Community Health Nursing 2 Finals (Week 13-17) PDF

CHNN – 312: COMMUNITY HEALTH NURSING 2 1ST SEMESTER FINALS 3RD YEAR NURSING WEEK 13 – Non-Communicable Disease Prevention procedures; applied rapidly to help identify...

CHNN – 312: COMMUNITY HEALTH NURSING 2 1ST SEMESTER FINALS 3RD YEAR NURSING WEEK 13 – Non-Communicable Disease Prevention procedures; applied rapidly to help identify individual’s chances of becoming ill. Non-Communicable Diseases A. Screening of Hypertension - Non-Infectious & Non-Transmissible. - “Lifestyle - Related Diseases” Common risk - Monitoring of blood pressure. factors like lifestyle. - Uses reliable aneroid devices such as - Common Lifestyle Related Non-Communicable sphygmomanometer calibrated every 6 months. Disease (LRNCD): CVD, CA cerebrovascular, - Blood pressure are recorded twice daily in COPD & diabetes. morning and evening for several days before a - Referred as “Chronic Disease”. diagnosis of HPN. - Signs and symptoms occur longer than 6 months. - Considered as lifestyle related; Classification of Blood Pressure Unhealthy habits Normal < 120 / 80 Prehypertension 120 - 139 / 80 - 89 Behavioral and modifiable risk factors like smoking, alcohol abuse, too much Hypertension Stage 1 (140 – 159 / 90 – 99) fat, salt, sugar and physical inactivity. Stage 2 (160 – 179 / 100 – 109) Stage 3 (> 180 / 110) Cardiovascular & Cerebrovascular Disease B. Screening for Elevated Cholesterol Cardiovascular - It involves taking blood samples to determine - Referred as heart disease. total serum cholesterol, low-density lipoprotein - It involves the heart or blood vessels (arteries, (LDL) and high-density lipoprotein (HDL). capillaries and veins). - Withhold food or drinks for at least 8 hours to Cerebrovascular Disease (Stroke) ensure accuracy of results in all adults aged 20 years or older. - Group of brain dysfunction related to disease of - Fasting lipoprotein profile should be obtained blood vessels supplying the brain. once every 5 years; If test is done in non-fasting - Most common causes are atherosclerosis and individual, the values for total cholesterol and hypertension. HDL cholesterol will be used. Hypertension (HPN) Values (mg/dL) Interpretation - It is defined as systolic blood pressure equal to LDL Cholesterol: or above 140mmHg or a diastolic blood pressure < 100 Optimal equal to or above 90mmHg. 100 – 129 Above Normal 130 – 159 Borderline Atherosclerosis 160 – 189 High - A disease of blood vessels characterized by the > 190 Very High deposition of fats and cholesterol within the walls Total Cholesterol: of the artery. < 200 Desirable - Uncontrolled atherosclerosis and HPN leads to 200 – 239 Borderline heart attack, stroke, kidney damage and a host of > 240 High complications. HDL Cholesterol: - Risk factors: Age, genetics, unhealthy diet, < 40 Low smoking, sedentary lifestyle & alcohol > 60 High consumption. Cancer Disease Screening - Based on estimated cancer cases by site and - Identification of an unrecognized disease by gender in 2010. application of test, examination & other - Leading cause of cancer: Harry’s House 1 | JK  In women: breast, lung, liver, corpus, Signs and Symptoms of Diabetes include: uteri colon, rectum. - Polydipsia - increased frequency and mount of In men: lung, liver, colon, rectum, urination and increased thirst. prostate, stomach. - Polyphagia - constant hunger and weight loss, - Malignant Neoplasm - is a group of various vision changes and fatigue. diseases involving unregulated cell growth. Cells - Complications: heart disease, neuropathies, divide, grow uncontrollably forming malignant amputations and dental disease. tumors and invade parts of body. - Lifestyle – related factors are: unhealthy diet, - Carcinogens – are substances that cause some overweight and obesity. cells to undergo genetic mutations. - Lifestyle – related factors are: cigarette Risk Factors for Non-Communicable Disease smoking, unhealthy diet, alcohol drinking, physical inactivity, overweight or obesity. 1. Physical Inactivity - Screening for Cancer – early detection of - Defined as less than 5 times of 30 minutes of warning signals using “C.A.U.T.I.O.N. U.S.” of moderate activity per week or less than 20 American Cancer Society. minutes of vigorous activity per week. Cancer Warning Signals by American Cancer Society 2. Cigarette Smoking (C.A.U.T.I.O.N. U.S.): - Smoking cigarettes damages the lining of blood Change in Bowel or bladder habits vessels and lessens HDL cholesterol and oxygen in the blood. A sore throat that does not heal - Chemicals found in cigarettes are carcinogens. Unusual bleeding or discharge - Cigarette smoking causes lung cancer of lungs, Thickening or lump in the Breast mouth, pharynx, larynx, esophagus. Indigestion or difficulty of swallowing Obvious change in wart or mole 3. Unhealthy Eating Nagging Cough or hoarseness - Obesogenic is known as unhealthy eating. Chronic Obstructive Pulmonary Disease (COPD) - High dietary intakes of saturated fats, trans-fat cholesterol and salt. - Is a disease of the lungs in which airways narrow - Low intakes of fruits, fish, vegetables are linked over time. to overweight and obesity. - Includes: chronic asthma and emphysema - Risk Factor: Smoking, second-hand smoke and 4. Excessive Alcohol Drinking pollution, also aggravate problem. - Ingestion of excessive alcohol may lead to Diabetes Disease metabolic and physiological effects on all organ systems such as: - A group of metabolic disease in which an Gastrointestinal Disturbances individual has high blood sugar because the Cardiovascular Disturbances pancreas does not produce enough insulin or - Alcohol may cause: malabsorption, cells do not respond to the insulin produced. inflammation of the gastrointestinal tract, liver - Insulin is a hormone that regulates blood sugar. problems and cancer. - Hyperglycemia or high blood sugar is a common - Linked with colon &rectal cancer. effect of diabetes. - Linked to development of cancer of breast, liver, esophagus, mouth and larynx. Current Guidelines of WHO (2005) for the diagnosis - Cardiovascular disorders include dysrhythmias, of diabetes: cardiomyopathy, HPN and atherosclerosis. Fasting Blood Sugar (FBS) of > 7.0mmol/l - Predict diabetes incidence by increasing blood (120mg/dl). glucose in blood. 2-hour Blood Sugar Test of >11.1 mmol/l 5.Viruses (200mg/fl); These tests predict the risk for premature mortality. - Oncoviruses are viruses that are capable of causing cancer by breaking the normal cell’s DNA chain during infection. Harry’s House 2 | JK  - These are: Levels of Activity Metabolic Equivalents Human Papilloma Virus (HPV) – linked (METS) of each intensity in cervical and vulvar cancer. Low – less than 150 Walking slowly around Epstein Barr Virus – linked in minutes / week. home, store or office, nasopharynx cancer and anal cancer. sitting, using computer, Human T-Lymphotropic Virus (HTLV- working at desk, using 1) – linked with Non-Hodgkin lymphoma. light hand tools, standing, Hepatitis B Virus (HBV) and Hepatitis performing light work. C Virus (HCV) – linked with liver cancer. (Making bed, washing dishes, ironing, preparing 6. Radiation food) - Is energy emitted and transferred through matter and space. Light (< 3.0 METS) - Two most common forms are: Medium – 150 – 300 Walking briskly, cleaning, Ultraviolet Radiation (UV) minutes of moderate sweeping floors, intensity / week or 75 – vacuuming carpet, Ionizing Radiation 150 minutes of vigorous washing car, doing - UV Radiation – unfavorably affects genes and intensity physical activity. carpentry, playing the cell enzymes producing DNA mutation. badminton, basketball - Ionizing Radiation – causes tissue and cell harm (shooting), bicycling on by breaking the DNA molecule; It comprises S- flat surfaces, ballroom rays, gamma rays and particulate radiation from dancing, fishing, tennis nuclear accidents, occupational exposure and doubles, non-competitive treatments. volleyball. - Solar radiation – is the chief source of UV radiation and the major cause of skin cancer. Moderate (3.0 – 6.0 - Risk for growth depends on the following: METS) type, amount, length of exposure. Risk incline to be cumulative. High – activity of more Running, hiking, jogging, than 300 minutes of shoveling sand, carting Prevention for Non-Communicable Disease moderate intensity a heavy loads, farming, week. digging ditches, - Physical Activity – defined as any bodily participation in a movement produces by skeletal muscles; results basketball game, soccer, in expenditure of energy and includes tennis singles, occupational, leisure-time and routine daily competitive volleyball at activities. the gym or beach. - Exercise – subcategory of physical activity that is planned, structured repetitive; aimed at improving Vigorous (> 8.0 METS) or maintaining physical fitness or health. - Physical Fitness - measure of patient’s ability to Recommendation perform physical activities with vigor & alertness without undue fatigue & with ample energy to - Medium and high levels of regular physical enjoy leisure-time pursuits & respond to activity. emergencies. - A range of 500 – 1,000 METs of moderate - Physical Fitness - requires endurance, strength, intensity for 5 days a week for 30 minutes or high- flexibility, balance, speed, reaction time & body intensity activity for 3 days a week for 20 minutes. composition. - Moderate intensity activity for 30 minutes for 5 Four Levels of Physical Activity: days each week, levels of regular physical activity is recommended for at least 30 minutes daily. 1. Inactive 2. Low Warm Up and Cool Down 3. Medium - To prevent potential risk. A gradual increasing of 4. High physical activity is recommended. Harry’s House 3 | JK Warm Up - Waist Measurement of > 102cm for males and > 88cm for women – is associated with an - Increase blood flow to heart & skeletal muscle. increased risk of Type 2 Diabetes and - Enhance oxygenation of tissues. Cardiovascular Disease. - Increases flexibility of muscles. - 7-10 minutes of slow walking, arm circles, leg Disease Risk Standard for Developing NCDs based exercises or wall push ups then followed on BMI and WC simultaneously by moderate to vigorous physical activity. BMI Waist Waist Classification Circumference Circumference Cooldown Men ≤ 40 in. Men ≥ 40 in. (≤ 102 cm) (≤ 102 cm) - To eliminate lactic acid in muscles. Women ≤ 35 in. Women ≥ 35 in. - Maintain blood flow to & from muscles. (≤ 88 cm) (≥ 88 cm) - Takes about 5 to 10m ins of slow walking, jogging Underweight - - or cycling. Normal - - Factors to Consider by the Nurse in Designing Overweight Increased High Physical Activity Program: Obese – Class High Very High 1 to 3 - Based on interest, preference, readiness of individuals. Healthy Diet across all age group in Infants and - Enjoyable, include variety of activities to Children: encourage participation. - Encourage direct involvement of family members Caloric and Nutritive Intake – support growth in physical activities like sports & another and development. recreational program. Encourage mother to do exclusive breastfeeding. Breast Milk – prevents nutritional deficiencies. Assessing Healthy Weight First Year of Life – Consumes 40% calories from Methods used in assessing healthy weight: fats. Age 2 - Recommendation: diet lower in total fat - Body Mass Index (BMI) – is calculated as weight saturated fat, cholesterol – lessen risk of chronic in kilograms divided by body weight in meters disease in latter years. squared (kg/m2). Family Beliefs and Practices – affects dietary Classification BMI Value habits and eating behaviors. - Underweight - < 18.5 - Normal weight - 18.5 – 24.9 Healthy Diet across all age group in Adolescent: - Overweight - 25.0 – 29.9 Dietary requirement – based on pubertal - Obesity: development and growth. Class I 30.0 – 34.9 Body size, compositions, functions & physical Class II 35.0 – 39.9 abilities are rapidly changing. Class III > 40.0 Recommendation is consumed diet with more nutrients than they have before. - Waist Circumference (WC) – assess central fat Added intake of iron, calcium, vit D – during onset distribution, degree of abdominal obesity. of menstruation in girls & increase physical - High WC is associated with increased risk for activity on boy. diabetes, dyslipidemia, hypertension & CVD. Recommendation is: fat less than 30% of calories - WC Measurement taken using standard tape per day with less animal fat and cholesterol to measure. less than 300 mg daily. - Accurate Measurement – achieved by Challenges: peer influence, social media, fast- measuring halfway between lowest rib & top of food establishment. hipbone, in line with belly button, in standing position with relaxed abdominal muscles taken at end of normal expiration. - WC is not same with belt size. Harry’s House 4 | JK Healthy Diet across all age group in Adult and - Strategy involving health education on benefits. Elderly: - Behavior modification technique. - Assist family with limited means in selecting low Recommendation: Allow in saturated fat & cost foods. cholesterol maintains desire body weight & lower risk of CVD. CDC Guidelines for Treating Tobacco Use and Changes in body size, body mass, basal Dependence metabolism rate, & physical activity-alters Ask Systematically identify all nutritional requirements. tobacco users at every Essential Components of Adult & Elderly diet – visit. complex carbohydrate, fiber for bowel Advise Strongly all tobacco users elimination, reduce serum cholesterol, reduced to quit. risk of colon cancer, improve glucose response. Assess Determine willingness to Supplementation after consultation – due to make quit attempt. reduced appetite, difficulty in swallowing & Assist Aide the client in quitting. chewing. Arrange a follow-up Ask client if they still smoke, compliment ex- Overweight and Obesity smokers soon after visit - Results from imbalance in energy due to and just before the excessive intake of calories with the number of original quit day. calories burned. Stress Management For Weight Loss Program: - Defined as nonspecific response on the body to - If overweight & obese- should consult first health any demand on it. care provider. - Managing stress involves understanding person’s - If with BMI of 30 and above or between 25 to 30 reaction to stress. with two or more weight – related health problems - Aim of managing stress is focus on minimizing or with waist circumference of over 35 inches for frequency of stress-inducing situations, women or 40 inches in men even if BMI is less increasing resistance, avoiding physiologic than 25, they qualify for weight loss program. arousal resulting from stress. Ineffective: - Alternative Medicine for Stress Management & Prevention of Stress: Biofeedback meditation, - Radical changes in food consumption is not breathing relaxation, exercise and massage. recommended due to dehydration, nutritional deprivation, fainting & heart attack. Non-Communicable Disease Prevention and Control - Withhold food at night. Program Recommended / Effective: Goal: - Reducing caloric intake, with attention to portion size while maintaining vitamins, mineral, fiber - Reduce the toil of morbidity, disability and combined with regular physical activity to lose premature deaths due to chronic, weight. noncommunicable lifestyle related disease. - 5 to 15% reduction in bodyweight over 6 months reduces obesity- related risk. Objectives: - Losing 0.5 to 2 lbs. weight per week. 1. Analyze the social, economic, political and - Include low-carbohydrate. Low-fat, high-protein, behavioral determinants of NCD. high fibers. 2. Reduce exposure of individuals& population to - Replace high-caloric with fiber, fruits and major determinants of NCD while preventing vegetables. emergence of preventable common risk factors. - Read nutrition facts on food labels. 3. Strengthen health care for people with NCD PHN must: through health sector reform and cost-effective intervention. - Assist in planning weight management program. Harry’s House 5 | JK National Policy on Strengthening the Prevention & - They address the multiple environmental Control of Chronic Lifestyle Related Non- determinants brought about, for example, by Communicable Diseases (Administrative Order-2011- globalization and urbanization that give rise to the 0003) development of unhealthy lifestyles. - Environmental interventions shall aim at 1. Environmental Interventions – macroeconomic and providing and encouraging healthy choices for all policy change. to be implemented in three major health promotion settings: community, school and Governance workplace. Policy and legislation Creating supportive environments 2. Lifestyle Interventions 2. Lifestyle Interventions Address common risk factors & intermediate risk factors by providing population-based lifestyle Behavioral interventions interventions (for example, information & Health promotion education & behavioral interventions for those Information and education who are already at risk). Improving the “built” environment 3. Clinical Interventions 3. Clinical Interventions Palliation and rehabilitation address capacity of Clinical preventive services health system to treat & manage diseases Risk factor detection (screening) and control through screening, risk factor modification, Acute care clinical management, palliation & rehabilitation. Chronic care and rehabilitation Primary level health facilities such as rural health Palliative care centers and primary hospitals shall: 4. Advocacy Provide appropriate services particularly on early 5. Research, Surveillance and Evaluation detection and screening and primary prevention. Community participation shall also be enhanced 6. Whole of Government and Whole of Society to strengthen awareness on prevention and Response control of lifestyle-related diseases and provide a supportive environment conducive for behavior Leadership change towards healthy lifestyle. Multisectoral partnership Balance between "healthy choices" and "healthy Community mobilization environments" because it recognizes that supportive environments are needed to empower 7. Health Sector Response healthy choices. It redistributes responsibility across whole society, govt, health sector, private Primary health care sector, NGO, communities, families & individuals Chronic care management all sharing accountability to promote healthy Health systems strengthening lifestyles and quality care for LRNCD. Areas for Intervention using Comprehensive “I was tryna count up all the places we've been, you're Approach always there, so don't overthink” Effect Change at Three Levels: - Grapejuice 1. Environment Interventions - Such as policy and regulatory interventions seek to create a supportive environment for healthier choices. Harry’s House 6 | JK  CHNN – 312: COMMUNITY HEALTH NURSING 2 1ST SEMESTER FINALS 3RD YEAR NURSING WEEK 14 – Prevention and Control of Communicable Wear long-sleeved clothing and pants. Disease Use mosquito repellants/coils & screens on doors & windows. Communicable Disease Clear hanging branches of trees along streams. Illness produced by infectious agent or its toxins Have blood examined if have the signs and by direct or indirect transmission of infectious symptoms of malaria. agent/ products from infected individual or Follow advice of health workers on how to take animal, vector or inanimate environment to anti-malaria drugs. susceptible host. Policies and Laws for Malaria Malaria ✓ 2014: AO 2014-0004 – PhilMIS: Reporting and Is a serious and sometimes fatal disease caused Recording of malaria cases. by a parasite that commonly infects a certain type ✓ 2013: AO 2013-0023 – “Guidelines on of mosquito which feeds on humans. Establishment of Collaborating Centers”. Cause: caused by parasite. ✓ 2013: AO 2013-0007 – “Guidelines on Protozoan Parasite (Plasmodium) have 4 main Establishment of Elimination Hub”. species: ✓ 2012: AO 2012-0026 – “Guidelines in the Plasmodium Falciparum Conduct of Border Operation”. Plasmodium Vivax ✓ 2009: AO 2009-0001 – “Revised Policy and Plasmodium Malaria Guidelines on the Diagnosis and Treatment of Plasmodium Ovale Malaria. ✓ 2009: AO 2009-0024 – “Reconstitution of the *Plasmodium Knowlesi – found in Country Coordinating Mechanism in Support of Palawan (2010). the Global Fund to Fight Against AIDS, Mode of Transmission: Tuberculosis and Malaria Grants in the Philippines” - Bite of infected anopheles (mosquito) during ✓ Department Circular No. 167 s. 1987: RA 7160 nighttime. “Local Government Code” – Semi-vertical Signs and Symptoms: Malaria program of 1991. ✓ EO 119 (1986): change in the bureaucracy of the Chills Philippine government – revising the system of High-grade fever the Department of Health. Severe headache ✓ “Malaria Eradication” to “Malaria control in Vomiting. 1983 ✓ EO 851 (1982): ordered the decentralization and Treatment: integration of malaria control in “the general First Line – Artemether-Lumefantrine + health services”. Primaquine. ✓ Cut-off from the support of USAID and WHO Second Line – Quinine Sulfate + (1973). Doxycycline/Tetracycline/Clindamycin. ✓ Republic Act 4832 (1966): Malaria Eradication Law; an act creating the malaria eradication Complicated Plasmodium falciparum – service and providing funds for the duration of the Quinine Dihydrochloride Infusion + Doxycycline/ campaign. Tetracycline / Clindamycin. Plasmodium Vivax or Plasmodium Ovale – Filariasis Chloroquine + Primaquine. Plasmodium Malaria – Primaquine. - Known as “Elephantiasis” - Cause: Parasitic worms known as filarial Prevention and Control: nematode (Bancroftian or Brugian filariasis). - Majority: Wuchereria Bancrofti Use long-lasting insecticidal mosquito nets, especially during nighttime. Harry’s House 7 | JK Mode of Transmission: Mode of Transmission: - Parasitic worms transmitted Person to person sexual contact. - Bite of infected mosquito From mother to child during pregnancy and child - Vectors: Aedes poecilius; Anopheles flavirostris. birth, through BLD products and tissue transfer. Signs and Symptoms: Signs and Symptoms: Pain & swelling of the breast, vagina, scrotum, - Symptoms vary, some STIs exist without legs, & arms symptoms. Fever Soreness Cough Unusual lumps or sores Chills Itching Wheezing Pain when urinating Unusual discharge from the genitals Treatment: Rabies Selective treatment with Diethylcarbamazine Citrate. - Cause: Rabies virus. Given if worsening of s/sx. - Spread by infected animals. Medicines: Diethylcarbamazine Citrate and - 100% fatal but, it is 100% preventable. Albendazole – once a year to 2 years and above. - Public health problem: It is one of the most acutely fatal infection Prevention and Control: It is responsible for the death of 200-300 Long sleeved shirt and long pants when working Filipinos annually. in farms or areas of endemic. Mode of Transmission: Mosquito net or mosquito repellant. Close contact with infected saliva (rabies virus). Sexually Transmitted Infections (STI’s) Transdermal bite; scratch by infected animal - Are infections that are spread primarily from (dogs, cats). person-to person during sex. When infectious material, usually saliva, comes - Cause: Bacteria, viruses and parasites. into direct contact with victim’s fresh skin lesions, through inhalation of virus-containing spray or Types of Bacteria, Viruses and Parasites: through organ transplants. - Gonorrhea (Neisseria gonorrhoeae) Signs and Symptoms: - Chlamydial infections (Chlamydia trachomatis) - Syphilis (Treponema pallidum) Headache and fever - Chancroid (Haemophilus ducreyi) Pain or numbness of bite site - Granuloma inguinale or donovanosis Delirium and paralysis (Klebsiella granulomatis, previously known as Muscle spasms Calymmatobacterium granulomatis) Hydrophobia and aerophobia - AIDS (Human Immunodeficiency Virus or HIV) - Genital herpes (Herpes simplex virus type 2) Treatment: - Genital warts and cervical cancer in women When bitten by a Dog (human papillomavirus) - Hepatitis (Hepatitis B virus); chronic cases may Wash the wound immediately with soap, running lead to cancer of liver. water - Inflammation in the brain, eye, and bowel Consult immediately (cytomegalovirus) Observe the dog for 14 days and consult your - Vaginal trichomoniasis (Trichomonas physician if any of the following occurs: vaginalis) ✓ Dog becomes wild and runs aimlessly. - Vaginal yeast infection or vulvovaginitis in ✓ Dog drools (saliva). women and inflammation of penis and foreskin or ✓ Dog bites any moving or non-moving balanoposthitis in men, caused by Candida object. albicans. ✓ Dog does not eat or drink. Harry’s House 8 | JK  ✓ Dog dies within observation period. and not to allow their pet dogs to roam around to If dog cannot be observed (stray dog), or if prevent contact with infected animals. suspected to be rabid, consult your physician Leptospirosis immediately or go to the nearest animal bite treatment center in your area. - Leptospirosis is a bacterial infection transmitted by many animals, such as rodents and other Prevention and Control: vermin. Be a responsible pet owner. - Waste products (e.g., urine and feces) of an infected animal, especially rats, contaminate the Have your pet dog immunized by a veterinarian soil, water, and vegetation. against rabies at 3 months old and every year - Cause: Leptospira Spirochetes Bacteria. thereafter. Never allow pet dog to roam – anti-rabies Mode of Transmission: prophylaxis administered after an exposure (such Ingesting contaminated food or water as bite, scratch, lick, etc.) from potentially rabid Broken skin or open wounds & mucous animals. membrane (eyes, nose, sinuses, mouth) come in Pre-Exposure Prophylaxis (PrEP) – vaccination contact w/ contaminated water (usually flood given to individuals who are at high risk of getting water) or soil. rabies. Incubation period of bacteria is 7-10 days. Health Promotion Signs and Symptoms: Celebration of Rabies Awareness Month under Fever Executive Order No. 84, March is Rabies Non-specific symptoms of muscle pain, Awareness Month. headache. Celebration of World Rabies Day – September Calf-muscle pain and reddish eyes in some cases 28 has been declared as World Rabies Day. Severe cases resulting in liver involvement, Dog Vaccination kidney failure, or brain involvement. This is the most effective measure to control Treatment: canine rabies. Take antibiotics as prescribed. The Department of Agriculture – Bureau of Animal Industry takes the lead in mass dog Early recognition and treatment within 2 days of vaccination campaigns and provision of animal illness prevents complications of leptospirosis, so rabies vaccine. early consultation is advised. Dog Population Management Prevention and Control: This includes stray dog management through Avoid swimming, wading in potentially impounding, field control and disposal, surgical contaminated water or flood water. and non-surgical sterilization and habitat control. Use proper protection if work requires has Central Database System the Philippine Animal exposure to contaminated water. Health Information System (PhilAHIS) was Drain potentially contaminated water when established to provide data on dog registration, possible. vaccination and reports of canine rabies Control rodents in household (use rat traps, rat maintained by the Department of Agriculture. poison) maintaining cleanliness in house. Responsible Pet Ownership Leprosy The program adopts the strategy of promoting - Is a chronic, mildly communicable disease that Responsible Pet Ownership to prevent spread of mainly affects the skin, the peripheral nerves, the rabies. eyes, and mucosa of the upper respiratory tract. The public is advised to bring their pet dogs for - Cause: Mycobacterium leprae bacillus. anti-rabies vaccination when they reach 3 months of age and yearly thereafter, provide proper nutrition, exercise and shelter to their pet dogs Harry’s House 9 | JK Mode of Transmission: Dengue virus has four serotypes: (DENV1, DENV2, DENV3 and DENV4). Transmitted via droplets, from the nose and First infection with one of the four serotypes mouth. usually is non-severe or asymptomatic, while During close and frequent contacts with untreated second infection with one of other serotypes cases. may cause severe dengue. Signs and Symptoms: Dengue has no treatment but the disease can be early managed. 3 Cardinal Signs of Leprosy Mode of Transmission: 1. Skin patch with loss of sensation – The skin lesion can be single or multiple, usually less Day biting Aedes aegypti and Aedes albopictus pigmented than the surrounding normal skin. mosquitoes. 2. Enlarged Peripheral Nerve – A thickened nerve A. Dengue NS1 RDT is often accompanied by other signs as a result of damage to the nerve. ✓ Requested between 1-5 days of illness. 3. Positive slit-skin smear – In a small proportion ✓ Use to detect dengue virus antigen during early of cases, rod-shaped, red-stained leprosy bacilli, phase of acute dengue infection. which are diagnostic of the disease, may be seen ✓ Is for free in all health centers and selected public in the smears taken from the affected skin when hospitals nationwide. examined under a microscope after appropriate staining. (Skin smears are also used to diagnose B. Polymerase Chain Reaction (PCR) leprosy). ✓ One of the gold standard laboratory tests to Classification Based on Skin Smears confirm dengue virus. ✓ Molecular based test confirmatory test. Negative smears – are grouped as ✓ Available only in dengue sub-national and Paucibacillary Leprosy (PB). national reference laboratories. Positive smears – are grouped as Multibacillary C. Nucleic Acid Amplification Test- Loop Mediated Leprosy (ML). Isothermal Amplification Assay (NAAT LAMP) Treatment: ✓ A novel molecular-based confirmatory test used Multidrug therapy (MDT) treatment: to detect dengue virus. ✓ Work just like PCR but cheaper and simpler in Multibacillary (MB) leprosy: rifampicin, nature. clofazimine, and dapsone. ✓ In the pipeline to be introduced under the National Paucibacillary (PB) leprosy: rifampicin and Dengue Prevention and Control Program in dapsone. district and provincial hospitals. Prevention and Control: D. Plaque Reduction Neutralization Test (PRNT) Treat all leprosy cases to prevent spread of ✓ Gold standard to characterize and quantify infection. circulating level of anti-DENV neutralizing Avoid direct contact with untreated patients antibody (NAb). (especially young children). ✓ Available only at the dengue national reference Practice personal hygiene. laboratory Dengue IgM/IgG. Maintain body resistance by healthful living. Practice good nutrition. E. Dengue IgM/IgG Have enough rest and exercise. ✓ Requested beyond five days of illness. Keep environment clean. ✓ Use to detect dengue antibodies during acute late stage of dengue infection (IgM) and to determine Dengue Fever and Dengue Hemorrhagic Fever previous infection (IgG). - Are acute viral infections that affect infants, young ✓ May give false positive result due to antibodies children, and adults. induced by dengue vaccine. - Cause: ✓ May cross react with other arboviral diseases such as Chikungunya and Zika. Harry’s House 10 | JK  ✓ DOH augmentation is limited to selected Clinical signs of fluid accumulation government hospitals only. (ascites) Mucosal bleeding F. Other tests: Lethargy or restlessness ✓ Total While Blood Cell (WBC) count Liver enlargement ✓ Platelet Increase in hematocrit and/or decreasing ✓ Hematocrit – Routinely used in hospitals as platelet count standard dengue diagnostic tests; Look for trend of decreasing WBC, decreasing platelet and C. Severe Dengue increasing hematocrit. - Severe plasma leakage leading to shock (DSS) Dengue Case Classification and Level of Severity - Fluid accumulation with respiratory distress - Severe bleeding – as evaluated by clinician A. Dengue without warning signs, dengue with - Severe organ impairment: warning signs and severe dengue. Liver: AST or ALT ≥ 1000 CNS: e.g. seizures, impaired - Dengue without warning warnings can be further consciousness classified according to signs and symptoms and Heart: and other organs (i.e. myocarditis, laboratory tests as suspect dengue, probable renal failure) dengue and confirmed dengue. Phases of Dengue Infection A. 1 - Suspect Dengue A. Febrile Phase - A previously well individual with acute febrile illness of 1-7 days duration plus two of the Usually last 2-7 days following: Mild hemorrhagic manifestations like petechiae Headache and mucosal membrane bleeding (e.g. nose and Body malaise gums) may be seen. Retro-orbital pain Monitoring of warning signs is crucial to recognize Myalgia its progression to critical phase. Arthralgia Anorexia B. Critical Phase Nausea and vomiting Phase when patient can either improve or Diarrhea deteriorate. Flushed skin Defervescence occurs between 3 to 7 days of Rash (petechial, Hermann’s sign) illness. Defervescence is known as the period in which A. 2 Probable Dengue the body temperature (fever) drops to almost - A suspect dengue case plus laboratory test: normal (between 37.5 to 38°C). Dengue NS1 antigen test and at least CBC. Those who will improve after defervescence will be categorized as Dengue without Warning A. 3 – Confirmed Dengue Signs, while those who will deteriorate will - A suspect or probable dengue case with positive manifest warning signs and will be categorized as result of viral culture and/or Polymerase Chain Dengue with Warning Signs or some may Reaction (PCR) and/or Nucleic Acid Amplification progress to Severe Dengue. Test- Loop Mediated Amplification Assay (NAAT- Warning signs occurs, severe dengue may follow LAMP) and/or Plaque Reduction Neutralization near the time of defervescence which usually Test (PRNT). happens between 24 to 48 hours. B. Dengue with Warning Signs C. Recovery Phase - A previously well person with acute febrile illness Happens in the next 48 to 72 hours in which the of 1-7 days plus any of the following: body fluids go back to normal. Abdominal pain or tenderness Patients’ general well-being improves. Persistent vomiting Some patients may have classical rash of “isles of white in the sea of red”. Harry’s House 11 | JK  The White Blood Cell (WBC) usually starts to rise 2. Self-Protection Measures soon after defervescence but the normalization of Wear long pants and long-sleeved shirt. platelet counts typically happens later than that of WBC. Use mosquito repellant every day. Management: 3. Seek Early Consultation 1) Group A – patients who may be sent home. Consult the doctors immediately if fever persists after 2 days and rashes appears. - These are patients who are able to: Tolerate adequate volumes of oral fluids. 4. Say Yes to Fogging Pass urine every 6 hours. When There is an Impending Outbreak or a Do not have any of the warning signs Hotspot. particularly when the fever subsides. Have stable hematocrit Tuberculosis 2) Group B – patient who should be referred for in- - Is an infectious disease that primarily affects the hospital management. lungs and this condition is known as pulmonary tuberculosis. - Patients shall be referred immediately to in- - Cause: Mycobacterium tuberculosis or tubercle hospital management if they have the following bacilli. conditions: Warning signs Without warning signs but with co- Mode of Transmission: existing conditions. Inhalation of bacteria released from air droplets Social circumstances. when a person with TB coughs or sneezes. Referring facility has no capability to The bacteria will be killed in 5 minutes after direct manage dengue with warning signs. exposure to sunlight but these bacteria can 3) Group C – patient with severe dengue. requiring survive for up to 1 year in a dark, moist, and emergency treatment and urgent referral. poorly ventilated area. - With severe dengue who require emergency Signs and Symptoms: treatment and urgent referral and have the - Cardinal signs and symptoms that are lasting for following: ≥ 2 weeks: Severe plasma leakage leading to Cough dengue shock and/or fluid accumulation Unexplained fever with respiratory distress. Unexplained weight loss Severe hemorrhages Night sweats Severe organ impairment If any of the above signs/symptoms are Patients in Group C shall be immediately present for at least two weeks, identify as referred and admitted in the hospital a presumptive TB. within 24 hours. Other s/s: Chest or back pain not Prevention and Control: referable to other diseases, Blood- streaked sputum or hemoptysis. Follow the 4-S against Dengue: Screening: Primary screening tool 1. Search and Destroy Symptom-based screening - refers to screening Cover water drums and pails. using any of the 4 cardinal TB signs & symptoms, Replace water in flower vases once a week. at least two weeks. Clean gutters of leaves and debris. Screening by chest X-ray - refers to using chest Collect and dispose all unusable tin cans, jars, X-ray to identify presumptive pulmonary. TB bottles and other items that can collect and hold (PTB) which will manifest with common water. abnormalities that are suggestive of PTB. Harry’s House 12 | JK  Primary screening tool Primary screening tool Other Model of Treatment Supervision: - refers to test or tool used initially to detect ✓ 99 DOTS - Is a low-cost approach for presumptive TB in systematic screening of TB. monitoring and improving TB medication adherence. Diagnosis: ✓ Smart pillboxes - Is a digital medication Bacteriologically confirmed TB (BCTB) – monitor that combines the functionality of refers to a patient from whom a biological a low-cost medication box with a small- specimen, either sputum or non-sputum sample, scale, battery-powered sensor and is positive for TB. mobile data connection. Rapid diagnostic test (RDT), such as Xpert ✓ Video-supported treatment - An MTB/RIF. Android application (app) that utilizes Smear microscopy – whether bright field or video recording and mobile fluorescence microscopy or loop mediated communication to remotely monitor and isothermal amplification (TBLAMP). support TB medication intake. Treatment Regimens for DS-TB: Patient-centered Tuberculosis Care - First Line TB medication are Isoniazid, - Recognizes and respects the patient’s rights and Rifampicin, Pyrazinamide and Ethambutol. values. - Holistic approach as pillar by WHO in its End TB Regimen 1: Intensive Phase: 2HRZE; Continuation Strategy. Phase: 4HR. Eligible TB Patients are: - Policies are the following: 1. Respect patient autonomy and support 1. PTB or EPTB (except central nervous system self-efficacy. [CNS], bones, joints) whether new or retreatment, 2. Patient’s physical comfort, safety & with final Xpert result: wellness will be maximized. Integrated MTB, RIF sensitive care for TB and other co-morbidities. MTB, RIF indeterminate 3. Provide Psycho-emotional support & 2. New PTB or new EPTB (except CNS, bones, protection from social isolation or joints), with positive SM/TB LAMP or clinically discrimination. diagnosed, and: 4. Link TB patients to social protection Xpert not done* measures, Impact of poverty and food Xpert result is MTB not detected insecurity on TB diagnosis and treatment will be recognized and addressed. Regimen 2: Intensive Phase: 2HRZE; Continuation Phase: 10HR. Eligible TB Patients are: Comprehensive Philippine Plan of Action to Eliminate Tuberculosis (RA 10767) 1. EPTB of CNS, bones, joints whether new or retreatment, w/ final Xpert result: - A program of the national government to MTB, RIF sensitive eliminate tuberculosis in the Philippines. MTB, RIF indeterminate Immediate release of Anti-TB services – during 2. New EPTB of CNS, bones, joints, w/ positive and after natural and man-made disaster SM/TB LAMP or clinically diagnosed, and: Provision of Health services - Free laboratory Xpert not done* in DOH hospital. Supply of free medication in Xpert result is MTB not detected health centers in coordination with LGU. Education Program – Encourage faculty of Prevention and Control: allied health and health institution to intensify Prevention Health Professional – Find TB information and education program, include in patients early & provide treatment through DOT curriculum development thus increase students’ (Directly Observed Treatment) to cure the patient. opportunity to learn principles of preventing, Prevention Individual – Adopt healthy lifestyle – detecting, motoring and controlling of TB. boost immune system. Regulation on Sale and Use of Anti TB drugs Treatment Adherence Interventions – social – “No prescription, No Anti-TB Drug. support, psychological support; tracers, PhilHealth TB Package. medication monitoring; staff education. Harry’s House 13 | JK Integrated TB Information System (ITIS) Laws for the Control of Communicable Disease - A DOH-developed official information system to RA 10767 – An Act Establishing a Philippine Plan collect, consolidate TB information under NTP. of Action to Eliminate Tuberculosis as Public - An electronic information system that is used to Health Problem. collect, consolidate and report data coming from RA 3573 – Known as the "Law on Reporting of all TB facilities managing TB under NTP. Communicable Diseases", which requires all individuals and health facilities to report notifiable Schistosomiasis diseases to national and local health authorities. - Disease affects the liver, central nervous system, RA 4073 – An Act Further Liberalizing the and other organs where eggs of Schistosoma Treatment of Leprosy by Amending and japonicum get lodged, causing granuloma. Repealing Certain Sections of the Revised - Acquired mostly through personal habits & Administrative Code. livelihood requiring contact with schisto-infested. RA 8504 – An act promulgating policies and - Cause: A blood fluke (parasite) called prescribing measures for the prevention and Schistosoma japonicum in the Philippines. control of HIV/aids in the Philippines. RA 9482 – “Anti-Rabies Act of 2007” An Act Mode of Transmission: Providing for The Control and Elimination of Transmitted through a tiny freshwater snail Human and Animal Rabies. (Oncomelania hupensis quadrasi). RA 1136 – An Act Reorganizing the Division of Tuberculosis in the Department of Health. Signs and Symptoms: Batas Pambansa Bilang 97 – An Act Providing for the Compulsory Immunization of Livestock, Abdominal pain, low-grade fever Poultry and other Animals against Dangerous Loose bowel movement, bloody stool Communicable Diseases. Inflammation of the liver EO 84 – Declaring March as the Rabies Bulging of the abdomen, enlargement of the Awareness Month, Rationalizing the Control spleen Measures for the Prevention and Eradication of Diagnostic: Rabies. EO 187 of 2003 – Instituting a Comprehensive Stool examination through Kato Katz Method and Unified Policy for the Tuberculosis Control in Serologic test: COPT (circumoval precipitin the Philippine. tests) and ELISA. MEMO CIRCULAR 98-155 – Pronounced the Treatment: National Tuberculosis Control Program as the highest priority health program of LGUs. Prognosis: curable at the early stage but fatal in Presidential Proclamation 46 of 1992 – the advanced stage. Reaffirm the commitment of the Philippines to the Drug of choice: Praziquantel tablets available for Universal Child and Mother Immunization (UCMI) free at the Schistosomiasis Control Teams goal by launching the Philippines Poliomyelitis (SCTs) or health centers. Eradication Project. Presidential Proclamation 1204 of 1998 – Prevention and Control: Declare the month of June of every year starting Submit stool for examination to the SCT or health this year 1998 as the National Dengue center. Construct and use sanitary toilets. Awareness Month. Avoid contact or exposing oneself to schisto- Administrative Order No. 24 series of 1996 – infested waters. National Tuberculosis Control Program, adapted Fence off or tie stray animals. DOTS in the management of TB. Keep environment clean and participate in community efforts to control disease. “In this world, It’s just us” Consult SCTs or health centers for additional - As it was information. Harry’s House 14 | JK  CHNN – 312: COMMUNITY HEALTH NURSING 2 1ST SEMESTER FINALS 3RD YEAR NURSING WEEK 15 – Delivering Healthcare to the Filipinos to the advancement of the highest standard of health worldwide” (WHO, 2017). Cultural Heritage Cultural Diversity - Includes: Cultures, customs, beliefs, traditions, beliefs that influence culture and - Is a complex and multifaceted concept that behavior, history, practices concerning the denotes the differences amongst individuals, natural environment, religious and scientific particularly those linked to values, attitudes, traditions, language, sports, food, drink, beliefs, norms, behaviors, customs, and ways of calendars, traditional clothing and others. living. Beliefs is a perception about the reality of things Cultural Competence and are shared ideas about how the world and his environment operate. - Is understanding as well as respecting the Norms are the rules by which human behavior is groups’ values and beliefs so as to function governed and result from the cultural values held effectively in caring for members of that cultural by the group. group. Subculture is used for fairly large aggregates of people who share characteristics that are not Barriers to Developing Cultural Competence common to all members of the culture and that (Stanhope, 2014) enable them to be a distinguishable subgroup. 1. Stereotyping is ascribing certain beliefs and Tradition a belief or behavior (folk custom) behaviors about a given racial and ethnic group passed down within a group or society with to an individual without assessing for individual symbolic meaning or special significance with differences. origins in the past. 2. Prejudice is the emotional manifestation of Value refers to a desirable or undesirable state of deeply held beliefs about a group that is not affairs. Values are a universal feature of all based on reason or experience but rather on cultures, although the types and expressions of negative or favorable preconceived feelings. 3. values differ widely. 3. Racism is a form of prejudice that occurs through Culture is a set of beliefs, values, and the exercise of power by individuals and assumptions about life that are widely held institutions against people who are judged to be among a group of people and is transmitted inferior on the basis of intelligence, morals, intergenerationally. beauty, inheritance, and self-worth. 4. Ethnocentrism, or cultural prejudice, is the belief Filipino Beliefs and Practices that one’s own cultural group determines the - Understanding the beliefs and practices these standards by which another group’s behavior is clients bring to the clinical setting, their responses judged. to health and illness, and the type of health care 5. Cultural Imposition is the belief in one’s own they expect to receive are important data that superiority, or ethnocentrism, and is the act of nurses should draw on when developing a plan of imposing one’s cultural beliefs, values, and care for clients. practices on individuals from another culture. - Ex. Kamayan, use of bawang for dog bite; Values 6. Cultural Conflict is a perceived threat that may for families. Reluctant to embrace birth control. arise from a misunderstanding of expectations when nurses are unable to respond appropriately Filipino Customs & Tradition to another individual’s cultural practice because - Ex. Child marriage in indigenous people of of unfamiliarity with the practice (Andrews and Tagakaolo community in Mindanao. Boyle, 2012). 7. Culture Shock is the feeling of helplessness, 2014 Lancet Commission on Culture and Health discomfort, and disorientation experienced by an individual attempting to understand or effectively - Argued that “The systematic neglect of culture in adapt to a cultural group whose beliefs and health and health care is the single biggest barrier Harry’s House 15 | JK  values are radically different from the individual’s Enhance potential of families on acute culture. and illness on palliative care or reduce burden. Trends in Public Health: National & Global 3. Focus on Care of population Aggregates to 1. Health Promotion / Healthy Lifestyle Promote Healthy Transitions Directions & Challenges - Rationale / Bases: - Rationale / Bases: Population shift leads to: Rapid rise of NCD/CVD, CA, Diabetes, ✓ Increasing health problem Kidney problem & COPD. among elders, ethnic and - Challenges: marginalized group. Health promotion strategy to link ✓ Emphasis on child, adolescent, unbalanced differences in health status reproductive / women’s health. among populations between and within Increasing scope, magnitude and impact countries through: of disaster around the world. ✓ Focus on determinants of health - Challenges: (WHO) Expertise and competence on use of ✓ Healthy environment epidemiologic approach to care for ✓ Effective health services population group ✓ Emphasis on importance of - Creative Options and Initiatives: empowerment to promote and Work and group approach to enhance sustain health environment and and empower potential of population health lifestyles. groups. - Creative Options and Initiatives: Expertise and competence on disaster Necessitating multi-agency partnerships, to ensure effective delivery of effective advocacy, health public policy and responses to the short, medium- and organizational practices, national and long-term health needs of the disaster – international networking. stricken population. ✓ Interventions to address Promoting equity to access needed challenges health and social services. ✓ Issues on poverty and health “Human Becoming Approach” to help ✓ Development of healthy settings clients handles, polarities, transition and 2. Acute Care / Illness Care Increasingly Being trajectories based on understanding the Delivered in home / community setting meaning of “lived experienced”. - Rationale / Bases: Ten Threats to Global Health (WHO, 2019) Early Hospital Discharge due to increasing cost of hospital care and 1. Air Pollution and Climate Change services, insurance requirements. Increasing burden of chronic and - Microscopic pollutants in the air can penetrate palliative care. respiratory and circulatory systems, damaging By 2010 in the USA, 70 % to 80% illness the lungs, heart and brain. care will be in home setting. - Killing 7 million people prematurely every year - Challenges: from diseases such as cancer, stroke, heart and Expertise and competence in specific lung disease. areas in acute care in home setting. - Around 90% of these deaths are in low- and - Creative Options and Initiatives: middle-income countries, with high volumes of emissions from industry, transport and Case management as nucleus if the agriculture. continuum of care with the nurse case - Primary cause of air pollution (burning fossil manager as orchestrator. fuels) is also a major contributor to climate Nurse role varies from monitoring long - change. term needs to managing current episode - The world is still on a course to warm by more of care. than 3°C this century. Effective use of two- way referral - Air pollution is considered by WHO as the system. greatest environmental risk to health. Harry’s House 16 | JK 2. Non-Communicable Diseases tuberculosis that is resistant to the two most powerful anti-TB drugs, isoniazid and rifampicin. - Such as diabetes, cancer and heart disease, are - Resistance to fluoroquinolone antibiotics in collectively responsible for over 70% of all deaths E. coli, used for the treatment of urinary tract worldwide. infections, is widespread. - 15 million people dying prematurely, aged - Bacteria Staphylococcus aureus are part of our between 30 and 69. skin flora and are also a common cause of - Five major risk factors: tobacco use, physical infections both in the community and in health- inactivity, the harmful use of alcohol, unhealthy care facilities. diets and air pollution. - Methicillin-resistant Staphylococcus aureus - These risk factors also exacerbate mental health (MRSA) infections are 64% more likely to die issues, that may originate from an early age: half than people with drug- sensitive infections. of all mental illness begins by the age of 14, but - Injectable extended-spectrum cephalosporin most cases go undetected and untreated. (ESC) ceftriaxone is the only empiric - WHO work with governments to help them meet monotherapy for gonorrhea. the global target of reducing physical inactivity by - Drug-resistant HIV (HIVDR) – People receiving 15% by 2030. antiretroviral therapy can acquire HIVDR. - Several environmental factors: - WHO ARV guidelines now recommend the Fear of violence and crime in outdoor adoption of a new drug, dolutegravir, as the areas preferred first-line treatment for adults and High-density traffic children. Low air quality, pollution - Partial resistance to artemisinin and Lack of parks, sidewalks and resistance to a number of the ACT partner sports/recreation facilities drugs has been confirmed in Cambodia, Lao, Myanmar, Thailand, and Vietnam in Malaria. 3. Global Influenza Pandemic - Drug-resistant Candida auris, one of the most - 153 institutions in 114 countries are involved in common invasive fungal infections, is already global surveillance, response of WHO monitoring widespread. of influenza viruses to detect potential pandemic 6. Ebola and Other High-Threat Pathogens strains. - In 2018, the Democratic Republic of the Congo 4. Fragile and Vulnerable Settings saw two separate Ebola outbreaks, both of which - Exist in almost all regions of the world. spread to cities of more than 1 million people. - Protracted crises through a combination of - WHO’s R&D Blueprint identifies diseases and challenges such as drought, famine, conflict, and pathogens that have potential to cause a public population displacement and weak health health emergency. services leave people living in these areas - This watchlist for priority research and without access to basic care. development includes Ebola, several other hemorrhagic fevers, Zika, Nipah, MERS-CoV, 5. Antimicrobial Resistance SARS and disease X, which represents the need - Is the ability of bacteria, parasites, viruses and to prepare for an unknown pathogen that could fungi to resist medicines – threatens to unable cause a serious epidemic. “Disease X”. easy treat infections. - Disease X - represents the knowledge that a - Leads to prolonged hospital stays and the need serious international epidemic could be caused for more expensive and intensive care. by a pathogen currently unknown to cause - Antimicrobials – are medicines used to prevent human disease. and treat infections in humans, animals and 7. Weak Primary Health Care plants. Multi- and pan-resistant bacteria is also known as “superbugs.” - Is usually the first point of contact people have - Resistance to tuberculosis drugs – Half a with their health care system, and ideally should million new cases of rifampicin-resistant TB (RR- provide comprehensive, affordable, community- TB) identified globally, of which the vast majority based care throughout life. have multi-drug resistant TB (MDR-TB), a form of Harry’s House 17 | JK  - Lack of resources in low or middle-income countries, but possibly also a focus in the past few decades on single disease program. - October 2018, renew commitment to primary health care made in Alma-Ata declaration (by WHO in Astana, Kazakhstan). 8. Vaccine Hesitancy - The reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases. - The reasons why people choose not to vaccinate are complex: Complacency Inconvenience in accessing vaccines Lack of confidence - Health workers, remain the most trusted advisor and influencer of vaccination decisions. 9. Dengue - Causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades. - A high number of cases occur in the rainy seasons of countries 10. HIV - The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment). - Providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection). - People like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. - A group increasingly affected by HIV are young girls and women (aged 15–24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa. “Now you're in my life, I can't get you off my mind” - Late Night Talking Harry’s House 18 | JK  CHNN – 312: COMMUNITY HEALTH NURSING 2 1ST SEMESTER FINALS 3RD YEAR NURSING WEEK 16 – Information Technology and Community 4 Elements of Telemedicine (WHO) Health 1. Purpose is providing clinical support. E-Health 2. Ov