A12 PREVMED MAIN HANDOUT APRIL 2024 DAWN CASUNCAD-56-60.pdf

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ Category III This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ Category III This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. EXPOSURE • Transdermal bites (puncture wounds, lacerations, avulsions) or scratches / abrasions with spontaneous bleeding • Licks on broken skin or mucous membrane • Exposure to a rabies patient through bites, contamination of mucous membranes (eyes, oral/nasal mucosa, genital/anal mucous membrane) or open skin lesions with body fluids through splattering and mouth-to-mouth resuscitation. • Unprotected handling of infected carcass • Ingestion of raw infected meat • Exposure to bats • All Category II exposures on head and neck area MANAGEMENT • Wash wound with soap and water. • Start the vaccine regimen. • Complete vaccination regimen until Day 7 regardless of the status of the biting Animal • Administer RIG immediately after vaccination against rabies. Table 11. National Rabies Prevention and Control Program Manual of Procedures 2019: 78 IMMUNIZATION ACTIVE IMMUNIZATION • Administration o Vaccine is administered to induce antibody and T-cell production in order to neutralize the rabies virus in the body. It induces an active immune response in 7-10 days after vaccination, which may persist for years provided that primary immunization is completed • Types of Rabies Vaccines o The National Rabies Prevention and Control Program (NRPCP) shall provide the following anti-rabies tissue culture vaccines (TVC) § Purified Vero Cell Rabies Vaccine (PVRV) – 0.5 ml/vial and 1.0 ml/vial § Purified Chick Embryo Cell Vaccine (PCECV) – 1.0 ml/vial List of TCV Provided by the NRPCP to Animal Bite Treatment Centers with Corresponding Preparations and Dose GENERIC NAME PREPARATION DOSE ID – 0.1mL 0.5 mL/vial Purified Vero Cell IM – 0.5mL Rabies Vaccine (PVRV) ID – 0.1mL ® Verorab 1.0 mL/vial IM – 1.0 mL Purified Chick Embryo ID – 0.1mL 1.0 mL/vial Cell Vaccine (PCECV) IM – 1.0mL Table 13. National Rabies Prevention and Control Program Manual of Procedures 2019: 84 • Updated 2-Site Intradermal Schedule o One dose for ID administration is equivalent to 0.1 ml o One dose shall be given on each deltoid on Days 0, 3, and 7 *For WHO pre-qualified vaccines, the day 28 dose may be omitted following the IPC Institute Pasteur du Cambodge (IPC) Intradermal regimen (2-2-2-00) o WHO Pre-qualified vaccines: § Rabies vaccine Inactivated (Freeze Dried) (RABIVAX-S) § Rabipur § Verorab § VaxiRab N • Administration o The total computed RIG shall be infiltrated around and into the wound as much as anatomically feasible, even if the lesion has healed. In case some amount of the total computed dose of RIG is left after all wounds have been infiltrated, the remaining volume of RIG that is not infiltrated into the wound DOES NOT need to be injected IM. It may be reserved for the next patient who needs RIG, ensuring aseptic retention of the RIG i.e., fractionated in smaller individual syringes o A gauge 23 or 24 needle, 1 inch length shall be used for infiltration. Multiple needle injections into the same wound shall be avoided. o Equine immunoglobulins (eRIG) are clinically equivalent to human rabies immunoglobulins (hRIG) and are considered safe and efficacious life- and cost-saving biologics. As ERIG products are highly purified, skin testing is no longer recommended. MANAGEMENT OF ADVERSE REACTION • Anaphylaxis o Give 0.1% adrenaline or epinephrine (1:1,000 or 1mg/ml) underneath the skin or into the muscle. § Adults – 0.5 ml § Children – 0.01ml/kg, maximum of 0.5 ml o Repeat epinephrine dose every 10-20 minutes for 3 doses o Give steroids after epinephrine • Hypersensitivity reactions • Give antihistamines, either as single drug or in combination • If status quo for 48 hrs despite combination of antihistamines, may give short course (5-7 days) of combined oral antihistamines plus steroids • If patient worsens and condition requires hospitalization or becomes life threatening, may give IV steroids in addition to antihistamines WOUND TREATMENT • Local wound treatment o Wounds shall be immediately and vigorously washed and PASSIVE IMMUNIZATION flushed with soap or detergent, and water preferably for 10 • Rabies immune globulins or RIG (also called passive minutes. If soap is not available, the wound shall be thoroughly immunization products) shall be given in combination with and extensively washed with water. rabies vaccine to provide the immediate availability of o Apply alcohol, povidone iodine or any antiseptic neutralizing antibodies at the site of the exposure before it is o Suturing of wounds shall be avoided at all times since it may physiologically possible for the patient to begin producing his or inoculate virus deeper into the wounds. Wounds may be her own antibodies after vaccination. This is especially capitated using sterile adhesive strips. If suturing is important for patients with Category III exposures. RIGs have a unavoidable, it shall be delayed for at least 2 hours after half-life of approximately 21 days. administration of RIG to allow diffusion of the antibody to Passive immunization against Rabies must be given within 7 days after occur through the tissues initiation of active immunization since that is the amount of time that the o Any ointment, cream or wound dressing shall not be applied to body needs to create antibodies from the active immunization. Beyond 7 the bite site because it will favor the growth of bacteria and will days, administration of Passive Immunization will neutralize antibodies occlude drainage of the wound, if any made by your body from the active immunization. Dr. de la Rosa o Anti-tetanus immunization shall be given, if indicated. History GENERIC NAME PREPARATION DOSE of tetanus immunization (TT/DPT/Td) shall be reviewed. Human Rabies Immune 150 IU/mL at 20 Animal bites are considered tetanus prone wounds. Globulin (HRIG) 2mL/vial IU/kg Completion of the primary series of tetanus immunization is recommended Purified Equine Rabies Immune 200 IU/mL at 40 Globulin (pERIG) 5mL/vial IU/kg • Routine Wound Management Table 14. National Rabies Prevention and Control Program Manual of Procedures 2019: 84 o The most common organism isolated from dog and cat bites is Pasteurella multocida. COMPUTATION AND DOSAGE OF RABIES IMMUNOGLOBULIN o Other organisms include S. aureus, Bacteroides sp, Fusobacterium and Capnocytophaga. Antimicrobials shall be recommended for the following conditions: § All frankly infected wounds § All category III cat bites § All other category III bites that are either deep, penetrating, multiple or extensive or located on the hand/face/genital area TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN Page 56 of 77 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. NON-COMMUNICABLE DISEASES • Non-communicable diseases (NCDs) include cardiovascular conditions (hypertension, stroke) diabetes mellitus, lung / chronic respiratory diseases and a range of cancers which are the top causes of deaths globally and locally. • Deaths from NCDs now exceed all communicable disease deaths combined • considered as lifestyle-related and are mostly the result of unhealthy habits. • Behavioral and modifiable risk factors like smoking, alcohol abuse, consuming too much fat, salt and sugar and physical inactivity have sparked an epidemic of these NCDs which pose a public threat and economic burden. • Prevention and control measures • Multisectoral collaboration is important in battling NCDs Evidence shows that NCDs and their risk factors increase the likelihood of hospitalization or death from COVID-19 across all age groups, a stark reminder of the role of NCDs in outbreak preparedness and response. NCDs can affect vulnerability to illness, pathogen performance, and the ability of health systems to handle health threats. High rates of NCDs perpetuate poverty, strain economic development, and burden fragile health systems, making countries less resilient when emergencies like infectious disease outbreaks or natural disasters occur. Integrating noncommunicable diseases in global health security approaches is important to addressing emergencies and ongoing health needs, increasing health equity, and building trust among partners. CDC Effect of COVID-19 on NCD programs: lockdowns have allowed increased population exposure to NCD risk factors: physical inactivity unhealthy diet, tobacco use, alcohol consumption, and obesity; further increasing NCDs among us, Filipinos. Dr. Tan PROGRAM COMPONENTS • Cardiovascular Disease • Diabetes Mellitus • Cancer • Chronic Respiratory Disease BASIC CONCEPTS Modifiable Risk Factors 1. Diet 2. Smoking 3. Stress 4. Birth weight 5. Dyslipidemia 6. Body weight 7. Alcohol 8. Sedentary lifestyle 9. Migration Non-Modifiable Risk Factors 1. Family history 2. Age 3. Sex 4. Menopause 5. Race 6. Type A personality This is a board favorite, so kailangan familiar kayo kung ano ang modifiable and non-modifiable risk factors. EASY! Dr. Mann SUPPLEMENT Burden of Disease (as of September 30, 2023) Top 20 Causes of Mortality in the Philippines 1. Ischemic heart diseases 2. Neoplasms 3. Cerebrovascular Diseases 4. Diabetes Mellitus 5. Pneumonia 6. Hypertensive diseases 7. Chronic lower respiratory diseases 8. Other heart diseases 9. Respiratory tuberculosis 10. Remainder of diseases of the genitourinary system SUPPLEMENT Burden of Disease (as of September 30, 2023) 11. All other external causes 12. Transport accidents 13. Diseases of the liver 14. Remainder of the diseases of the digestive system 15. Remainder of endocrine nutritional and metabolic diseases 16. Certain condition originating in the perinatal period 17. Remainder of diseases of the nervous system 18. Remainder of diseases in the respiratory system 19. Congenital malformations 20. Gastric and duodenal ulcer Philippine Statistics Authority Press Release: December 29, 2023 NUTRITION • Healthy Diet o The World Health Organization defines Healthy Diet as a diet that helps protect against malnutrition in all its forms and is a foundation for health and development. o It also helps to prevent non-communicable diseases including diabetes, cardiovascular diseases, some cancers and other conditions linked to obesity. • Burden – The Philippines is affected by the triple burden of malnutrition: o Undernutrition like wasting and stunting o Overnutrition like overweight and obesity o Micronutrient deficiencies PHILIPPINE FOOD FORTIFICATION PROGRAM FORTIFICATION AS DEFINED BY CODEX ALIMENTARIUS • “the addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups” • Mandatory Food Fortification o (1) Rice-with Iron; o (2) Wheat flour – with vitamin A and Iron; o (3) Refined sugar-with vitamin A; o (4) Cooking oil- with vitamin A; and o (5) Other staple foods with nutrients as may later be required by the National Nutrition Council (NNC). VITAMIN A, VITAMIN A DEFICIENCY (VAD) AND ITS CONSEQUENCES • Vitamin A – an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence • Vitamin A deficiency – a condition characterized by depleted liver stores & low blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor absorption or utilization of vit. A in the body • VAD affects: o children’s proper growth o resistance to infection o increased child mortality o severe deficiency results to blindness, night blindness and Bitot’s spot IRON AND IRON DEFICIENCY ANEMIA (IDA) AND ITS CONSEQUENCES • Iron – an essential mineral and is part of hemoglobin, the red protein in red blood cells that carries oxygen from the lungs to the cells • Iron Deficiency Anemia – condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood • IDA results in premature delivery, increased maternal mortality, reduce ability to fight infection and transmittable diseases and low productivity IODINE AND IODINE DEFICIENCY DISORDERS (IDD) • Iodine -a mineral and a component of the thyroid hormones • Thyroid hormones – needed for the brain and nervous system to develop & function normally • Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various condition e.g. goiter, cretinism, mental retardation, loss of IQ points TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 57 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. POLICY ON FOOD FORTIFICATION • ASIN LAW: Republic Act 8172, “An Act Promoting Salt Iodization Nationwide and for other purposes”, Signed into law on Dec. 20, 1995 • Food Fortification Law: Republic Act 8976, “An Act Establishing the Philippine Food Fortification Program and for other purposes” mandating fortification of flour, oil and sugar with Vitamin A and flour and rice with iron by November 7, 2004 MATERNAL, NEWBORN AND CHILD HEALTH AND NUTRITION MNCHN Core Package of Services • Pre-pregnancy: provision of iron and folate supplementation, advice on family planning and healthy lifestyle, provision of family planning services, prevention and management of infection and lifestyle-related diseases. Also encompass adolescent health services, deworming of women of reproductive age (to reduce other causes of iron deficiency anemia), nutritional counseling, oral health • Pregnancy: first prenatal visit at first trimester, at least 4 prenatal visits throughout the course of pregnancy to detect and manage danger signs and complications of pregnancy, provision of iron and folate supplementation for 3 months, iodine supplementation and 2 tetanus toxoid immunization, counselling on healthy lifestyle and breastfeeding, prevention and management of infection, as well as oral health services. • Delivery: skilled birth attendance/skilled health professionalassisted delivery and facility-based deliveries including the use of partograph, proper management of pregnancy and delivery complications and newborn complications, and access to BEmONC or CEmONC services • Post-Partum: visit within 72 hours and on the 7th day postpartum to check for conditions such as bleeding or infections, Vitamin A supplements to the mother, and counselling on family planning and available services. It also includes maternal nutrition and lactation counseling and postnatal visit of the newborn together with her visit • Newborn care until the first week of life: Interventions within the first 90 minutes such as immediate drying, skin to skin contact between mother and newborn, cord clamping after 1 to 3 minutes, non-separation of baby from the mother, early initiation of breastfeeding, as well as essential newborn care after 90 minutes to 6 hours, newborn care prior to discharge, after discharge as well as additional care • Child Care: immunization, micronutrient supplementation (Vitamin A, iron); exclusive breastfeeding up to 6 months, sustained breastfeeding up to 24 months with complementary feeding, integrated management of childhood illnesses, injury prevention, oral health and insecticide-treated nets for mothers and children in malaria endemic areas OPERATION TIMBANG PLUS • Annual measurement of weight and height of all preschoolers (0-59 months old or below five years old) to identify and locate the malnourished children • Data are used for local nutrition action planning o Quantifying number of malnourished o Identifying who will be given priority interventions in the community • Moreover, results provide information on nutritional status of the preschoolers and community in general, thus, providing information on the effectiveness of the local nutrition program • Annually, the National Nutrition Council processes results and generates a list of nutritionally-at-risk cities/municipalities o List is disseminated to government, NGOs so these areas are given priority attention in nutrition programming planning and intervention EXPANDED PROGRAM ON IMMUNIZATION • The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant / childhood vaccines. • Six vaccine-preventable diseases were initially included in the EPI: o Tuberculosis o Poliomyelitis o Diphtheria o Tetanus o Pertussis o Measles • Overall Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases. • Specific Goals (6): o To immunize all infants/children against the most common vaccine-preventable diseases. o To sustain the polio-free status of the Philippines. (not anymore L) o To eliminate measles infection. o To eliminate maternal and neonatal tetanus o To control diphtheria, pertussis, hepatitis b and German measles. o To prevent extra pulmonary tuberculosis among children. • Mandates: Republic Act No. 10152 “Mandatory Infants and Children Health Immunization Act of 2011 Signed by President Benigno Aquino III in July 26, 2010. • Coverage—The mandatory basic immunization for all infants and children under 5 provided under this Act shall cover the following vaccine-preventable diseases: o Tuberculosis; o Diphtheria, tetanus and pertussis; o Poliomyelitis; o Measles; o Mumps; o Rubella or German measles; o Hepatitis-B; o H. influenza type B (HIB); and o Such other types as may be determined by the Secretary of Health in a department circular. STRATEGIES • Conduct of Routine Immunization for Infants/Children/Women through Reaching Every Barangay (REB) strategy – improve the access to routine immunization and reduce dropouts. • Supplemental Immunization Activity (SIA) – it is used to reach children who have not been vaccinated or have not developed sufficient immunity after previous vaccination. • Strengthening vaccine-preventable disease surveillance. INTRODUCTION TO NEW VACCINES • For 2012, Rotavirus and Pneumococcal vaccines were introduced in the national immunization program. • Immunization will be prioritized among the infants of families listed in the National Housing and Targeting System (NHTS) for Poverty Reduction nationwide. • The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health. POLIO ERADICATION • The Philippines has sustained its polio-free status since October 2000. (2019 the Philippines declared an outbreak of polio, losing the polio-free status of our country L) • Department of Health recently announced a Supplemental Immunization Activity (SIA) starting 19 August 2019 aims to provide an extra dose of Oral Polio Vaccine (OPV) to all children under the age of 5 years regardless of previous polio immunizations, residing in NCR, Region 3 (Central Luzon) and Region 4A (Calabarzon) MEASLES ELIMINATION • Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011. • Implemented the 2-dose measles-containing vaccine (MCV) in 2009 o MCV1 (monovalent measles) at 9-11 months old o MCV2 (MMR) at 12-15 months old TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 58 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. • “Iligtas sa Tigdas ang Pinas” : 15.6 million (84%) out of the 18.5 million children ages 9 months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between April - June 2011 • The Department of Health (DOH), launched the National Ligtas Tigdas Supplemental Immunization Activity (SIA) to halt the ongoing transmission of measles especially among unvaccinated children and pregnant women (NCR 2018) HEPATITIS B CONTROL • Republic Act No. 10152 this bill provides for all infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of birth. • One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and Newborn Care Package (EINC). • The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by HbsAg A FULLY IMMUNIZED CHILD (FIC): • Received the following vaccines before ONE YEAR OLD: o 1 dose of BCG at birth or any time before reaching 12 months o One dose of measles before reaching 12 months o 3 doses each of Pentavalent vaccines § Pentavalent Vaccine includes the ff: – Diphtheria – Pertussis – Tetanus – Hepatitis B – Haemophilus influenzae Type B (HiB) o 3 doses each OPV SCHOOL BASED IMMUNIZATION • MR and Td (Grade 1 and Grade 7) • Measles, Mumps and Rubella (MMR) and Tetanus-diphtheria (Td) (1st year to fourth year 2013 data) • Human Papillomavirus (HPV) (female, 9-13 years old, Grade 4) HERD IMMUNITY • A vaccine provides herd immunity if it not only protects the immunized individual, but also prevents that person from transmitting the disease to others. SUPPLEMENT: Elmore, Joann G.. Jekel’s Epidemiology, Biostatistics and Preventive Medicine [A] In the absence of herd immunity, the number of cases doubles each disease generation. [B] In the presence of 50% herd immunity, the number of cases remains constant. The plus sign represents an infected person; the minus sign represents an uninfected person; and the circled minus sign represents an immune person who will not pass the infection to others. The arrows represent significant exposure with transmission of infection (if the first person is infectious) or equivalent close contact without transmission of infection • When most of a population is immune to an infectious disease, this provides indirect protection—or herd immunity (also called herd protection)—to those who are not immune to the disease. • Look at the picture above, under the assumption of figure A, if there is no herd immunity against the disease, everyone is susceptible, the number of cases doubles every disease generation. However, if there is 50% herd immunity against the disease, the number of cases is small and remains approximately constant. • it is not necessary to have a 100% level of herd immunity to prevent the occurrence of an epidemic • At ang hirap ma-achieve ang 100% bakuna noh. WALANG GANON MARS! Elmore, Joann G.. Jekel’s Epidemiology, Biostatistics and Preventive Medicine. Dr. Mann NEWBORN SCREENING PROGRAM (RA 9288) • Republic Act no. 9288 otherwise known as Newborn Screening Act of 2004 • OBLIGATION TO INFORM o Any health practitioner who delivers, or assists in the delivery, of a newborn in the Philippines shall, prior to delivery, inform the parents or legal guardian of the newborn of the availability, nature, and benefits of newborn screening. PERFORMANCE OF NEWBORN SCREENING • Newborn screening shall be performed after twenty-four (24) hours of life but not later than three (3) days from complete delivery of the newborn. • A newborn that must be placed in intensive care in order to ensure survival may be exempted from the 3-day requirement but must be tested by seven (7) days of age. • It shall be the joint responsibility of the parent(s) and the practitioner or other person delivering the newborn to ensure that newborn screening is performed. SIX DISORDERS THAT ARE COMMONLY SCREENED • Congenital Hypothyroidism (CH) • Congenital Adrenal Hyperplasia (CAH) • Galactosemia (GAL) • Phenylketonuria (PKU) • Glucose-6-Phosphate-Dehydrogenase Deficiency • Maple Syrup Urine Disorder (MSUD) January 2012: Inclusion of Maple Syrup Urine Disease (MSUD) in the NBS Panel of Disorders Dr. Mann EXPANDED NEWBORN SCREENING PROGRAM • The expanded newborn screening program will increase the screening panel of disorders from six (6) to twenty-eight (28). This will provide opportunities to significantly improve the quality of life of affected newborns through facilitating early diagnosis and early treatment Tandaan! Si Cystic Fibrosis ay kasama sa ENBS kahit hindi siya ganun kaprevalent dito sa Pinas. Dr. de la Rosa INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) • The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. • IMCI is a major strategy for child survival, healthy growth and development and is based on the combined delivery of essential interventions at community, health facility and health systems levels. • IMCI includes elements of prevention as well as curative and addresses the most common conditions that affect young children. • The strategy was developed by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF). • In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital staff were capacitated to implement the strategy at the frontline level. LETHARGY UNCONSCIOUSNESS VOMITING DANGER SIGNS CONVULSIONS INABILITY TO DRINK OR BREASTFEED PREVENTABLE AND TREATABLE CONDITIONS: • Pneumonia • Diarrhea • Malaria • Measles • Malnutrition Three (3) out of four (4) episodes of childhood illness are caused by these five conditions Dr. Mann TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 59 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. CHILDREN COVERED BY THE IMCI PROTOCOL • Sick children birth up to 2 months (Sick Young Infant) • Sick children 2 months up to 5 years old (Sick child) STRATEGIES/PRINCIPLES OF IMCI • All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all Sick Young Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital • The children and infants are then assessed for main symptoms. For sick children, the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional, immunization and deworming status and for other problems • Only a limited number of clinical signs are used • A combination of individual signs leads to a child’s classification within one or more symptom groups rather than a diagnosis. • IMCI management procedures use limited number of essential drugs and encourage active participation of caretakers in the treatment of children • Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI BASIS FOR CLASSIFYING THE CHILD’S ILLNESS • The child’s illness is classified based on a color-coded triage system: o PINK – indicates urgent hospital referral or admission o YELLOW – indicates initiation of specific Outpatient Treatment o GREEN – indicates supportive home care STEPS OF THE IMCI CASE MANAGEMENT PROCESS • At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the child’s problems. Determine whether this is an initial or a follow-up visit. • The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and other processes • Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. • Once admitted, the hospital protocol is used in the management of the sick child. ANTIMICROBIAL STEWARDSHIP PROGRAM • AMS program – Antimicrobial Stewardship program is the program of the DOH tasked with concerted implementation of systematic, multi-disciplinary, multi-pronged interventions in both public and private hospitals in the Philippines to improve appropriate use of antimicrobials, which is essential for preventing the emergence and spread of AMR. • Restricted antimicrobials shall only be utilized by institutions with tertiary clinical laboratories • Restricted antimicrobials require approval for use from the AMS committee of the hospital this is under core element 4: Action https://www.philhealth.gov.ph/circulars/2018/circ2018-0009.pdf Members of the AMS team • Physician • Nurse • Midwife • Clinical community Pharmacist • AMS Secretariat. CATEGORIES OF ANTIMICROBIALS AND THEIR CORRESPONDING INTERVENTIONAL STRATEGIES DOH Antimicrobial Stewardship Program in Hospitals Manual of Procedures NATIONAL ANTIMICROBIRAL RESISTANCE SURVEILLANCE PROGRAM (ARSP) REPORTABLE PATHOGEN • Enterococcus faecium • Enterococcus faecalis • Staphylococcus aureus • Methicillin-resistant staphylococcus aureus (MRSA) • Streptococcus pneumoniae • Acetinobacter baumanii • Escherichia coli • Neisseria gonorrhoeae • Pseudomonas aeruginosa • Salmonella enterica • Non-typhoidal salmonella • Shigella POTENTIAL RED FLAGS IN PATIENTS (WILL TRIGGER REFERRAL FOR MICROBIOLOGICAL TESTING) • Immunocompromised patient • Bouts of inpatient IV treatment such as chemotherapy • Dialysis patient • Close contact with AMR patient • Undergoing IV treatment at home • Has an attached catheter which is open to infection • Previous (recent) history of repeated antibiotic use over a period of time • Self-medication and/or incomplete microbiological regimen • Use of restricted antimicrobials regimen • Antibiotic treatment failure HIV/STI PREVENTION PROGRAM PROGRAM ACTIVITIES: • With regard to the prevention and fight against stigma and discrimination, the following are the strategies and interventions: o Availability of free voluntary HIV Counseling and Testing Service; o 100% Condom Use Program (CUP) especially for entertainment establishments; o Peer education and outreach; o Multi-sectoral coordination through Philippine National AIDS Council (PNAC); o Empowerment of communities; o Community assemblies and for a to reduce stigma; o Augmentation of resources of social Hygiene Clinics; and o Procured male condoms distributed as education materials during outreach. SIX CORE ELEMENTS OF THE DOH AMS PROGRAM DOH Antimicrobial Stewardship Program in Hospitals Manual of Procedures PREVENTIVE MEASURES, SAFE PRACTICES AND PROCEDURES RESTRICTED ANTIMICROBIALS • Creation of rights-based and community-led behavior 1. Cefepime 6. Voriconazole modification programs that seek to encourage HIV risk 2. Ertapenem 7. Colistin reduction behavior among PLHIVs; 3. Meropenem 8. Micafungin • Establishment and enforcement of rights-based mechanisms to 4. Vancomycin 9. Aztreonam strongly encourage newly tested HIV-positive individuals to 5. Amphotericin B 10. Linezolid TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN Page 60 of 77 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.