Family Health PDF

FAMILY HEALTH Prepared By: Olivia V. Nielsen, RN MAN ( C ) Objectives: At the end of the lecture-discussion, the students will be able to: 1. Define family. 2. Define health. 3. Discuss the task of the Family Health Office. 4. Define violence against women and children (VAWC). 5. D...

FAMILY HEALTH Prepared By: Olivia V. Nielsen, RN MAN ( C ) Objectives: At the end of the lecture-discussion, the students will be able to: 1. Define family. 2. Define health. 3. Discuss the task of the Family Health Office. 4. Define violence against women and children (VAWC). 5. Discuss the different acts committed by person which is included in violence against women and children. 6. Define newborn screening. 7. Discuss the importance of newborn screening. FAMILY HEALTH Family-defined as the basic unit of the society. Health- defined as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO).  The Family Health Office is tasked to operationalize health programs geared towards the health of the family.It is concerned with the health of the mother and the unborn, the newborn, infant, child, the adolescent and youth, the adult men and women and older persons.  Family Health Office aims to: 1. Improve the survival, health and well being of mothers and the unborn through a package of services for the pre-pregnancy, prenatal, natal and postnatal stages. 2. Reduce morbidity and mortality rates for children 0- 9 years. 3. Reduce mortality from preventable causes among adolescents and young people. 4. Reduce morbidity and mortality among Filipino adults and improve their quality of life 5. Reduce mortality and morbidity of older persons and improve their quality of life. Programs Under Family Health: 1. Maternal Health Program 2. The Family Planning Program 3. The Child Health Programs (Newborns, Infants and Children) a. Infant and Young Child feeding b. Newborn Screening c. EPI d. Management of Childhood Illnesses e. Micronutrient Supplementation f. Dental Health g. Early Child Development 4. Nutrition Program 5. Oral Health Program 6. The Adolescent Health program 7. The Adult Men 8. The adult Women 9. The Older Person THE MATERNAL HEALTH PROGRAM  The Philippines is tasked to reduce maternal mortality ratio (MMR) by three quarters by 2015 to achieve its milllenium development goal.  This means a MMR of 112/100,00o live births in 2010 and 80/100,00 live births by 2015.  The underlying causes of maternal deaths are delays in actions: delay in seeking health care, delay in making referral and delay in providing appropriate medical management.  Other factors that contribute to maternal deaths includes closely spaced births, frequent pregnancies, poor detection and management of high-risk pregnancies, poor access to health facilities brought about by geographic distance and cost of transportation, and as well health care and health staff who lack competence in handling obstetrical emergencies.  The overall goal of the program is to improve the survival, health and well being of mothers and the unborn through a package of services for the pre- pregnancy, prenatal, natal and postnatal stages. ESSENTIAL HEALTH SERVICE PACKAGES AVAILABLE IN THE HEALTH CARE FACILITIES: a. Antenatal Registration b. Tetanus Toxoid Immunization c. Micronutrient supplementation d. Treatment of Diseases and Other Conditions e. Clean and Safe Delivery  A. Antenatal Registration Prenatal Visits Period of Pregnancy 1st Visit As early in pregnancy as possible before four months or during the first trimester 2nd Visit During the 2nd trimester 3rd Visit During the 3rd trimester Every 2 weeks After 8th month of pregnancy till delivery B. Tetanus Toxoid Immunization  Protects mother and child against tetanus and noenatal tetanus.  A series of 2 doses of Tetanus Toxoid vaccination must be received by a woman one month before delivery to protect baby from neonatal tetanus  The 3 booster dose shots to complete the 5 doses following the recommended schedule provides full protection for both mother and child  The mother then is called as a “fully immunized mother” (FIM).  Minimum Percent Vaccine Duration of Protection Age/Interval Protected As early as possible TT1 -- -- during pregnancy infants born to the mother will be protected from TT2 At least 4 weeks later 80% neonatal tetanus gives 3 years protection for the mother infants born to the mother will be protected from At least 6 months TT3 95% neonatal tetanus later gives 5 years protection for the mother infants born to the mother will be protected from TT4 At least 1 year later 99% neonatal tetanus gives 10 years protection for the mother gives lifetime protection for the mother TT5 At least 1 year later 99% all infants born to that  C. Micronutrient Supplementation  Micronutrient supplementation is vital for pregnant women. These are necessary to prevent anemia, vitamin A deficiency and other nutritional disorders. They are: VItamins Dose Schedule of Giving Remarks Vitamin A 10,000 IU Twice a week starting Do not give Vit. A on the 4th month of supplementation pregnancy before the 4th month of pregnancy. It might cause congenital problems in the baby. Iron 60mg/400 ug tablet daily  D. Treatment of Diseases and Other Conditions Conditions/Diseases What to do Do not give Diffficulty of breathing/ Clear airway obstruction of airway Place in her best position Refer woman to hospital with EmOC capabilities Unconscious Keep on her back arms at Do not give Oral the side Rehydration Solution to a Tilt head backwards woman who is unconscious (unless truama is suspected) or has convultions Lift chin to open airway Do not give IVF if you are Clear secretions from throat not trained to do so Give IVF to prevent or correct shock Monitor blood pressure, pulse and shortness of breath every 15 minutes Conditions/diseases What to do Do not give Intestinal parasite infection Give mebendazole 500mg Do not give mebendazole in tablet single dose anytime the first 1-3 months of from 4-9 months of pregnancy. This might cause pregnancy if none was given congenital problems in baby. in the past 6 months Malaria Give sulfadoxin- pyrimethamine to women from malaria endemic areas who are in 1st or 2nd pregnancy, 500mg -25mg tab, 3 tabs at the beginning of 2nd to 3rd tri semesters not less than one month interval E. Clean and Safe Delivery  The presence of a skilled birth attendant will ensure hygiene during labor and delivery. It may also provide safe and non-traumatic care, recognize complications and also manage and refer the woman to a higher level of care when necessary.The necessary steps to follow during labor, childbirth and immediate post partum include the following: 1. Do a quick check upon admission for emergency signs:  Unconscious/convulsion  Vaginal bleeding  Severe abdominal pain  Looks very ill  Severe headache with visual disturbance  Severe breathing difficulty  Fever severe vomiting 2. Make the woman comfortable 3. Assess the woman in labor  Do history taking:  LMP  Number of pregnancy  Start of labor pains  Age/height  Danger signs of pregnancy 4. Determine the stage of labor 5. Decide if the woman can safely deliver 6. Give supportive care throughout the labor  There are many things that a woman needs to do during labor. This will help her deliver clean, safe and free from fatigue. These are:  Encourage to take a bath at the onset of labor  Encourage to drink but not to eat as this may interfer surgery in case needed  Encourage to empty bladder and bowels to facilitate delivery of the baby. Remind to empty bladder every 2 hours  Encourage to do breathing technique to help energy in pushing baby out the vagina. Panting can be done by breathing with open mouth with 2 short breaths followed by long breath. This prevent pushing at the end of the first stage. 7. Monitor and manage labor 8. Monitor closely within one hour after delivery and give supportive care 9. Continue care after one hour postpartum. Keep watch closely for at least 2 hours 10. Educate and counsel on FP and provide FP method if available and decision was made by the woman. 11. Inform, teach and counsel the woman on important MCH messages:  Birth registration  Importance of BF  Newborn screening for babies delivered in RHU or at home within 48 hours up to 2 weeks after birth  Schedule when to return for consultation for post partum visits Recommended Schedule of Post Partum Care Visits: 1st Visit 1st week post partum preferably 3-5 days 2nd Visit 6 weeks post partum F. Support to Breast feeding G. Family Planning Counselling  Birth spacing of 3 to 5 years interval will help completely recover the health of a mother from previous pregnancy and childbirth. The risks of complications increases after the second birth. THE FAMILY PLANNING Goal: To provide universal access to family planning information and services wherever and whenever these are needed. Aim: 1. Reduce infant deaths 2. Neonatal deaths 3. Under-five deaths 4. Maternal deaths THE CHILD HEALTH PROGRAMS (NEWBORNS, INFANTS AND CHILDREN) Newborns , infants and children are vulnerable age group for common childhood diseases. The risk of infection among children is higher when not screened for metabolic disorder, not exclusively breastfed, unvaccinated, not properly managed when sick, not given with vitamin supplementation and many others. To address problems, child health programs heve been created and available in all health facilities which includes: a. Infant and Young Child feeding b. Newborn Screening c. EPI d. Management of Childhood Illnesses e. Micronutrient Supplementation f. Dental Health g. Early Child Development h. Child health Injuries Goal: To reduce morbidity and mortality rates for children 0-9 years with the strategies necessary for program implementation. Laws That Protects Infant and Young Child Feeding 1. Milk Code (EO 51) 2. The Rooming-In and Breastfeeding Act of 1992 -Mother Baby Friendly Hospital 3. Food Fortification Law (RA 8976) or An Act Establishing the Philippine Food Fortification Program and for Other Purposes -declares a policy that food fortification is vital due to processing and/ or storahe of food. EXPANDED PROGRAM ON IMMUNIZATION The EPI Target disease: 1. Tuberculosis 2. Diptheria 3. Pertussis 4. Tetanus 5. Poliomyelitis 6. Measles 7. Hepatitis  EPI schedule on immunization:  Every Wednesday=Immunization day (country)  Monthly=Barangay Health Station  Quarterly=far flung areas  Routine immunization schedule for Infants:  Fully Immunized child= receives one dose of BCG, 3 dose of OPV, 3 dose of DPT, 3 doses of HB and one dose of measles before child’s first birthday.  Minimu Minimu m m Age Number Vaccine Dose Interval Route Site Reason at 1st of Doses Between Dose Doses BCG given at earliest possible age protects the Right possibility Birth or Bacillus deltoid of TB anytime Intrader Calmette 1 0.05 mL -- region meningitis after mal -Guérin of the and other birth arm TB infections in which infants are prone[ Diphthe Upper ria- An early start outer Pertussi Intram with DPT reduces 6 weeks 3 0.5 mL 4 weeks portion s- uscular the chance of of the Tetanus severe pertussis. thigh Vaccine The extent of protection against polio is increased Oral 2-3 the earlier the OPV Polio 6 weeks 3 4 weeks Oral Mouth drops is given. Vaccine Keeps the Philippines polio- free.  An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a carrier. 6 weeks Prevents liver interval cirrhosis and from Upper liver cancer 1st dose to Hepatiti Intra outer which are more 2nd dose, sB At birth 3 0.5 mL musc portion likely to 8 weeks Vaccine ular of the develop if interval thigh infected with from Hepatitis B 2nd dose to early in life. third dose. About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B infection.  At least 85% of measles can be prevente d by immuni zation at this age. Prevents Upper Measles death outer Vaccine 9 Subcuta (2% die), 1 0.5 mL -- portion (not months neous malnutr of the MMR) ition, arms pneumo nia, diarrhea (at least 20%) get these complic ations from measles. MANAGEMENT OF CHILDHOOD ILLNESS Methods in Managing Childhood Illness: a. Assess the patient-history taking (asking ,observing) b. Classify the disease-mild, moderate and severe c. Treat the patient d. Counsel the patient-provide health education NUTRITION PROGRAM Goal: To improve quality of life of Filipinos through better nutrition, improve health and increased productivity. Programs and Projects: 1. Micronutrient Supplementation a. Vitamin A capsules-2x a year through the “Araw ng Sangkap Pinoy”(ASAP), known as Garantisadong Pambata (GP), or Child Health Week. 2. Food fortification -Sangkap Pinoy Seal (flour with Vit. A, cooking oil and refine sugar with Vit. A, rice with iron) -Utilization of iodized salt (IDD) 3. Essential Maternal and Child Health Service Package -Breastfeeding -Complimentary feeding -Micro nutrient supplementation 4. N utrition information, communication and education 5. Home, School and Community Food Production -Establishments of kitchens, gardens in homes, schools and in communities in urban and rural areas to serve as source of additional food for the home 6. Food Assistance -Rice distribution in school by the local units -Tindahan Natin Program-gives discount 7. Livelihood Assistance ORAL HEALTH PROGRAM Goal: Reduce the prevalence rate of dental caries and periodontal diseases from 92% in 1998 to 85% and from 78% in 1998 to 60% by end of 2010 among general population. THE ADOLESCENT HEALTH PROGRAM Essential Health Care Package : 1. Management of illness 2. Counselling on substance abuse, sexuality and reproductive tract infections 3. Nutrition and diet counselling 4. Mental health 5. Family planning 6. Dental care THE ADULT MEN/THE ADULT WOMEN Essential Health Care Package : 1. Management of illness 2. Counselling on substance abuse, sexuality and reproductive tract infections 3. Nutrition and diet counselling 4. Mental health 5. Family planning 6. Dental care 7. Screening and management of lifestyle related and other degenerative diseases THE OLDER PERSON Goals: Reduce morbidity and mortality of older persons and improve their quality of life. Essential Health Care Package : 1. Management of illness 2. Counselling on substance abuse, sexuality and reproductive tract infections 3. Nutrition and diet counselling 4. Mental health 5. Family planning 6. Dental care 7. Screening and management of lifestyle related and other degenerative diseases 8. Screening management of chronic debilitating and infectious diseases 9. Post-productive care Violence Against Women and Children (VAWC)  REPUBLIC ACT NO. 9262  AN ACT DEFINING VIOLENCE AGAINST WOMEN AND THEIR CHILDREN, PROVIDING FOR PROTECTIVE MEASURES FOR VICTIMS, PRESCRIBING PENALTIES THEREFORE, AND FOR OTHER PURPOSES Definition: (a) "Violence against women and their children" refers to any act or a series of acts committed by any person against a woman who is his wife, former wife, or against a woman with whom the person has or had a sexual or dating relationship, or with whom he has a common child, or against her child whether legitimate or illegitimate, within or without the family abode, which result in or is likely to result in physical, sexual, psychological harm or suffering, or economic abuse including threats of such acts, battery, assault, coercion, harassment or arbitrary deprivation of liberty. It includes, but is not limited to, the following acts: A. "Physical Violence" refers to acts that include bodily or physical harm; B. "Sexual violence" refers to an act which is sexual in nature, committed against a woman or her child. It includes, but is not limited to: a) rape, sexual harassment, acts of lasciviousness, treating a woman or her child as a sex object, making demeaning and sexually suggestive remarks, physically attacking the sexual parts of the victim's body, forcing her/him to watch obscene publications and indecent shows or forcing the woman or her child to do indecent acts and/or make films thereof, forcing the wife and mistress/lover to live in the conjugal home or sleep together in the same room with the abuser; b) acts causing or attempting to cause the victim to engage in any sexual activity by force, threat of force, physical or other harm or threat of physical or other harm or coercion; c) Prostituting the woman or child. C. "Psychological violence" refers to acts or omissions causing or likely to cause mental or emotional suffering of the victim such as but not limited to intimidation, harassment, stalking, damage to property, public ridicule or humiliation, repeated verbal abuse and mental infidelity. It includes causing or allowing the victim to witness the physical, sexual or psychological abuse of a member of the family to which the victim belongs, or to witness pornography in any form or to witness abusive injury to pets or to unlawful or unwanted deprivation of the right to custody and/or visitation of common children. D. "Economic abuse" refers to acts that make or attempt to make a woman financially dependent which includes, but is not limited to the following: 1. withdrawal of financial support or preventing the victim from engaging in any legitimate profession, occupation, business or activity, except in cases wherein the other spouse/partner objects on valid, serious and moral grounds as defined in Article 73 of the Family Code; 2. deprivation or threat of deprivation of financial resources and the right to the use and enjoyment of the conjugal, community or property owned in common; 3. destroying household property; 4. controlling the victims' own money or properties or solely controlling the conjugal money or properties. (b) "Battery" refers to an act of inflicting physical harm upon the woman or her child resulting to the physical and psychological or emotional distress. (c) "Battered Woman Syndrome" refers to a scientifically defined pattern of psychological and behavioral symptoms found in women living in battering relationships as a result of cumulative abuse. (d) "Stalking" refers to an intentional act committed by a person who, knowingly and without lawful justification follows the woman or her child or places the woman or her child under surveillance directly or indirectly or a combination thereof. (e) "Dating relationship" refers to a situation wherein the parties live as husband and wife without the benefit of marriage or are romantically involved over time and on a continuing basis during the course of the relationship. A casual acquaintance or ordinary socialization between two individuals in a business or social context is not a dating relationship. (f) "Sexual relations" refers to a single sexual act which may or may not result in the bearing of a common child. (g) "Safe place or shelter" refers to any home or institution maintained or managed by the Department of Social Welfare and Development (DSWD) or by any other agency or voluntary organization accredited by the DSWD for the purposes of this Act or any other suitable place the resident of which is willing temporarily to receive the victim. (h) "Children" refers to those below eighteen (18) years of age or older but are incapable of taking care of themselves as defined under Republic Act No. 7610. As used in this Act, it includes the biological children of the victim and other children under her care.  LEGAL OBLIGATIONS: Republic Act of 9262 , Section 31: Health Care Provider Response to abuse- any health care provider including physician, nurse, clinician, barangay health worker, therapist or counselor who suspect abuse or has been informed by the victim of violence shall: a. Properly document any of the victim’s physical, emotional or psychological injuries; b. Properly record any of victim’s suspicions, observation and circumstances of the examination or visit; c. Automatically provide the victim free of charge a medical certificate concerning the examination or visit; d. Safeguard the records and make them available to the victim upon request at actual cost; and e. Provide the victim immediate and adequate notice of rights and remedies provided under this Act and service available to them. New Born Screening Test Act of 2004 R.A. 9288  Ensure an integrative and sustainable implementation of the government’s policy to protect and improve the right of health of the people. R ig h t o f c h ild re n to liv e / s u rviv e. R ig h t t o fu ll o f h e a lth y d e v e lo p m e n t a s n o rm a l in d ivid u a ls. Basic Information About Newborn Screening New Born screening Is a simple procedure to find out if your baby has congenital metabolic disorder that may lead to mental retardation or even death if left untreated. W h y is n e w b o rn s c re e n in g im p o rta n t?  Most babies with metabolic disorders look “normal” at birth. By doing newborn screening, metabolic disorders may be detected even before clinical signs and symptoms are present. And as a result of this, treatment can be given to prevent consequences of untreated conditions. W h e n is n e w b o rn s c re e n in g done. Newborn screening done on the 48th to 72th hour of life. However, it may also be done 24 hours from birth. Some disorders are not detected if the test is done earlier than 24 hours. H o w is n e w b o rn s c re e n in g done  Newborn screening is a simple procedure. Using the heel prick method, a few drops of blood are taken from the baby’s heel and blotted on a special absorbent filter card. The blood is dried for 4 hours and sent to the Newborn Screening Center (NSC). W h o w ill c o lle c t th e s a m p le fo r n e w b o rn s c re e n in g. The blood sample for newborn screening may be collected by trained physician, nurse, midwife or medical technologist.  W h e n a re N e w b o rn s c re e n in g re s u lt a v a ila b le ?  Normal Newborn Screening results are available 7 – 14 working days from the time newborn screening samples are received at Newborn Screening Centers. Positive newborn screening results are relayed from the Newborn Screening Center- Visayas to the Newborn Screening Facilities immediately. Parents claim the newborn Screening results from their physician practitioner. W h a t is t h e m e a n in g o f t h e N e w b o rn S c re e n in g R e s u lt ? A negative screen means that the Newborn Screening result is normal. Positive screen means that the newborn must be brought back to his/her health practitioner for further testing. W h a t s h o u ld b e d o n e w h e n a b a b y h a s a p o s itiv e N e w b o rn S c re e n in g R e s u lt. Babies with positive results should be referred at once to a specialist for confirmatory testing and further management.  Why screen your baby? 1.C o n g e n ita l H y p o th y ro id is m (C H )  CH result from lack or absence of thyroid hormone which is essential for the growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within four (4) weeks, the baby’s physical growth will be affected He/she may suffer from mental retardation. Cause: Lack of thyroid hormone (thyroxine, or T4), Treatment: Thyroid Hormone (Synthroid or Levothroid), is crushed, mixed with food and administered OD. Let start with this picture. Please take a look. The boy in a stroller is Benjie. He was 14 years old at the time this picture was taken. He could not walk, talk and even sit erect. His mental age is placed at 1 month old. When he was brought to the hospital at age 12 for diagnosis, his fontanels were open. He is now 18 years old. The girl who is standing beside him is Rina. She was 8 years old at time of pictorial. She is now in her first year in high school. She lives a normal life and is on top of her class Both kids have problems at birth which was not manifested physically when they were born. Both have congenital hypothyroidism. When Rina was about 2 days old, her parents had her go through newborn screening, she was diagnosed, treated and until this time continuously taking a medication that costs her P8 everyday. Benji was not subjected to newborn screening, was not diagnosed early enough and only received treatment when he was 12 years old. Benji’s parents live in a rural area where his father is a seasonal farmer. His mother could not help in augmenting the family income because all her time is devoted to taking care of their 14 year old son with a mental age of one month. So, newborn screening is about saving babies from mental retardation and possibly death. It is about helping the society prevent more mentally retarded children to come, helping more mothers to contribute productively to the family income because their time will not be devoted to taking care of a retarded child and, helping government, in the long run, in reducing budgets for welfare services for retarded children. 2. C o n g e n ita l A d re n a l H y p e rp la s ia (C A H ) CAH is an endocrine disorder that causes severe salt loss, dehydration and abnormally high levels of male sex hormones in both boys. If not detected and treated early babies may die with in 7-14 days. Cause: Lack of 21 hydroxylase enzyme= cannot produce cortisol and aldosterone which are essential for glucose metabolism and salt absorption. Treatment: Steroids (daily medication of oral hydrocortisone-children; prednisone/dexamethasone-older= to produce cortisol. Salt tablets as a dietary supplement for salt wasting.) 3. G a la c to s e m ia (G A L ) GAL is a condition in which babies are unable to process galactose. The sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts. Cause: Galactose-1-phosphate uridyl transferase (GALT) Treatment: Dietary exclusion of galactose (change milk to soy- based formulas=no lactose content) 4. P h e n y lke to n u ria (P K U ) PKU is a rare condition in which the baby cannot properly use one of the building blocks of protein called phenylalanine. Excessive accumulation of phenylalanine in the blood causes brain damage. Causes: Deficiency of the liver enzyme, phenylalanine hydroxylase Treatment: Restricting phenylalanine in the diet (change milk to PKU milk).Phenylalanine is abundant in meat, fish, eggs and predominant component of the artificial sweetener aspartame). (Lifetime treatment). 5. G lu c o s e -6 - P h o s p h a te D e h y d ro g e n a s e D e fic ie n c y ( G 6 P D D e f.)  G6PD Deficiency is a condition where the body lacks the enzyme called G6PD babies with this deficiency may have hemolytic anemia resulting from exposure to oxidative substances found in drugs, foods and chemicals. Causes: Lack of Glucose-6-Phosphate Dehydrogenase. The enzyme of G6PD is important to red blood cells, when there is a lacking of this type of enzyme or it is missing then red blood cells are easily destroyed.  Treatment: avoid intake of foods containing substance that requires the G6PD enzyme in metabolism. The following medicines can sometimes cause problems for people with G6PD deficiency and should be avoided if possible. Ciprofloxacin Dapsone Levofloxacin Methylthioninium Chloride (Methylene blue) Moxifloxacin Nalidixic Acid Nitrofurantion Norfloxacin Ofloxacin Primaquine Rasburicase Sulphonamides including Cotrimoxazole (Septrin®)  Foods to be avoided:  Fava Beans - Dingdong nuts, Mr. Bean Redwine Legumes - Habitswelas, Garbanzos, Kadyos or Black Beans, Monggo Blueberry Soya Food - Taho, Tofu or Tokwa, Soy Sauce Tonic Water Bitter Melon or Ampalaya  Herbs to be avoided:  Cattle gallstone bezoar Honeysuckle flower Chimonanathus flower 100% Pearl powder Figwortflower Acalypha indica  Chemicals to be avoided:  Methylene Blue Arsine Phenylhydrazine Toluidine Blue Trinitrotoluene  Aniline Eyes  Camphor  Napthalene (Moth Balls)  Henna  Alaxan Gel  Begesic  Ben-gay  Broncho Rub White  Efficascent Oil  Listerine mouthwash  Listerine Pocketpacks  Mediplastin  Megascent Oil  Mentopas Medicated Plaster  Metsal  Omega Pain Killer  Perskindol  Rowachol  Sarna  Transpulmin Balsam THANK YOU FOR LISTENING!!!