFER!!!

Fever:no malarias/s: (+)runny nose(+)measles(+)other infection that may cause fever like wounds….

treatment: a.give paracetamol or TSB onlyb.advise when to return immediatelyc.follow up 2 days

MEASLES PINK YELLOW YELLOW GREENAssess:(+)fever and (+)generalize rashesIn addition to any of these:(+)Coughing(+)Runny nose(+)Red eyes

Severe complicated measless/s:C-U-V-A(+)cloudy cornea d/t severe vitamin A deficiency(+)mouth ulcer with deep or extensive mouth ulcers.

treatment:1.give vit.A2.give 1st dose of antibiotic3.Apply tetracycline ointment both eyes if with eye complication4.REFER!!!

Measles w/ eye complications/s:pus draining on eyes

treatment:1.give vit.A2. apply tetracycline ointment both eyes TID until redness or pus is gone3.Follow up 2 days

Measles w/ mouth complications/s:(+)mouth ulcer but not deep & non extensive

treatment:1.give vit.A2.apply gentian violet half strength on mouth BID3.follow up 2 days

Measles

s/s:same in assessment

treatment:1.give vit.A

MEASLES

EAR PROBLEM/ INFECTION

EAR PROBLEM PINK YELLOW YELLOW GREENAssess:1.Ear pain? (irritability,rubbing or tagging his ear)

2.ear discharges?If yes how long?<14 days- acute> 14 days- chronic

3.is there any swelling behind the ear?

Mastoiditis

s/s:-Tender swelling behind the ear

treatment:a.give 1st dose of antibioticb.if with pain give paracetamol c.REFER!!!

Acute ear infection/Acute otitis medias/s:-<14 days ear discharges or ear pain

treatment:a.give 5 days antibioticb.Dry the ear by wiching.c.follow up 5 days

Chronic ear infection/ chronic otitis medias/s:->14 days ear discharges or ear pain

treatment:a.Dry the ear by wiching.b.follow up 5 days

No ear Infection

s/s:-no ear problem proceed to next assessment in IMCI guidelines

treatment:a.no treatment needed

SUMMARY OF FOLLOW UP CARE

AFTER 2 DAYS AFTER 5 DAYS AFTER 14 DAYS AFTER 30 DAYSPneumoniaDysenteryMalariaMeasles with eye/mouth complicationsFever:dengue unlikelyFever:Malaria unlikelyFever:No malaria

Persistent diarrheaFeeding problemsSome/no DHNChronic ear infectionAcute ear infectionNo pneumonia

Anemia Very low wt.

Check Nutritional Status:

Nutritional Status PINK YELLOW GREENAssess:-wt if appropriate to childs age.

On the curve-appropriate wt according to age

Above the curve-appropriate wt according to age

Below the buttom curve-below normal wt accdg to age

Severe Malnutritions/s:Marasmus-visible severe wasting-skinny & bonny type-baggy pants on buttocksKwashiorkor-moonface-edema on both feet-simply known as “jollibee”treatment:1.Give vitamin A to increase immune system.2.REFER!!!!

Very low wts/s:below the bottom curve in wt by agetreatment:1.assess childs feeding2.immediate counsel the mother about the recommended feeding3.Give Vitamin A4.follow up 30 days

Not very low wts/s:on or above the bottom curve in wt by agetreatment:1.assess childs feeding to children below 2y/o2.counsel the mother that the high incidence of malnutrition and anemia starts from 6mos upto 2years of age

PINK YELLOW GREENAsses:-palm of hand

Severe Anemias/s:-severe palmar pallor or white paper palmtreatment:1.Give vitamin A to increase immune system.2.REFER!!!!

Anemias/s:-some palmar pallortreatment:1.give 14 days iron2.give anti helmentics with reminders.3.follow up 14 days

No anemiano s/s proceed to next assessment in IMCI guidelinestreatment:same in not very low wt.

Check immunization status:Immunization OLD NEWAt birth BCG BCG,HEPA B1

6wks old DPT 1, OPV1, HEPA B1 DPT 1, OPV1, HEPA B2

10wks old DPT 2, OPV2, HEPA B2 DPT 1, OPV1,

14wks old DPT 3, OPV3, HEPA B3 DPT 1, OPV1, HEPA B3

9mos old Measles Measles

Contraindications in giving vaccine:1. Do not immunize a child that is candidate for referral2. Do not give life attenuated vaccine to an immunocompromise child such as: symptomatic AIDS/HIV 3. Do not give DPT if the child has a history of recurrent convulsion. Because of the P instead give DT

vaccines that are available in private clinic.4. Do not give DPT 2 & DPT 3 if the child had convulsion within 3 days after previous dose was given. Again

that is because of the P instead give DT vaccine that are available in private clinic.

Reminders!!!1. A child with diarrhea who is due for OPV should receive a dose of OPV but it is not counted.

Example: baby jane visited health center to receive OPV1 but she is (+) for diarrhea. What will the nurse do? You may still give the OPV1 vaccine to jane but her visit is not counted, after 4 wks baby jane has no diarrhea so the nurse will give OPV1 to baby jane because her 1st visit is not counted due to her diarrhea.

2. If only one child at the health center needs immunization, you may do so open vial vaccine and give it to the child because of the principle. ”life before resources”

Open vaccines should be discarded after:4-6 hours for BCG and Measles8 hours(duty hours) for DPT,OPV,Hepa B and TT

You may keep open vials of OPV for the next immunization if:a. The expiry date has not yet passed.b. Vaccine stores at 0-8 degree Celsius.

c. And must not taken out of the health center for outreach activitiesd. No changes in color (VVM) vaccine vial monitor a device to determine color in vial.

CLASSIFICATIONS NEEDING VITAMIN A:1. Severe Pneumonia2. Severe persistent diarrhea3. Persistent diarrhea4. Severe complicated measles5. Measles with eye or mouth complications6. Measles7. Severe malnutrition8. Severe anemia9. Very low wt.

CHECK FEEDING PROBLEMS:

BABY A BABY BAt birth – 6 mos old-exclusive BF-8-12x BF within 24 hours

At birth – 4 mos old-exclusive BF-8-12x BF within 24 hours4 mos – 6 mos old-BF + once a day or 2x a day complementary foods if child shows: a. interest to semi solid foodb.appears hungry after BFc.not gaining weight appropriately

6 mos – 12 mos old-BF + complementary foods 3x a day-if no BF complementary foods 5x a day

6 mos – 12 mos old-BF + complementary foods 3x a day-if no BF complementary foods 5x a day

12 mos – 2 y/o- BF + complementary foods 5x a day-if no BF complementary foods 5x a day

12 mos – 2 y/o- BF + complementary foods 5x a day-if no BF complementary foods 5x a day

2y/o and above-5x a day family food

2y/o and above-5x a day family food

BREASTMILK:1.it contains the ffng:Macronutrients: LactoseProteinsfats

Micronutrients:Vit. AVit.CIron

MineralsAntibodies igA

2.Milk formula should be given through cups or spoon and never bottle.3.Complementary foods must be energy rich,nutrient rich,locally affordable. Like mashed potato,bananansquash,tokwa,egg,bulanglang,lugaw rcipes are: pulverize dilis,mongo or shrimp for protein,iodized salt for iodine and malungay or horse radish for iron.4.Signs of hunger:a. beginninng to fussb.sucking of thumb or fistc. movements of lips

YOUNG INFANT COMMON ILLNESS/PROBLEMS

POSSIBLE SERIOUS BACTERIAL INFECTION (PINK)

LOCAL BACTERIAL INFECTION (YELLOW)

REMINDERS!

Danger sign C-U-A no voitsF-ever Axilla:37.5 C Rectal:38 C if hyperthermia If hypothermia Axilla:35.5 C Rectal: 36 C belowF-ast breathing RR=60bpmU-mbilical cord redness (extended upto near skin)N-asal FlaringC-hest indrawing severe in characteristicE-ar pus or dischargesS-kin pustules (severe and many)B-ulging Fontanels

TREATMENT:a.give 1st dose of antibiotic IMgentamycin IM and benzylpenicillinb.keep infant warmc.treat infant to prevent low blood sugard.REFER!!!

-Umbilical redness or pus-skin pustules

TREATMENT:a.give 5 days oral antibiotics POb.treat the local infection appy gentian violet in affected areac.follow up 2 daysRe assessment after 2 days…If pus or redness remains:refer!!!If pus or redness worse:refer!!!If pus or redness improves: continue antibiotic

a.In assessing chest indrawing,nasal flaring,fast breathing the infant must be calm.b.avoid cotrimoxazole to young infant < 1 month old age,premature and with jaundice because of premature liver but you may give the 2nd line of antibiotic.c.if RR on the first count is 60bpm repeat again.d.If thermometer is not available, touch or feel the axilla or abdomen.

Nasal Flaring-widening of nostrils during breaths in.

Grunting-soft,short sound of a young infant during breaths out.

FEEDING PROBLEMS:

POSSIBLE SERIOUS BACTERIAL INFECTION (PINK)

FEEDING PROBLEM (YELLOW) REMINDERS!

-not able to feed-no sucking at all-no attachment at all in mother’s breast.TREATMENT:a.give 1st dose of antibiotic IMgentamycin IM and benzylpenicillinb.keep infant warmc.treat infant to prevent low blood sugard.REFER!!!

-receives other foods and fluids-<8x BF within 24 hrs-oral trash-not sucking effectively-not well attach on mothers breast

TREATMENT:-counsel the mother to reduce other food and increase BF -8-12x BF within 24 hours-applied antibiotic with gentian violet half strength-teach the mother regarding correct position/attachment

NO FEEDING PROBLEM(GREEN)

3 signs of good sucking:a.slow suckingb.deep suckingc.with some pausing4 signs of good attachment:a.chin touching the breastb.mouth widely open alwaysc.lower lip turns outwardd.more areola visible above the below part.Correct attachment:a.touch infants lip with her nippleb.wait unti the infants mouth is opening widelyc.move her infant quickly onto her breast.Correct positioning:a.show the mother how to hold her infantb.with the infants head and body straightc.facing her breast,with infants nose opposite to her nippled.hold infants wholebody,not just neck and shouldere.infants body close to her body

CO-PAR COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH(Book of MAGLAYA)

COMMUNITY ORGANIZING -CO PARTICIPATORY ACTION RESEARCH - PARCommunity organizing-process by which health services,agencies and peoples of the community are brought together to:-identify their own problem-plan activities-act on this basis-evaluate activitiesCO emphasis: strengthening the community members in the capability of problem solving and decision making skills.(necessary for the self reliant development)CO main objectives/aims: 1.Transform the PULUVI into SUPER ACTIVE community.

P-assiveU-nresponsiveL-azyU-nderservedV-oiceless, poorI-ndividualistic

S-ystematic ( APIE)U-nitedP-articipativeE-nergeticR-esponsiveA-ctive

2.CO process plays the role of community organizer3.The person who mobilizes I-F-C4.to come together in unity and5.collectively address a given issue,need or problemRoles and Responsibility of a CHNMGA CHN ROLES:M-anagerG-uideA-dovacate

C-ounselor,coordinator,change agentH-ealth care providerN-urse trainer

R-esearcherO-rganizerL-eaderE-ducator*primary roleS-upervisor of midwife

Participatory action research-an investigation-on problems and issues of the community-by way of research-representatives of the community participate in the actual research-act as researcher themselves,doing research of their own problem-essential element of PAR is the”PARTICIPATION”PAR Objectives:1.To encourage consciousness(aware) of the suffering2.To empower people to determine the cause of their problem3.To analyze this problems4.To develop competence for changing their own situation5.To act by themselves in responding to their own problem.Ideal Participatory research process involves the community in all research aspects:1.Identification of research problem2.Formulation of research design3.Data Gathering4.Data analysis5.Data presentation6.Planning7.Action/MobiliztaionPAR involves REAR-esearchE-ducationA-ction

Phases in Organizing Community“POTIP”P-reparatory phaseO-rganizational phaseT-raining/educational phaseI-ntersectoral/collaborative phaseP-hase out

Phases in Organizing Community=“POTIP”PREPARATORY PHASE

Pre entry EntryA.area selectioncriteria in selecting community-site must be depressed/poor and underserved-area must not have a serious peace and order problem-willingness to be organized-needing health assistance-counterpart of the community (support commitment and resources)-accesible to transportation and communicationB.Communkty Profiling-Identify Contact person-Gather overview of the demographic characteristics and health services or facilities of the community.

A.Community Integration(establishing rappor & imbile their community life)-courtesy call to barangay captain:considered as the father of the community.-Immerse yourself/live with them-Reside on the designated area main objective:to gain trust and cooperation.Guidelines in conducting Integration work:1.Recognize the role and position of local authorities.2.choose a modest center dwelling which the people will not hesitate to enter.3.Make house calls (home visit)and seek out people where they usually gather.4.Participate in some social activities.

5.Avoid raising expectations of the people.Be clear with your objectives and limitations.

ORGANIZATIONAL PHASESocial preparation Spotting & developing

potential leadersCore group formation Setting up community org

or committee-continously learning more about the conditions of the community.-Main Objectives: to deepen and strengthen ties with the community

-person who have deep concern and understanding on the conditions of the communityCHARACTERISTICS OF A POTENTIAL LEADERS:1.respected of community members2.has wide influence to elite & poor community members.3.responsible & committed.4.has good communication skills.5.willing to work for a desired change.

-core group consist of the identified potential leaders.-Main role:represents the different sectors of the community like:-Elder sector-Youth sector-Children sector-Handicapped sector-Fisherman/farmer sector-Women sector-Livelihood sector-Health sector

-when all sectoral organization have been put up.-This organization will facilitate wider participation and collective action on community problems.

TRAINING/EDUCATIONAL PHASE-To strengthen the organization and develop its capability to attend the community basic healthcare needs.Conducting Community diagnosis

Health Services and mobilization of resources

Leadership-formation activities

Training of community health workers

-done to come up with the profile of the community needs, issues and problems.-Social Investigations is collecting collating, analyzing & understanding data to draw a clear picture of the community.-known as the community study.2 types of community Dx:1.comprehensive community diagnosis:aims to obtain general information about the community2.Problem oriented community diagnosis-particular need-particular group

-actual exercises of people power and confidence.

-constant meetings-different activities (APIE)-team building exercises to enhance cohesiveness

- village or grassroot workers lik BHW,hilot-Conduct training needs assessment (TNA)-to determine the level of health skills and knowledge the trainees possess.-result of the assessment serves as basis for the health skills training and curriculum.

INTERSECTORAL/ COLLABORATION PHASE:-Facilitate and collaborate with:-Institution-Agencies-Other key people-Articulate the communities for support and assistance

PHASE OUT-After 5 years of activities the nurse gradually prepares for:

a. Turnover of workb. Develops a plan for monitoring or action planc. Subsequent follow up of the organizations activities

When to phase out:a. Objectives have been attained.b. Impact of the project has become visible or change has been made.c. Community members can take over the APIE of the projectd. Community resources can already be maximize by the peoplee. Community base organization has been established

Phase of strategy 1. Impact assessment

URBAN- rapid urban appraisalRURAL- rapid rural appraisal

2. Phase out action plan3. Gradual pull out of intervention4. Institutionalization of the community organization with other agencies who provided support of

(SEC) security exchange committee.5. Provision of consultancy services.

Critical steps in building people’s organization1. Integration2. Social Investigation3. Tentative program planning4. Groundwork-going around motivating/inviting people in a one on one basis5. Meeting-present of needs and problem and their opinion with their decision about it.6. Role Playing – meansto act out on the meeting7. Action/mobilization-Implementation of the role played8. Evaluation-to review the success and failure of activities9. Reflection-they talk about what happen10. Organization

EPIDEMIOLOGY:- Study on disease occurrence or distribution- Backbone on disease prevention

Endemic- constant and always presentSporadic- occasional, irregularEpidemic – sudden increase or in excess of “expected level”

- outbreakPandemic – worldwide distribution

DEMOGRAPHY:- Study on human population size, distribution & composition

Census-complete enumeration of the population

2 ways of assigning people:1.DeJure- people were assigned to the place where they usually live regardless of where they are at the time of census.-bilang sila kahit wala sa bahay.

2.Defacto-people were assigned to the place where they are physically, present at the time of census regardless of their usual place of residence.-kapag present ka sa loob ng bahay kahit di ka nakatira don kasama ka sa bilang ng census.

VITAL HEALTH STATISTICS- Study on vital events such as birth, death, illness or disease.

Roles/responsibility of CHN:C-ollect dataA-nalyze dataT-abulate dataE-valuate dataR-ecommended programs

Formula: