REVIEWER

2017
KALUSUGALINGAN
QUIZ SHOW

DepEd - Division of Santa Rosa City

School Health Section

VGManalo/2017
 TABLE OF CONTENTS

Topics
NUTRITION ............................................................................................................. 3
HANDWASHING ................................................................................................... 16
BREASTFEEDING ................................................................................................ 19
MENSTRUAL HYGIENE MANAGEMENT ............................................................ 24
SOIL TRANSMITTED HELMINTHIASIS CONTROL PROGRAM (STHCP) ....... 28
RENAL DISEASE CONTROL PROGRAM (REDCOP) ........................................ 32
NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM ................... 38
NATIONAL RABIES PREVENTION AND CONTROL PROGRAM ..................... 43
NATIONAL TUBERCULOSIS CONTROL PROGRAM (NTP) ............................. 52
HUMAN IMMUNODEFICIENCY VIRUS (HIV)/ ACQUIRED IMMUNE
DEFICIENCY SYNDROME (AIDS) ....................................................................... 58
SEXUALLY TRANSMITTED INFECTION (STI) ................................................... 63
DANGEROUS DRUGS CAMPAIGN ..................................................................... 66
DENTAL PROGRAMS (ORAL HEALTH AWARENESS WEEK/NATIONAL
DENTAL HEALTH MONTH/ BRIGHT SMILES, BRIGHT FUTURES PROGRAM)
............................................................................................................................... 70

2
 NUTRITION

Nutrition the sum of processes involved in taking in nutrients, assimilating and using
them to maintain body tissue and provide energy, a foundation for life and health

Health a state of optimal well-being physical, mental, and social; relative freedom
from disease and disability

Food any substance consumed to provide nutritional support for the body. It is usually
of plant or animal origin and contains essential nutrients, such as fats, proteins,
vitamins or minerals.

Nutrients - are substances in food that the body processes to enable it to function

3 basic functions of Nutrients in the body:

1. Provide energy sources

2. Build tissue
3. Regulate metabolic processes

Nutrients can generally be broken onto two categories

A. Macronutrients
1. Carbohydrates
2. Proteins
3. Fats
B. Micronutrients
1. Vitamins
2. Minerals

Carbohydrates provide the bodys primary source of fuel for heat and energy. Each
gram of carbohydrate consumed yields 4 kilocalories of body energy.

Protein the primary function of protein is tissue building. It provides amino acids, the
building units necessary for constructing and repairing body tissues. Protein can
yield 4 kilocalories of body energy

Fats provides the bodys secondary, or storage, form of heat and energy. It is a more
concentrated form of energy, yielding 9 kilocalories for each gram consumed.

Vitamins - are organic compounds which are needed in small quantities to sustain life

Vitamins are classified into 2 groups:

A. Water Soluble Vitamins

B. Fat Soluble Vitamins

3
WATER SOLUBLE VITAMINS

VITAMIN What it does for our Where do we get it Deficiency disease

bodies from

B1 (thiamin) Helps release energy Yeast extracts (e.g. Beriberi

from carbohydrates Vegemite)
Is needed for proper Wheat germ and
working of the heart, wheat bran
digestive and nervous Nuts and seeds
systems Fortified bread and
Important for growth breakfast cereals
Lean pork
Wholemeal flour and
cereals

B2 Important for growth Dairy products (milk, Cracked lips & mouth
(riboflavin) and repair of tissues, cheese, yoghurt) corners
especially the skin and Yeast extracts (e.g. Swollen red tongue
eyes Vegemite) Eyes burning or itching
Helps release energy Egg whites & tearing from extra
from food Almonds blood vessels in the
Mushrooms cornea
Wholemeal flour and Scaly greasy
cereals dermatitis in skin folds
Green vegetables

B3 (niacin) Helps to release Lean meat Pellagra

energy from food Yeast
Important for Bran
growth Peanuts
Helps control Tuna and salmon
cholesterol levels Legumes
Important for Fortified breakfast
nervous system and cereals
digestive health Eggs
Vegetables
Milk

B6 Helps process protein Lean meat and Specific anemia

(pyridoxine) and carbohydrate poultry Disturbance in the
Assists in making red Fish central nervous system
blood cells Yeast extracts (e.g.
Important for brain Vegemite)
function and immune Soybeans
system health Nuts
Whole grains

4
VITAMIN What it does for our Where do we get it Deficiency disease
bodies from

Green leafy
vegetables

B5 Helps process Yeast extracts (e.g. Unlikely because of

(Pantothenic carbohydrate, fat and Vegemite) widespread occurrence
acid) protein for energy Fish
Involved in the Lean meat
formation of fatty Legumes
acids and cholesterol Nuts
Eggs
Green leafy
vegetables
Bread and cereals

B12 Works with folate to Found only in animal Pernicious Anemia

(cobalamin) produce new blood and products (lean meat,
nerve cells and DNA chicken, fish, seafood,
Helps process eggs and milk)
carbohydrate and fat Fortified soy
products

Biotin Helps process fat and Egg yolk Natural deficiency

protein Oats unknown
Important for growth Whole grains
and nerve cell function Legumes
Mushrooms
Nuts

Folate (folic Produces red blood Yeast extracts (e.g. Megaloblastic Anemia
acid) cells and DNA Vegemite)
Keeps the nervous Green leafy
system healthy vegetables
Important in early Whole grains
pregnancy to prevent Peas
neural tube defects Nuts
Avocado

C (ascorbic Needed for healthy Fruit and vegetables Scurvy

acid) skin, gums, teeth, (citrus fruit and
bones and cartilage juices, berries,
Assists with pineapple, mango,
absorption of some pawpaw, capsicum,
types of iron parsley, broccoli,
Assists with wound spinach, cabbage)

5
 VITAMIN What it does for our Where do we get it Deficiency disease
bodies from

healing and resistance

to infection

Beriberi a disease of peripheral nerves caused by a deficiency of thiamine (Vitamin B1);

characterize by pain (neuritis) and paralysis of legs and arms, cardiovascular changes and
edema

Pellagra deficiency disease caused by a lack of dietary niacin, and an inadequate amount
of protein containing the amino acid tryptophan, a precursor

Pernicious Anemia is a chronic illness caused by impaired absorption of vitamin B12

because of a lack of intrinsic factor (IF) in gastric secretions.

Megaloblastic Anemia a type of anemia characterized by the appearance of very large

red blood cells. It results from the deficiency of folate (folic acid)

Scurvy a vitamin-deficiency disease caused by a lack of Vitamin C. It is a hemorrhagic

disease with diffuse tissue bleeding, painful limbs and joints, thickened bones, and skin
discoloration from tissue bleeding; bones fracture easily, wounds do not heal, gums are
swollen and bleed, and teeth loosen.

6
FAT SOLUBLE VITAMINS

What it does for Where we get it Deficiency Disease

VITAMIN
our bodies from

Vitamin A (occurs as Essential for Retinol Night blindness

both retinol and eyesight, especially Oily fish (salmon, Xerosis
beta-carotene, night vision sardines, herring) Xerophthalmia
which is then Essential for Full cream dairy
converted by the normal growth in products
body into retinol) children Butter and table
Keeps the skin in margarine
the mouth, Egg yolk
respiratory tract Beta-carotene
and urinary tract Orange, yellow
moist (protects and green fruits
against harmful and vegetables
bacteria) (carrots, spinach,
Builds immunity apricots, mango,
(ability to fight pumpkin, broccoli)
infections)

Vitamin D Works with Sunlight (about 10 Rickets

(cholecalciferol) calcium and minutes every day) Faulty bone growth
phosphorus to make Cod liver oil and
strong, healthy oily fish (herring,
bones and teeth salmon, tuna and
A deficiency in sardines)
Vitamin D can cause Fortified
rickets, which margarine
increases the Eggs
chance of a child
having fractures

Vitamin E This antioxidant Wheat germ Breakdown of red

(tocopherol) may play a role in Vegetable oils and blood cells,
preventing cancer margarine Hemolytic Anemia
and heart disease Nuts and seeds
Eggs
Whole grains
Fish
Fruit and
vegetables

Vitamin K Essential for blood Green leafy Bleeding tendencies,

(phylloquinone) clotting vegetables hemorrhagic disease
Bone development Broccoli and Poor bone growth
cauliflower

7
 What it does for Where we get it Deficiency Disease
VITAMIN
our bodies from

Eggs
Cheese
Wholemeal flour
and bread
Xerosis itching and burning, red inflamed lids

Xerophthalmia abnormal dryness and thickening of the conjunctiva and

cornea due to Vitamin A deficiency

Rickets a disease of childhood characterized by softening of the bones from an

inadequate intake of Vitamin D and insufficient exposure to sunlight; also associated with
impaired calcium and phosphorus metabolism

Hemolytic Anemia Vitamin E deficiency in the premature infant is associated with a

hemolytic anemia. It is a condition in which red blood cells are destroyed and removed
from the bloodstream before their normal lifespan is over

8
Minerals - are necessary for three main reasons:

building strong bones and teeth

controlling body fluids inside and outside cells
turning the food you eat into energy

MINERAL What it does for our bodies Where we get it from

Calcium Essential for building strong Dairy products (milk, cheese

healthy bones and teeth and yoghurt)
Helps muscle contraction and nerve Canned sardines and salmon
function with bones
Helps blood clotting Wholegrains
Tofu and soy fortified drinks
Broccoli
Almonds

Chromium Helps with normal growth Yeast extract (vegemite,

Plays a role in controlling blood Marmite)
sugar levels Egg yolk
Liver and kidney
Lean meat
Wholegrains
Cheese

Copper Joins with iron in formation of red Oysters, crab, lobster,

blood cells mussels
Helps with the functioning of the Nuts
nervous system Yeast extract (e.g. Vegemite)
Wholegrains

Fluorine / Helps with the structure of Fluoridated drinking water

Fluoride healthy bones and teeth Fish
Decreases the chance of dental Tea
caries
Helps in the prevention of
osteoporosis

Iodine Promotes normal thyroid function Seafood

Helps brain function and normal Seaweed
growth Iodised salt
Bread (through iodised salt)

Iron Helps red blood cells carry oxygen Lean red meat, poultry,
around the body seafood
Prevents anaemia Dark leafy vegetables
Fortified breakfast cereals
Wholegrains

9
MINERAL What it does for our bodies Where we get it from

Legumes
Eggs

Magnesium Provides structure for healthy Milk

bones Wholegrains
Involved in the release of energy Green leafy vegetables
from food Legumes
Essential for muscle and nerve Lean meats and fish
function Nuts and seeds
Bananas

Manganese Helps in the formation of healthy Nuts

bones Wholegrains
Helps in the processing of Cereals
carbohydrates, cholesterol and Vegetables
protein Oils

Phosphorus Works with calcium in the Widely available in many foods

formation of strong healthy bones however the richest sources
and teeth are:
Helps the body to store and use Meat
energy Milk and cheese
Eggs
Yeast extract (e.g. Vegemite)
Bran and wheat germ
Nuts and seeds

Potassium Controls nerve impulses and muscle Nuts

contractions Yeast extract, e.g. Vegemite
Helps maintain fluid balance Dried fruit
Bananas
Bran and wheat germ
Raw fruit and vegetables
Lean meat and fish

Sodium/Salt Controls nerve impulse Foods high in sodium are

transmission processed or commercial
Helps maintain water balance products:
Table, sea and vegetable salt
Sauces and stocks
Yeast extract, e.g. Vegemite
Processed meats (ham, devon,
salami)
Cheese
Bread

10
MINERAL What it does for our bodies Where we get it from

Zinc Aids in wound healing and immune Lean meat, fish and chicken
function Milk
Essential for normal taste, smell Wholegrains
and sight Legumes and nuts
Helps in the formation of strong
bones

11
Optimal Nutrition means that a person receives and uses substances that are obtained
from a varied diet containing carbohydrates, fats, proteins, certain minerals,
vitamins, water and dietary fiber in optimal amounts.

Undernutrition an abnormal state resulting from the consumption of an inadequate

quantity of food over an extended period of time. It is manifested by underweight,
stunting or growth retardation, and in severe cases, clinical signs of marasmus or
kwashiorkor

Overnutrition state that results from excess nutrient and energy intake overtime

Body Mass Index (BMI) an indicator of nutritional status expressed as body weight in
kilograms divided by the square of the height in meters. It provides a measure of
body mass, ranging from thinness to obesity

BMI = weight(kg)
height (m2)

Ex. Weight = 45 kg Height = 152 cm or 1.52 meters

BMI = 45 kg = 45 = 19.48
(1.52m x 1.52 m) 2.31

CLASSIFICATION OF BODY MASS INDEX IN ADULTS

< 18.5 Underweight

18.5-24.9 Normal
25.0 -29.9 Overweight
30.0 39.9 Obese
> 40.0 Extremely Obese

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 10 KUMAINMENTS

The 10 KUMAINMENTS - the popular version of the revised Nutritional Guidelines for

Filipinos (NGF) developed by inter-agency Technical Working Group led by the Food

and Nutrition Research Institute of the Department of Science and Technology

(FNRI-DOST) and approved by the National Nutrition Council Governing Board in

October 2012.

- it consists of simple and easy to remember guidelines to help improve the nutritional

status of Filipinos to be able to live healthier and more productive lives

- it aims to improve the eating habits and behaviours of Filipinos to prevent

malnutrition and diet-related non-communicable diseases such as cancer, diabetes

and cardiovascular diseases.

13
 NUTRITION MONTH

Nutrition Month - is special health awareness campaign pursuant to Presidential Decree

491 or the Nutrition Act of the Philippines.

National Nutrition Council (NNC) - is appointed by the government as the lead agency to
coordinate the nationwide celebration of Nutrition Month. This agency is composed of
committed and competent public servants having the vision to ensure the nutritional well-
being of all Filipinos.

As stated in the Section 7 of the Presidential Decree:

SEC. 7. Nutrition Month The month of July shall be designated as NUTRITION MONTH,
for the purpose of creating greater awareness among our people on the importance of
nutrition. Activities thereto shall be approved and coordinated by the Council. This
Nutrition Month of July shall be in lieu of the previously declared Nutrition Week in March.

YEAR NUTRITION MONTH THEME

1976 Maximum utilization of local resources

1977 Strengthening the nutrition program at the barangay level

1978 Ugnayan ng kabataan sa nutrisyon

1979 Malusog na bata, malusog na bansa

1980 Wastong nutrisyon, landas tungo sa magandang kinabukasan

1981 Nutrisyon at kaunlaran

1982 Nutrisyon at kabuhayan sa kaunlaran

1983 Tiyakin ang kinabukasan, wastong pagkain ay kaugalian

1984 Wastong nutrisyon sa sariling pagsisikap

1985 Increased family productivity for economic recovery

1986 Sa lakas ng sambayanan, wastong nutrisyon ang kailangan

1987 Sa pagbubuklod ng diwa at bisig, wastong nutrisyon makakamit

1988 Nutrition in development

1989 Sapat sa sustansiya, lakas ng pamilya

1990 Malnutrisyon: tuklasin at pugsain

1991 Sa sama-samang pagkilos, malnutrisyoy malulutas

1992 Karapatan ng bawat Pilipino, wastong nutrisyon ay matamo

1993 Higit sa lahat, pagkaing sapat para sa lahat

14
1994 Prutas at gulay ng bayan, taglay ay lakas at yaman

1995 Buto at ngipin patibayin, gatas ating inumin

1996 Kapag kumain nang sapat, wastong timbang ang katapat

1997 Kalusugan tiyakin sa masustansiya at ligtas na pagkain

1998 Fortified foods kainin, dadgag sustansiyay kamtin selyong sangkap

pinoy hanapin

1999 Pagkaing sapat siguruhin, wastong nutrisyon ating kamtin

2000 Wastong nutrisyon: alamin at gawin

2001 Wastong nutrisyon: alamin at gawin at palaganapin

2002 Pagkain at paglaki ay bantayan, upang ang wastong nutrisyon ay kamtan

2003 Kabataan palusugin, isulong ang breastfeeding

2004 Breastfeeding panatilihin, dagdagan ng wastong pagkain

2005 Batang may kinabukasan, sa wastong nutrisyon simulan

2006 Kumain nang RIGHT, para maging batang BRIGHT

2007 Healthy lifestyle ng kabataan, landas sa kinabukasan

2008 Sa wastong nutrisyon ni mommy, siguradong healthy si baby

2009 Wastong nutrisyon kailangan, lifestyle diseases iwasan

2010 Sa pagkaing tama at sapat, wastong timbang ni baby ang katapat

2011 Isulong ang BREASTFEEDING Tama, Sapat at EKsklusibo!

2012 Pagkain ng gulay ugaliin, araw-araw itong ihain

2013 Gutom at malnutrisyon, sama-sama nating wakasan

2014 Kalamidad paghandaan: Gutom at malnutrisyon agapan!

2015 Timbang iwasto sa tamang nutrisyon at ehersisyo!

2016 First 1000 days ni baby pahalagahan para sa malusog na kinabukasan

15
 HANDWASHING

Keeping hands clean through improved hand hygiene is one of the most important
steps we can take to avoid getting sick and spreading germs to others. Many diseases and
conditions are spread by not washing hands with soap and clean, running water. If clean,
running water is not accessible, as is common in many parts of the world, use soap and
available water. If soap and water are unavailable, use an alcohol-based hand sanitizer
that contains at least 60% alcohol to clean hands.

WHEN SHOULD YOU WASH YOUR HANDS?

a) Before, during, and after preparing food

b) Before eating food
c) Before and after caring for someone who is sick
d) Before and after treating a cut or wound
e) After using the toilet
f) After changing diapers or cleaning up a child who has used the toilet
g) After blowing your nose, coughing, or sneezing
h) After touching an animal, animal feed, or animal waste
i) After handling pet food or pet treats
j) After touching garbage

FUNDAMENTAL FIVE

Five facts everyone should know about handwashing with soap:

1) Washing hands with water alone is not enough!

Washing hands with water alone, a common practice around the world, is
significantly less effective than washing hands with soap. Proper handwashing
requires soap and only a small amount of water. Using soap works by breaking
down the grease and dirt that carry most germs, facilitating the rubbing and
friction that dislodge them and leaving hands smelling pleasant. The clean smell
and feeling that soap creates are incentives for its use. With proper use, all
soaps are equally effective at rinsing away disease-causing germs.

2) Handwashing with soap can prevent diseases that kill millions of children every
year.
Handwashing with soap is among the most effective ways to prevent diarrheal
diseases and pneumonia, which together are responsible for the majority of
child deaths. Every year, more than 3.5 million children do not live to celebrate
their fifth birthday because of diarrhea and pneumonia. Handwashing can also
prevent skin infections, eye infections, intestinal worms, SARS and Avian Flu,
and benefits the health of people living with HIV/AIDS. Handwashing is

16
 effective in preventing the spread of disease even in overcrowded, highly
contaminated slum environments, research shows.

3) The critical moments for handwashing with soap are after using the toilet or
cleaning a child and before handling food.
Hands should be washed with soap after using the toilet, after cleaning a childs
bottom (or any other contact with human excreta, including that of babies and
children) and before any contact with food. Hands are the principal carriers of
disease-causing germs. It is important to ensure that people have a way to wash
their hands at these critical moments. Simple, low-cost solutions like Tippy Taps
are within the financial and technological reach of even the poorest
communities.

4) Handwashing with soap is the single most cost-effective health intervention.

Handwashing promotion is cost-effective when compared with other frequently
funded health interventions. A $3.35 investment in handwashing brings the
same health benefits as an $11.00 investment in latrine construction, a $200.00
investment in household water supply and an investment of thousands of dollars
in immunization. Investments in the promotion of handwashing with soap can
also maximize the health benefits of investments in water supply and sanitation
infrastructure and reduce health risks when families do not have access to
basic sanitation and water supply services. Cost is not typically a barrier to
handwashing promotion; almost all households in the world already have soap
though it is commonly used for laundry, dish washing and bathing rather than
for handwashing.

5) Social marketing approaches that center on the potential handwasher and his
or her specific motivations are more effective than traditional disease-focused
approaches.
Research shows that handwashing behavior can be changed on a large scale
through the use of social marketing approaches. The key is to view the potential
handwasher as a consumer and then research that consumers handwashing
habits, as well as the factors that might encourage him or her to adopt new
handwashing behaviors; design appropriate messages that appeal to the
consumers needs, wishes and preferences; and implement promotion programs
that make use of a variety of message delivery channels.

DATE TO REMEMBER

October 15 Global Handwashing Day

17
ORDERS, MEMORANDUMS

DepEd Order No. 10, s. 2016 Policy and Guidelines for the Comprehensive
Water, Sanitation and Hygiene in Schools (WinS) Program

HOW TO HANDWASH?

Washing your hands properly takes about as long as singing "Happy Birthday" twice,
using the images below.

18
 BREASTFEEDING

EXCLUSIVE BREASTFEEDING
- The infant only receives breastmilk without any additional food or drink, not even
water for the first six months.

WHY DO EXCLUSIVE BREASTFED BABIES NEED NO ADDITIONAL WATER?

Eighty-eight (88) percent of breastmilk is made-up of water. Even though a

newborn gets little water in colostrum, no additional water is needed because
a baby is born with extra water. The breastmilk with higher water content
is usually available in mothers about the third or fourth day from birth.

Breast milk is also low in solutes or dissolved substances such as sodium,

potassium, nitrogen and chloride. Thus, less water is needed to flush out
these solutes. With less solutes, the babys kidneys which are still immature
are not overworked.

WHY BREASTFEED EXCLUSIVELY?

Babies who were not breastfed in the 6 months of their lives are 25 times
more likely to die than those who experienced exclusive breastfeeding from
the time they were born.
Breastfeeding not only saves babies from death, but also provides long term
benefits.
Breasfed babies do better in school cognitive tests by as much as 4.9 points.
There is a positive association of breastfeeding with educational attainment.

COLOSTRUM
- A special milk that is yellow to orange in color and thick and sticky
- The first milk the breasts produce during late pregnancy or after giving birth
- Low in fat, high in carbohydrates, protein and antibodies to help keep baby healthy
- Extremely easy to digest
- Perfect first food for the baby
- Low in volume but high in concentrated nutrition for the newborn
- It has a laxative effect on the baby, helping the baby pass his early stools, which
aids in the excretion of excess bilirubin and helps prevent jaundice.

BENEFITS OF BREASTFEEDING TO MOTHERS

Lowers the risk of breast cancer

Helps mothers to lose weight faster
Reduces mothers risk of developing osteoporosis in later years
Prevents/stops postpartum hemorrhage
Natural contraceptive

19
FACTS ABOUT BREASTFEEDING

1) Practically all mothers can breastfeed.

a) Few true contraindications to breastfeeding:
Galactosemia
Heart failure
Serious kidney, liver or lung disease
Few maternal drugs such as amethopterin, thiouracil and
radioactive or chemotherapeutic drugs
b) Malnutrition is not a contraindication as a malnourished mother
produces the same quality or nutritional content of milk like a well-
nourished mother.
2) A mother produces enough breastmilk for her baby
3) A baby needs to be fed on demand
In the first 2 days of life 2-4 times a day
3rd day onward 10-20 feeding in 24 hours
Second week 5-10 times a day
Third week onwards 1 feeding every 3-4 hours
4) Babies are content with breastmilk alone
Breastmilk is adequate when the baby:
Is satisfied after 15 20 minutes of feeding
Falls asleep right away after each feeding and sleeps for about
3 4 hours
Gains weight satisfactorily, i.e. about kilogram every month
for the first six (6) months such that birth weight will be
doubled by about the sixth (6th) month, and tripled by the first
year
Urinates about six (6) times a day (wetness test).

5) Breastfeeding does not cause the breast to sag

6) Breast size is not important in producing breastmilk
7) A mother can breastfeed even when she is sick or tired
8) Breasts do not produce sour or spoiled milk
9) Colostrum is not dirty milk and should not be thrown away
10) Breastmilk is not too thin
It is important for a baby to have both foremilk (breastmilk released at the
start of feeding) and hindmilk (milk released towards the end of the
feeding) to get a complete meal, which includes all the water that the baby
needs. The hindmilk is especially high in fat which helps the baby feel full
and satisfied. It is important to let the baby suckle as long as s/he wants.
11) Mothers have breastmilk in their first hour or day of giving birth because during
the latter stage of pregnancy, her body starts producing colostrum.All a mother
has to do is to offer her breast to her baby so the baby can start getting milk. The
more the baby sucks the mothers breast, the more milk are produced.

20
HOW CAN MOTHERS WHO WORK AWAY FROM HOME CONTINUE TO
BREASTFEED THEIR BABY?

While at their workplace, mothers can express their milk to relieve pain due
to full breasts, to ensure continuous milk production and prevent breasts
from drying up.
While the mother is away, the expressed breastmilk can be fed to a baby
using a clean cup.

TERMS TO REMEMBER
Areola Circular area of pigmented skin that surrounds the nipple
Breastfeeding The method of feeding an infant directly from the human
breast
Donor milk The human milk from a non-biological mother
Lactation Production and secretion of milk
Wet-nursing The feeding of a newborn from another mothers breast when
his/her own mother cannot breastfeed.

BREASTFEEDING TSEK

- The exclusive breastfeeding campaign launched by the Department of Health

(DOH) last February 23, 2011.
- The primary target of this campaign is the new and expectant mothers in urban
areas
- It encourages mothers to exclusively breastfeed their babies from birth up to 6
months
- Exclusive breastfeeding means that for the first six months from birth, nothing
except breast milk will be given to babies.
- The campaign aims to establish a supportive community, as well as to promote
public consciousness on the health benefits of breastfeeding.

TSEK means:

Tama by immediate skin-to-skin contact between mother and baby after birth,
and initiation of breastfeeding within the first hour of life.

Sapat by encouraging and assuring mothers that little breastmilk is enough for
the first week and that frequent breastfeeding ensures continuous breastmilk
supply to respond to the increasing needs of the baby

EKsklusibo by giving only breastmilk and no other liquid to the baby for the first
six months. Breastmilk has all the other and nutrients that the baby needs for the
first six months after which the baby should be given appropriate complementary
foods while continuing breastfeeding.

21
DATES TO REMEMBER

August celebrated as Breastfeeding Awareness Month in the Philippines by

virtue of R.A. No. 10028

August 1-7- World Breastfeeding Week by virtue of Proclamation No. 113,

s. 2006

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Executive Order 51 also known as The Milk Code

National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements,
and Other Related Products, Penalizing Violation Thereof, and for Other Purposes

Republic Act No. 10028 also known as Expanded Breastfeeding Promotion Act of
2009
An Act Expanding the Promotion of Breastfeeding, Amending for the Purpose
Republic Act No. 7600, Otherwise Known as An Act Providing Incentives to All
Government and Private Health Institutions with Rooming-In and Breastfeeding
Practices and for Other Purposes

Pursuant to RA 10028, all health and non-health facilities, establishments or

institutions shall establish lactation stations.
o Lactation or Breastfeeding Station Private, clean, sanitary and
well-ventilated rooms or areas in the workplace where nursing mothers
can wash up, breastfeed or express their milk comfortably and store
this afterward.
o Lactation Break A nursing/lactating employee shall be allowed to
have 40 minutes paid lactation break for every 8-hour work period
which can be divided into 2-3 milk expressions (exclusive of meal
breaks)

Republic Act No. 7600 also known as The Rooming-In and Breastfeeding Act
of 1992
AN ACT PROVIDING INCENTIVES TO ALL GOVERNMENT AND PRIVATE
HEALTH INSTITUTIONS WITH ROOMING-IN AND BREASTFEEDING
PRACTICES AND FOR OTHER PURPOSES

Administrative Order No. 2009-0025 - Adopting New Policies and Protocol on

Essential Newborn Care

22
 Administrative Order No. 18, s. 2007 - Labelling of Infant Formula
Breastmilk Supplement or Follow on Formula

Administrative Order No. 2005-0014 - National Policies on Infant and Young

Child Feeding

Administrative Order No. 2007-0026 - Revitalization of Mother-Baby Friendly

Hospital Initiative in Health Facilities with Maternity and Newborn Care
Services

Administrative Order No. 2009-0025 - Adopting New Policies and Protocol on

Essential Newborn Care

Administrative Order No. 2006-0012 - Revised Implementing Rules And

Regulations of Executive Order No. 51, Otherwise Known as The Milk Code ,
Relevant International Agreements, Penalizing Violations Thereof, And For Other
Purposes

Administrative Order No. 2012-0027 - The Inter-Agency Committee (IAC)

Guidelines in the Exercise of their Powers and Functions as Stated in Executive
Order (E.O.) 51, s. 1986 Otherwise Known as, The National Code of Marketing of
Breastmilk Substitute, Breastmilk Supplements and Other Related Products and
its Revised Implementing Rules and Regulations (RIRR)

Philippine Plan of Action for Nutrition

The countrys framework for nutrition identifies as priority action the promotion,
protection and support of breastfeeding and complementary feeding and the other
necessary conditions to promote infant and young child feeding practices.

23
 MENSTRUAL HYGIENE MANAGEMENT

MENSTRUATION

A signal that as a girl, you are growing up normally.

Your body begins to develop and change as you transition from being a child to an
adult, preparing so that you can have a baby someday.
Your period is the 2-7 days that a girl, like you, experiences menstrual flow-
meaning blood and tissues leave your body through your vagina.
It is the elimination of the thickened lining of the uterus from the body through
the vagina. Menstrual fluid contains blood, cells from the lining of the uterus and
mucus.

MENSTRUAL CYCLE

24
 Follicular Phase
Prompted by the hypothalamus, the pituitary gland releases follicle stimulating
hormone (FSH). This hormone stimulates the ovary to produce around 5-20
follicles which bead on the surface.
Each follicle houses an immature egg. Usually, one follicle will mature into an
egg, while the others die. The growth of the follicles stimulates the lining of
the uterus to thicken in preparation for possible pregnancy (due to the
production of the hormone estrogen).
It begins on the first day of menstruation and ends with ovulation.

Ovulation Phase
Ovulation refers to the release of a mature egg from the ovary.
The rise of estrogen levels during the follicular phase triggers the release of
gonadotropin-releasing hormone (GnRH) from the brain. This prompts the
pituitary gland to produce increased levels of luteinizing hormone (LH) and FSH.
Within 2 days, ovulation is triggered by the high levels of LH. Following
ovulation, the egg is swept into the fallopian tube and moved along towards the
uterus. If fertilization does not occur, the egg dies within 6-24 hours.
If the egg is fertilized by a sperm, pregnancy can occur from as early as 5 days
before ovulation until up to 24 hours following ovulation.

Luteal Phase
During the ovulation, the egg bursts from its follicle, but the ruptured follicle
stays on the surface of the ovary. For the next two weeks or so, the follicle
transforms into a structure known as the corpus luteum. Large amounts of the
hormone progesterone as well as some estrogen are released. This combination
of hormones maintains the thickened lining of the uterus, waiting for a
fertilized egg to implant.
If the fertilized egg implants in the lining of the uterus, it produces the
hormones that are necessary to maintain the corpus luteum. This includes human
chorionic gonadotropin (HCG), the hormone that is detected in a urine test for
pregnancy. The corpus luteum keeps producing the raised levels of progesterone
that are needed to maintain the thickened lining of the uterus.
If pregnancy does not occur, the corpus luteum withers and dies, usually around
22 in a 28-day cycle. The drop in progesterone levels causes the lining of the
uterus to fall away. This is known as menstruation. The cycle then repeats.
During this phase, women may experience physical and emotional changes
including tender or lumpy breasts, fluid retention, bloating, mood swings,
tiredness or anxiety.

25
When do girls, like you, get their period?

You can begin menstruating any time from age 8-18, although most girls start
having their period between the ages of 10 to 14.

How often will you get your period?

It normally happens every 28 days, but can be from 21-35 days. You may have
irregular periods for the first year or two as your body is adjusting to many changes. You
may also experience having irregular periods if you are under stress, exercising heavily,
eating poorly or in an emergency situation.

How long will you have your period?

Your bleeding can last for 2-7 days. But it can and may vary for many girls.

Is there a bad odor when you have your period?

The bad odor that you sometimes smell comes from the bacteria that begins to
grow when it is warm and moist. Changing your pad or cloth often (every 3-5 hours or
when the cloth/pad becomes soak) will help eliminate odor and reduce the chance of
getting an infection.

Is it normal to feel pain during your period?

Yes. You may experience pain in your lower back or in your stomach when you have
your menstrual period. To relieve your discomfort, it is helpful to move and stretch, have
some exercise, apply a hot compress to any painful area, or have a warm bath. If
available, ibuprofen medicine may help relieve the pain.

Why do you have a clear or white discharge throughout the month?

When not menstruating, you may have vaginal discharge- this is normal. Discharge
may be clear, cloudy white or yellowish. Changes in discharge may signal infection.

What if blood leaks through your clothing?

It happens to just about every girl at some point. Sometimes it happens when you
arent home, so you cant change right away. But if you are wearing a sweater or a jacket,
you can take it off and tie it around your waist. Then get a new pad so that it doesnt
bleed through your cloth more than it already has. To avoid this, change your pads
regularly and keep extras in your bag.

What can you do?

Be prepared! Use sanitary pads or cloth pasadors to absorb the blood.

Change your sanitary pad or pasador every 3-5 hours or more, if needed.
Keep a sanitary pad or pasador with you at all times, even if you dont think your
period is coming. It is better to be prepared, especially when you are at school.
Take a bath as needed and wash genital area with bath soap and water at least
twice a day.

26
 Wash hands with soap and water after using the toilet or changing sanitary
pads/pasador.
Wipe private area from front to back after toilet use to prevent infection.
Do not use special products, perfumes, herbs or ointments on private parts.
Watch out for signs of infection- changes in discharge, odor, itching and burning
sensation.

MENSTRUAL MYTHS

True or False

1) You can bathe when you have your period.

True. Bathing and washing are good habits to maintain proper hygiene when you
have your period. Being in water will not cause sickness or insanity and may help
prevent infection during menstruation.

2) Eating sour or salty foods can stop your period.

False. Eating sour or salty foods will not stop your menstrual flow. Neither will
drinking cold liquids. You should eat whatever you feel good during menstruation,
including healthy choices.

3) You shouldnt run or move around too much when you have your period.
False. You do not need to reduce your movements when you have your period.
Increasing physical movement may actually reduce pain associated with menstrual
cramps and provide additional energy. However, if you have cramps and feel like
limiting physical activity or having more rest, listen to your bodys needs.

4) Menstrual blood is dirty.

False. Menstruation is not a disease or an impurity, it is a natural biological
experience of women and girls.

MENSTRUAL HYGIENE DAY

- Created to publicly recognize the right of women to hygienically manage their

menstruation wherever they are. By acknowledging that menstruation is a normal
human process and a sign of good health, Menstrual Hygiene Day confronts the
stigmas attached to menstruation with collective advocacy, education and action.
- Initiated by WASH United, the first global Menstrual Hygiene Day was celebrated
on May 28.

27
SOIL TRANSMITTED HELMINTHIASIS CONTROL PROGRAM (STHCP)

VISION: Healthy and Productive Filipinos in the 21st Century

MISSION: To reduce the morbidity and mortality due to soil transmitted helminth
(STH) infections

STAKEHOLDERS AND BENEFICIARIES: The DOH is the lead agency in the deworming
of children while the Department of Education (DepEd) is in charge of deworming all
children aged 6-12 years old enrolled in public schools (Grade 1-VI). Deworming is done by
teachers under the supervision of school nurses or any health personnel.

SOIL-TRANSMITTED HELMINTHIASIS

- An infection caused by nematodes or a sub-group within the group of helminth

infections (species).
- It is caused specifically by helminths through soil contaminated with fecal matter
- Among the most common infections worldwide and affect the poorest and most
deprived communities
- Helminth means parasitic worm
- A high prevalence of helminthiasis is also generally associated with areas that are
basically agricultural and low in the economic and human development scale.
- The highest intensity of infection has been documented among children aged 1-12
years old. Pre-school aged children (1-4 years old) suffer the greatest morbidity,
while school-aged children (5-12 years old) harbour the greatest load of infection.
- Affects all 81 provinces in the country with baseline data of 65% among the 6-14
years old while prevalence rate of 66% among children aged 1-5 years old.

MAIN SPECIES THAT INFECT PEOPLE

1) Roundworm (Ascaris lumbricoides)

The largest nematode parasitizing the human intestine

Length:
o Adult male: 15-30 cm
o Adult female: 20-35 cm

Infection with this parasite is known as ascariasis and is the most common
helminthic infection in the world
Adult worms can live 1 to 2 years
People with Ascaris often show no symptoms. If symptoms do occur, they can be
light and include abdominal discomfort.
Heavy infections can cause intestinal blockage and impair growth in children.

28
 2) Hookworms (Necator americanus and Ancylostoma duodenale)

It produces 10,000 20,000 eggs per day. Eggs are deposited in soil, hatch and
develop to larvae after 1 week to filreform larvae which is the infective stage
Grows up to 1 cm long
Attach to mucosa of small intestine
Suck up to 0.2 ml to 0.03 ml of blood per day
Lifespan is from 2-8 years
Human infection is mainly acquired by walking barefoot on contaminated soil.
One kind of hookworm can also be transmitted through the ingestion of larvae.
The most serious effects of hookworm infection are blood loss leading to
anemia.

3) Whipworm (Trichuris trichiura)

The adult worms (approximately 4 cm in length) live in cecum and ascending

colon.
The lifespan of the adults is about 1 year.
Most common among poor children from resource-poor regions of the world
People with whipworm can suffer light or heavy infections.
People with light infections usually have no symptoms.
People with heavy symptoms can experience frequent, painful passage of stool
that contains a mixture of mucus, water and blood. Rectal prolapse can also
occur.
Heavy infection in children can lead to severe anemia, growth retardation and
impaired cognitive development.

DEWORMING

- The administration of Albendazole (or Mebendazole), without prior diagnosis of

current infection, to control and treat intestinal helminth infections such as
hookworm, Ascaris and Trichuris.

MASS DEWORMING

- Utilized by the government as one of the major strategies to reduce the burden of
helminth infections among children aged 1-12 years old

DOSE

- Albendazole 200 mg or tablet for children who are more than 1 but below 2 years
old
- Albendazole 400 mg or 1 tablet for children who are 2 to 12 years old
- Mebendazole 500 mg for 1 to 12 years old

These drugs are given every six (6) months.

Drugs is administered within 2 hours after a meal.

29
SCHEDULE OF MASS DRUG ADMINISTRATION

Target Population Month

1-4 years old (Round 1) January
1-4 years old (Round 2) July
5-12 years old (Round 1) July
5-12 years old (Round 2) January (of the following year)

PRECAUTIONARY MEASURES ON MASS DEWORMING

Albendazole or Mebendazole is not recommended if the child has any of the following
conditions:

1) Seriously ill child

2) Children experiencing abdominal pain
3) Children with diarrhea
4) Children who previously suffered hypersensitivity to the drug

SERIOUS ADVERSE EVENTS FOLLOWING DEWORMING

- Mass Drug Administration Provider shall ensure that the children will take
deworming drugs on full stomach

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Administrative Order 2015-0030 - Guidelines on the Implementation of the
National School Deworming Day
Department Memorandum No. 2015-0399 - Guidelines on the Implementation of
the Harmonized Schedule and Combined Mass Drug Administration (HSCMDA) for
the Prevention and Control of Lymphatic Filariasis, Schistosomiasis and Soil-
Transmitted Helminthiasis
Administrative Order No. 2010-0023 - Guidelines on Deworming Drug
Administration and the Management of Adverse Events Following Deworming
(AEFD)

Recommends Albendazole or Mebendazole for the prevention, control and

treatment of soil-transmitted helminthiasis.

Administrative Order No. 2006-0028 - Strategic and Operational Framework

for Establishing Integrated Helminth Control Program (IHCP)
DepEd Memorandum No.28 s. 2007 - Implementation of the Mass Deworming
Program in All Public Elementary Schools Nationwide
DepEd Order No. 65 s. 2009 - Implementation of Essential Health Care Program
(EHCP) for the School Children (Bi-annual deworming of school children)

30
 Regional Memorandum No. 60 s. 2011 - Implementation of Essential Health Care
Program (EHCP) for school children (A record of deworming activities per class
should be kept by the classroom adviser for easy monitoring)

31
 RENAL DISEASE CONTROL PROGRAM (REDCOP)

THE HUMAN KIDNEYS

Kidneys are important parts of the urinary system.

Found at each side of the spine, below the rib cage of the human body.
Each kidney is as big as a fist, weighs pound and looks like a kidney bean.
The kidneys perform vital life-maintaining functions
Monitors and regulators of body fluid.
Excrete fluids when the body has an excess of them and retain the
substances necessary for the bodys continuing function.
Produce and release a variety of chemicals to keep the body healthy
and filter the entire blood supply every 2 minutes, excreting waste
materials through the urine.
The kidneys also produce erythropoietin, a hormone that controls the production of
red blood cells by the bone marrow.
They also are involved in the regulation of blood pressure. This probably happens
through the regulation of blood volume and the amount of sodium in the body as well
as the production of substances such as the angiotensin.

GENERAL WAYS OF PROTECTING YOUR KIDNEYS

Kidney disease often cannot be cured, but fortunately, it can be prevented. Early
detection and prevention of kidney failure is vital, as is the need to ensure that acute
cases avoid, if possible, the progression to Chronic Kidney Disease V.

1) Exercise regularly

Eat healthy diet

Eat just enough protein. Excess intake of protein would lead to the
accumulation of waste products like urea, creatinine and uric acid in the
blood. Consumption of white meat (chicken, fish and eggs) is better than
the intake of red meat (pork and beef). Avoid concentrated foods like
organ meats, kare-kare, laing and processed foods.
Phosphorus level in the blood increases as kidney function declines,
therefore, it is important to avoid foods high in this nutrient, such as:

Excess intake of milk, cheese and other dairy products

Legumes like beans and mongo beans
Chocolate and cocoa
Pinipig, peanuts and pili nuts

High levels of phosphorus causes skin itchiness and disturbances in the

bone and calcium metabolism in the body. Doctors prescribe phosphate
binders to correct levels of phophorus in the blood.

32
 Avoid salty foods and condiments (bagoong, dried fish, salted egg,
chips, soy sauce, fish sauce, vetsin, broth cubes). Excess sodium in the
diet could cause high blood pressure and edema.

Eat only the recommended amount of fruits and vegetables especially

if you are on hemodialysis. High levels of potassium in the blood causes
irregular heartbeat, palpitation and worse could lead to cardiac arrest.

Drink the right amount of water or follow what is prescribed by your

doctor. Avoid excess intake of fluids especially when there is edema or
oliguria.

Eat enough carbohydrates and fats for daily energy source of the body.
Fat can be eaten in allowed amount, through frying and sauting of
foods. To avoid increases in the blood cholesterol levels, buy and use
vegetable and plant oil sources.

Avoid eating of simple sugars and sweets (cakes, candies, chocolate

bars) if you have diabetes. These foods can increase your blood glucose
level and may create another problem.
2) Maintain ideal body weight
3) Avoid smoking
4) Avoid taking medications or herbal supplements without advice of physician
5) Consult doctor right away if with symptoms
6) Have annual physical check-up especially if with or with family history of
hypertension, diabetes or renal failure
7) If hypertensive and diabetic,
Take medications regularly
See the doctor regularly
Know blood sugar and blood pressure goals and make sure targets are met
Make sure the doctor checks the kidneys regularly

FACTS AND FIGURES

Kidney diseases are the seventh (7th) leading cause of death among Filipinos.
According to NKTI, stage-five chronic kidney disease (CKD-V) affects some 10,800
Filipinos yearly.
Each year, 30,000 to 40,000 CKD-V patients around the world need to undergo
dialysis.
By virtue of Presidential Decree (P.D.) 184 s. 1993, JUNE is declared as the National
Kidney Month in the Philippines and the National Kidney and Transplant Institute
(NKTI) is declared as the lead hospital in the celebration.
March 10 celebrated as the World Kidney Day by the International Society of
Nephrologists and International Federation of Kidney Foundations

33
FIVE STAGES OF CHRONIC KIDNEY DISEASE (CKD)

Stage 1 with normal or high GFR (GFR > 90 mL/min)

Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)

Glomerular Filtration Rate (GFR)

- Best measure of kidney function
- Number used to figure out a persons stage of kidney disease

WHAT ARE THE SIGNS AND SYMPTOMS OF KIDNEY DISORDER?

Fluid retention or edema MAIN SYMPTOM

This may be evident in the following:
Puffiness around the eyes
Swelling in the feet and legs
Water in the lungs leading to difficulty of breathing
Change in urination
May be consist of:
pain or unusual sensation during voiding
increased or decreased frequency of urination
difficulty in initiating urination
frequent urination at night
change in color of urine
blood in the urine or bubbly appearance of the urine
Anorexia
Vomiting
Pallor
Difficulty in sleeping
Generalized body weakness
Presence of protein in the urine (proteinuria)
Presence of red blood cells in the urine (hematuria)
Hypertension
Repeated urinary tract infections
Back pain or pain in the lower abdomen

34
WHAT DISEASES COMMONLY AFFECT THE KIDNEYS?

Infection
- Most common disorder of the kidneys and the urinary
tract.Uncomplicated urinary tract infections are very easy to treat.
Stones
Solid residues in the urinary tract that may cause obstruction to the
-
flow of urine which in turn may lead to infection of the kidneys and
subsequent scarring.
Glomerulonephritis
- Inflammation of the glomeruli, the small vessels in the nephron. If not
treated, patients may suffer slow progressive damage to the kidneys
and develop renal failure.
Hypertension
- Occurs with many cases of kidney diseases
- Prolonged hypertension damages the small arteries in the kidneys.
This may start a vicious cycle: damaged kidneys cause more serious
hypertension which in turn brings more damage to the kidneys.
Diabetes
- May also damage the kidneys
- It is the leading cause of chronic renal failure in many countries.
Abnormalities in the urinary tract that are congenital or inborn may
consequently lead to poor function, obstruction or infection of the kidneys.

Some drugs, herbal medicine, solvents and insectides can also harm the kidneys.

WHAT ARE THE WARNING SIGNS OF KIDNEY DISEASE?

Puffiness of the eye area

Progressive swelling of parts of the body usually at the ankles
Back pain on the lower part just below the ribcage
Changes in urination (increased or decreased frequency of urination, frequent
urination at night, pain or unusually sensation during voiding, hesitancy or difficulty
in initiating urination, change in color of the urine, blood in the urine)
New onset of high blood pressure

THERAPEUTIC OPTIONS

1) Medical Therapy

Because kidney failure is already irreversible at later stages, treatment focuses on

controlling the symptoms, minimizing complications and slowing the progression of
the disease.

Associated diseases that cause or result from chronic renal failure must be
controlled. Hypertension, diabetes, congestive heart failure, UTI, kidney stones,
obstructions of the urinary tract, glomerulonephritis, and other disorders should be
treated appropriately.

35
 Medications such as iron supplements and erythropoietin injections may be needed
to control anemia. Blood transfusion may be given but they are less preferred.

Fluid intake may be restricted, often to an amount equal to the volume of urine
produced. Dietary protein restriction may slow the build-up of wastes in the
bloodstream and control associated symptoms such as nausea and vomiting. Salt,
potassium, phosphorus and other electrolytes may be restricted.

2) Dialysis and Transplantation

May be required eventually when end stage renal disease ensues or when 85-90 percent
of kidney function is lost.

Hemodialysis
- Uses a special filter called a dialyzer that functions as an artificial
kidney to clean the blood.
- During treatment, blood travels through the tubes into the dialyzer
which filters out wastes and extra water. Then the cleaned blood
flows through another set of tubes back into the body. The dialyzer is
connected to the machine that monitors blood flow and removes
wastes from the blood.
- Hemodialysis is usually performed 2 to 3 times a week. Each
treatment last for 4 hours.

Peritoneal Dialysis
- Another procedure that removes extra water and wastes from the
body.
- This type of dialysis uses the lining of the abdomen to filter the
blood. This lining is called the peritoneal membrane and acts as the
artificial kidney. A mixture of minerals and sugar dissolved in water
called dialysis solution travels through a soft tube into the abdomen.
The sugar, called dextrose, draws wastes, chemical and extra water
from the tiny blood vessels in the peritoneal membrane into the
dialysis solution. After several hours, the used solution is drained
from the abdomen through the tube, taking the wastes from the blood
with it. Then the patient fills his abdomen with fresh dialysis solution
and the cycle is repeated usually 3 to 4 times a day. Each cycle is
called an exchange.

36
 Kidney Transplantation

- Surgically places a healthy kidney from another person into the body of
the patient with end stage renal disease. The donated kidney does the
work that the 2 failed kidneys used to do. It is generally not necessary
to remove the diseased kidneys. A donated kidney may come from an
anonymous donor who has recently died or from a living person usually
relative. The kidney that the patient receives must be a good match for
his body. The more the new kidney is like his own, the less likely will his
immune system reject it. The patient will be made to take special drugs
called immunosuppressives to help trick his immune system so it would
not reject the transplanted kidney.

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Republic Act 7170 Also known as the Organ Donation Act of 1991
An Act Authorizing the Legacy or Donation of All or Part of a Human Body After
Death for Specified Purposes

Administrative Order No. 2010-0018 - Revised National Policy On Living Non

Related Donation and Transplantation and Its Implementing Structure Amending
for the Purpose Administrative Order No. 2008-0004-A

Administrative Order No. 2009-0012 - Guidelines Institutionalizing and

Strengthening the Philippine Renal Disease Registry under the DOH

Administrative Order No. 2008-0004 - Revised National Policy on Living Non

Related Organ Donation and Transplantation and its Implementing Structure

Administrative Order No. 2008-0004-A - Amendment to Administrative Order

No. 2008-0004 on Revised National Policy on Living Non Related Organ Donation
and Transplantation and its Implementing Structure

Administrative Order No. 124 s. 2002 - National Policy on Kidney

Transplantation From Living Non Related Donors (LNRDs)

Department Memorandum No. 2008-0204 - Collection and Submission of Philippine

Renal Disease Registry Forms

37
 NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM

The National Dengue Prevention and Control Program was first initiated by the
Department of Health (DOH) in 1993. Region VII and the National Capital Region served
as the pilot sites. It was not until 1998 when the program was implemented nationwide. The
target populations of the program are the general population, the local government units,
and the local health workers.

Vision: Dengue Risk-Free Philippines

Mission: To improve the quality of health of Filipinos by adopting an integrated dengue

control approach in the prevention and control of dengue infection.

Goal: Reduce morbidity and mortality from dengue infection by preventing the
transmission of the virus from the mosquito vector to human.

DENGUE

- Most rapidly spreading mosquito-borne viral disease in the world

- Caused by 4 distinct, but closely related, serotypes of the virus (DEN-1, DEN-2,
DEN-3 and DEN-4)
- An all year round disease in the Philippines
- The most important mosquito-borne viral disease of humans and the most
important tropical disease in Latin America and Asia
- Found mainly in poverty stricken areas
- Burden is highest among poorest and children
- Symptoms usually last for 2-7 days, after an incubation period of 4-10 days after
the bite from an infected mosquito.
- After the incubation period, the illness begins fast and will be followed by 3
phases: febrile, critical and recovery.

TRANSMISSION

- The Aedes aegypti mosquito is the primary vector of dengue. This virus is
transmitted through the bites of infected female mosquitoes. After virus
incubation for 4-10 days, an infected mosquito is capable of transmitting the virus
for the rest of its life.
- Infected humans are the main carriers and multipliers of the virus, serving as a
source of the virus for uninfected mosquitoes. Patients who are already infected
with dengue virus can transmit the infection via Aedes mosquitoes after their first
symptoms appear.
- Aedes albopictus, a secondary vector in Asia, has spread to the North America and
Europe largely due to the international trade in used tires (a breeding habitat) and
other goods (ex: lucky bamboo). Aedes albopictus is highly adaptive and can survive
in cooler temperate regions of Europe. Its spread is due to its tolerance to
temperatures below freezing, hibernation and ability to shelter in microhabitats.

38
CHARACTERISTICS OF Aedes aegypti

- A day biting mosquito (2 hours after sunrise and 2 hours before sunset)
- Lives in urban habitats and breeds in man-made containers
- Limited and low-flying movement
- Fine white dots at the base of the wings; with white bands on the legs
- Has a lifespan of 2-4 weeks but their eggs can survive in dry state in 1 year and
hatches on rainy season
- Attracted to chemicals emitted by mammals including humans like carbon dioxide,
lactic acid, ammonia and octenol
- Needs blood to allow eggs to mature for laying
- Females bites multiple people during each feeding period

CASE CLASSIFICATION AND LEVELS OF SEVERITY (as per AO 2012-0006)

a) Dengue Without Warning Signs

Probable Dengue:
Lives in or travels to dengue-endemic area, with fever plus any two of the
clinical signs and symptoms:
a) Headache
b) Body malaise
c) Myalgia
d) Arthralgia
e) Retro-orbital pain
f) Anorexia
g) Nausea
h) Vomiting
i) Diarrhea
j) Flushed skin
k) Rash (petechial, Hermanns sign)
Hermanns sign general flushing of the skin
AND
l) Laboratory test, at least CBC (leukopenia [reduced White Blood Cells
{WBC}], with or without thrombocytopenia [low platelet count]) and/or
dengue NS1 antigen test or dengue IgM (Immunoglobulin M) antibody
test (optional)

Note: The earliest abnormality in the full blood count is a progressive decrease in total
WBC count, which should alert the physician to a high probability of dengue.

Confirmed Dengue:
Viral Culture Isolation
Polymerase Chain Reaction (PCR)

39
 b) Dengue With Warning Signs
Lives in or travels to dengue-endemic area, with fever lasting for 2-7 days, plus any
of the following:
Abdominal pain or tenderness
Persistent vomiting
Clinical signs of fluid accumulation
Bleeding
Lethargy, restlessness
Liver enlargement
Laboratory: increase in hematocrit and/or decreasing platelet count

Confirmed Dengue:
Viral Culture Isolation
Polymerase Chain Reaction (PCR)

c) Severe Dengue
Lives in or travels to dengue-endemic area, with fever of 2-7 days and any of the
above clinical manifestations for dengue with or without warning signs, plus any of
the following:
Severe plasma leakage leading to:
o Shock
o Fluid accumulation with respiratory distress
Severe bleeding
Severe organ impairment

COURSE OF DENGUE ILLNESS

a) Febrile Phase
- Usually lasts 2-7 days
- Monitoring of warning signs is crucial to recognize its progression to the critical
phase
- Clinical Problems Encountered in this Phase: dehydration, high fever may cause
febrile seizures in young children, neurological disturbances

b) Critical Phase
- Defervescence occurs on Day 3-7 of the illness, around this time the patient can
either improve or deteriorate
- Those who improve after defervescence have Dengue Without Warning Signs,
while those who deteriorate have Dengue with Warning Signs
- Clinical Problems Encountered in this Phase: shock from plasma leakage, severe
hemorrhage, organ impairment

40
 c) Recovery Phase
- Patients general well-being improves, hemodynamic status stabilizes and diuresis
ensues
- Some patient may have a classical rash of isles of white in the sea of red

PREVENTION AND CONTROL

DENGVAXIA
- Vaccine developed by Sanofi Pasteur
- Not necessarily a cure but it can prevent people from acquiring dengue
- The vaccine can fight against four (4) dengue strains, although effectiveness
varies per serotype
- Recommended to be given in three doses at six (6) months interval
- As of now, the vaccine is given to healthy individuals from 9-45 years old
- It cannot be given to people with compromised immunity such as those taking
medications that suppresses immunity like HIV/AIDS patients and post-transplant
patients
- The Philippines is the second country to approve the dengue vaccine for public use,
the first was Mexico last December, 2015.

MAG4S LABAN SA DENGUE

Search and Destroy

Para di maipunan ng tubig at pamugaran ng kiti-kiti:
o Palitan and tubig at linisin ang flower vase minsan sa isang linggo
o Takpan ng lupa o buhangin ang mga butas sa paligid ng inyong bahay
o Takpan ang mga timba, drum o iba pang imbakan ng tubig
o Tanggalin at butasan ang mga gulong sa ibabaw ng inyong bubong o mga gulong
sa inyong paligid

41
 o Itaob ang mga bote, lata at iba pang maaaring pag-ipunan ng tubig at
pangitlugan ng lamok
o Linisin at alisin ang tubig sa paminggalan

Self-Protection Measures
Iwasan ang maiikling kasuotan upang di madaling makagat ng lamok
Maaari ding gumamit ng mosquito repellant sa araw

Seek Early Consultation

Kung may lagnat na ng 2 araw at may rashes sa balat, pumunta at komunsulta
agad sa pinakamalapit na health center o ospital

Say NO to Indiscriminate Fogging

Yes to fogging only during outbreaks

DATES TO REMEMBER

June declared as Dengue Awareness Month in the Philippines by virtue of

Proclamation No. 1204 signed in April 1998 by then President Fidel V. Ramos
June 15 designated as the ASEAN Dengue Day in the 10 member-states of the
Association of Southeast Asian Nations

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

DOH Administrative Order No. 2012-0006 - Revised Dengue Clinical Case

Management Guidelines 2011

42
 NATIONAL RABIES PREVENTION AND CONTROL PROGRAM

VISION: Rabies Free Philippines by 2020

GOAL: To eliminate rabies and declare the Philippines Rabies Free by the year 2020

RABIES

- A zoonotic disease and human infection caused by Lyssavirus, usually occurring

after a transdermal bite or scratch by an infected animal.
- Transmission may also occur when infectious material, usually the saliva, comes into
direct contact with the victims mucosa or fresh skin lesions.
- Very rarely, rabies may occur through inhalation of virus-containing aerosol or via
infected organ transplants.
- It is a highly fatal disease characterized by fluctuations in consciousness, phobic
or inspiratory spasms and autonomic instability.
- A neglected disease of poor and vulnerable populations whose deaths are rarely
reported.
- It occurs mainly in remote rural communities where measures to prevent dog to
human transmission have not been implemented.

FACTS AND FIGURES

- Rabies remains to be a public health problem in the Philippines

- It is the most acutely fatal infectious disease responsible for the death of 200-
250 Filipinos every year. At least one-third of human rabies deaths are among
children less than15 years of age. Two thirds of human rabies cases are males.
- Dogs are the source of the vast majority of human rabies deaths.
- The high cost of anti-rabies vaccine and immunoglobulins, expenditure for medical
consultations and the loss of income are an additional burden to a regular Filipino
family confronted with a potential rabies exposure.
- To date, 9 islands have been declared jointly by the DOH (Department of Health)
and DA (Department of Agriculture) as Rabies Free Zones. These islands include:
the provinces of Siquijor, Batanes, Biliran, Camiquin, Marinduque, the island
Municipality of Limasawa, Camotes Island, Daang Batayan of Cebu and Apo Island
of Negros Oriental.

HISTORY OF THE RABIES VACCINE

On the 6th of July 1885, Pasteur had an unexpected visitor from three people who
lived in the Alsace region of France. Monsieur Theodore Vone owned a dog who had
developed rabies. The dog, whos become wild, bit Joseph Meister, Vones nine-year-old
neighbor.

With the pair was Josephs distraught mother who knew her child would die if he
developed rabies. That seemed likely since the lad had fourteen dog bites.

43
What was Pasteur to do?

He knew that his vaccine had saved the lives of fifty dogs, but he did not know
whether it would work for a human. On the other hand, the boy would surely die if no one
tried to help him before he developed the symptoms of rabies.

When he described how he resolved his dilemma - to inject or not inject Joseph
with the rabies vaccine - Pasteur used these words (in English translation):

As the death of this child appeared inevitable, I decided, not without deep and
severe unease, as one can well imagine, to try on Joseph Meister the procedure
which had consistently worked in dogs.

Going forward with the first shot, Pasteur and two of his colleagues gave Joseph
another twelve injections over the next ten days. Pasteur explains:

...on July 6, at 8 in the evening, sixty hours after the bites of July 4, and in the
presence of Drs. Vulpian and Granter, one injected under a fold of skin in the right
hypochondrium, one-half Pravaz syringe of spinal cord of a rabbit dead of rabies on
June 21 and conserved since then in a flask of dry air, that is to say for 15 days.

What was the result?

Joseph survived! He was the first person to receive Pasteurs injections which
stopped the rabies virus (known as lyssavirus) in his body from progressing into a full-
blown, fatal illness.

RABIES IN HUMANS

- Bite and non-bite exposures inflicted by infected humans could theoretically

transmit rabies, but no such case has been documented in the country.
- The only documented human-to-human cases were through corneal as well as
through liver, kidney and other organ transplants.
- The rabies virus is not found in human or animal blood and feces thus, these body
fluids do not pose a risk for rabies transmission.
- Casual contact, such as touching/talking to a person with rabies or contact with
non-infectious fluid (blood, feces), does not constitute an exposure and does not
require post-exposure prophylaxis (PEP).

MODES OF TRANSMISSION

a) Bites from infected animals

- Most common mode of transmission of rabies to humans
- Exposure to rabies may come from bites of infected dogs, cats, other domestic
and wild animals including bats. However, bites from rats, rabbits, other rodents,
reptiles and birds do not pose a risk for rabies infection.

44
b) Non-bite exposures
- Are less important and are infrequent modes of transmission
- However, scratches, open wounds or mucous membranes that are licked by an
infected animal, can be points of entry of the rabies virus and these may be in the
form of the following:
Contamination of intact mucosa (eyes, nose, mouth, genitalia) with saliva
of infected animal
Licks on broken skin
Inhalation of aerosolized virus in closed areas (e.g. caves with rabid bats,
laboratories for rabies diagnosis).

INCUBATION PERIOD

Incubation period- the period from the time of exposure up to the appearance of
first clinical signs and symptoms of rabies.
The average incubation period of human rabies is between one to three (1-3)
months. In 90-95 % of cases, incubation period is less than one year but may be
longer in 5-10 % cases.
Duration of the incubation period depends on certain factors:
The amount of the virus inoculated into the wound or mucosa.
Severity of exposure - Patients with multiple and/or deep penetrating
bite wounds may have shorter incubation period.
Location of exposure - Patients with bite wounds in highly innervated
areas and/or close to the central nervous system may have shorter
incubation period.

CLINICAL STAGES

a) Prodromal Stage
- Occurs when there is initial viral replication at the striated muscle cells at the site
of inoculation just before it enters the brain.
- This stage lasts for 0-10 days with non-specific manifestations, which include
fever, sore throat, anorexia, nausea, vomiting, generalized body malaise, headache
and abdominal pain.
- Paresthesia or pain at the site of bite is due to viral multiplication at the spinal
ganglion just before it enters the brain.

b) Acute Neurologic
- The acute neurologic stage is the stage when the virus reaches the CNS and
replicates most exclusively within the grey matter.
- This stage has two types of presentation: encephalitic or furious type, which is
present in 80% of rabies cases, and paralytic or dumb type, which is seen in 20 %.
- Autonomic manifestations such as hypersalivation appear during this stage.
- This stage lasts for 2-7 days

45
 FURIOUS TYPE DUMB TYPE

Hyperactivity (anxiety, agitation, Acute progressive ascending myelitis,

running, biting, bizarre behavior
alternating with periods of calm) which
may occur spontaneously or may be
precipitated by tactile or auditory,
visual or other stimuli.
symmetrical or asymmetrical with
flaccid paralysis, pain and fasciculation
in the affected muscles with mild
sensory disturbance.

A complete paraplegia develops

The most characteristic symptom is eventually with fatal paralysis of the
spasm of the pharyngeal muscles often respiratory and pharyngeal muscles.
triggered by an attempt to drink water
(hydrophobia) or by blowing air on
patient's face (aerophobia). Spasmodic
contractions of the muscles may spread
to the respiratory and other muscles
leading to attacks of apnea.
c) Coma
- Begins within 10 days of onset, and the duration varies

d) Death
- Without intensive supportive care, respiratory depression, cardiorespiratory
arrest, and death occur in almost 100% of cases.

RABIES INFECTION IN DOGS

- Dogs are the principal reservoir of rabies in the country.

- Rabies in domestic animals like cattle, carabao, pigs, goats and horses has been
reported since the 1930s but were all traced to bite of rabid dogs.

INCUBATION PERIOD OF RABIES INFECTION IN DOGS

- Incubation period of rabies in dogs vary from 10-80 days after exposure.
- In majority of dogs, virus excretion begins at the earliest 2-7 days shortly before
or after the appearance of the clinical signs and symptoms of rabies.

LABORATORY DIAGNOSIS OF RABIES INFECTION IN DOGS

a) Fluorescent Antibody Test (FAT)

- The gold standard for laboratory diagnosis for animal rabies
- An immunoassay using monoclonal antibodies specific for rabies in an impression
smear of the hippocampus (Ammons horns) and brain stem treated with
fluorescent in isothiocyanate-labeled anti-rabies globulin. It needs a fluorescent
microscope to determine the staining reaction and the result may be obtained
within 24 hours.

46
 - In the absence of FAT, other examinations are Direct Microscopic Examination
(DME) and Mouse Inoculation Test (MIT).

b) Sellers Test or Negri Body Detection in Direct Microscopic Examination (DME)

- Technique using impression smear for the detection of rabies inclusion bodies
known as Negri bodies, through direct microscopic examination.
- Demonstration of typical Negri bodies with Direct Microscopic Examination (DME)
is considered diagnostic: however, the brains of as many as 15% of the infected
animals may not contain demonstrable Negri bodies.
- In cases in which Negri bodies cannot be demonstrated, Mouse Inoculation Test
(MIT) should be done.

c) Mouse Inoculation Test (MIT)

- An invivo test to confirm the infectivity of the rabies virus through virus isolation.
- Suckling mice (less than 3 days old) are more susceptible to rabies than weaning
and adult mice and should be used whenever possible. The long post-inoculation
observation period of 21 days limits its clinical usefulness in the management of
animal bite cases.

CATEGORIES OF RABIES EXPOSURE WITH CORRESPONDING

MANAGEMENT

CATEGORY OF TYPE OF EXPOSURE MANAGEMENT

EXPOSURE
CATEGORY I Feeding/touching an animal 1. Wash exposed skin
immediately with soap and
Licking of intact skin (with water.
reliable history and
thorough physical 2. No vaccine or RIG needed
examination)
Pre-exposure prophylaxis may
Exposure to patient with be considered for high risk
signs persons.
and symptoms of rabies by
sharing of eating or drinking
utensils

Casual contact (talking to,

visiting and feeding
suspected
rabies cases) and routine
delivery of health care to
patient with signs and
symptoms of rabies

47
CATEGORY II Nibbling of uncovered skin 1. Wash wound with soap
with or without and water.
bruising/hematoma 2. Start vaccine
immediately:
Minor /superficial a. Complete vaccination regimen
scratches/abrasions without until Day 28 if:
bleeding, including those i) biting animal is laboratory
induced to bleed proven to be rabid OR
ii) biting animal is killed/died
All Category II exposures without laboratory testing OR
on iii) biting animal has signs and
the head and neck area are symptoms of rabies OR
considered Category III iv) biting animal is not
and available for observation
should be managed as such for 14 days

b. May omit Day 28 dose if:

i) biting animal is alive AND
remains healthy after the 14-
day observation period, OR
ii) biting animal died within the
14 days observation period,
confirmed by veterinarian to
have no signs and symptoms of
rabies and was FAT negative

RIG is not indicated

CATEGORY III Transdermal bites (puncture 1. Wash wound with soap

wounds, lacerations, and water.
avulsions) 2. Start vaccine and RIG
or scratches/abrasions with immediately:
spontaneous bleeding a. Complete vaccination regimen
until Day 28 if:
Licks on broken skin or i) biting animal is laboratory
mucous proven to be rabid OR
membrane ii) biting animal is killed/died
without laboratory testing OR
Exposure to a rabies patient iii) biting animal has signs and
through bites, symptoms of rabies OR
contamination of mucous iv) biting animal is not available
membranes (eyes, for observation for 14 days
oral/nasal mucosa,
genital/anal mucous b. May omit Day 28 dose if:
membrane) or open skin i) biting animal is alive AND
lesions with body fluids remains healthy after the 14-
through splattering and day observation period, OR

48
 mouth-to-mouth biting animal died within the 14
resuscitation days observation period,
confirmed by veterinarian to
Unprotected handling of have no signs and symptoms of
infected carcass rabies and was FAT-negative.

Ingestion of raw infected

meat

Exposure to bats

All Category II exposures

on head and neck areas.

GUIDELINES IN THE PREVENTION AND CONTROL OF HUMAN RABIES

Pre-Exposure Prophylaxis (PrEP)

- Rabies vaccination administered before an exposure to potentially rabid animals.
- Given to high risk personnel and schoolchildren aged 5 to 14 in areas where there is
high incidence of rabies.

Post-Exposure Prophylaxis (PEP)

- Refers to anti rabies treatment administered after an exposure to potentially
rabid animals.
- It includes local wound care, administration of rabies vaccine with or without
Rabies Immunoglobulin (RIG) depending on the category of exposure.
- It is the most effective means of preventing rabies among exposed individuals. PEP
should be provided as soon as possible to all rabies exposure.
- Pregnancy and infancy are not contraindications to PEP with modern culture cell
vaccine and RIG.
- Babies who are born to rabid mothers should be given rabies vaccination as well as
RIG as early as possible upon birth.
- Exposed persons who are present for evaluation or treatment weeks or months
after the bite should be managed as if the exposure has occurred recently.
However, if the biting animal has remained healthy and alive with no signs of rabies
until 14 days after the bite, PEP is no longer recommended.
- PEP is required for bites by livestock (cows, pigs, horses, goats, etc.) as well as wild
animals (monkeys, bats). PEP is not recommended for bite/s of rats, mice, rabbits,
snakes and other reptiles, avians, insects and fish.

49
LOCAL WOUND CARE

a) Wash wounds immediately and vigorously with soap/ detergent, and water,
preferably for 10 minutes. If soap is not available, the wound should be thoroughly
and extensively washed with water.
b) Apply alcohol, povidone iodine or any antiseptic.
c) Mucous membranes such as eyes, nose or mouth shall be flushed well with water.
d) Suturing of wounds should be avoided since it may inoculate the virus deeper into
the wounds. Wounds may be coaptated using sterile adhesive strips. If suturing is
unavoidable, it should be delayed for at least 2 hours after administration of RIG
to allow diffusion of the antibody to the tissues.
e) Do not apply any ointment, cream or wound dressing to the bite wound.
f) The public should be educated in simple local wound treatment and warned not to
use procedures that may further contaminate the wounds (e.g. tandok, bato,
rubbing garlic on the wounds and other non-traditional practices.
g) Antimicrobials are recommended for the following conditions:
All frankly infected wound
All category III cat bites
All other category III bites that are either deep, penetrating, multiple or
extensive or located on the hand, face and genital area.
Anti- tetanus immunization may be given if indicated. History of tetanus
immunization (TT/DPT/Td) should be reviewed. Animal bites are considered
tetanus prone wounds. Completion of the primary series of tetanus
immunization is required

IMMUNIZATION

a) Active Immunization
- Refers to the administration of vaccine to induce protective immune response
through antibody and T-cell production in order to neutralize the rabies virus in
the body.
- It induces an active immune response in seven ten (7-10) days after vaccination
which persists for many years provided that primary immunization is completed.

b) Passive Immunization
Rabies Immunoglobulin (RIG) is given in combination with rabies vaccine to
provide the immediate availability of neutralizing antibodies at the site of
the exposure before it is physiologically possible for the patient to begin
producing his or her own antibodies after vaccination. This is given to
patients with Category III exposures. However, immunocompromised
individuals such those with HIV Infection, cancer/transplant patients,
patients on immunosuppressive therapy should be given RIG for both CAT II
and III exposures. Human Rabies Immunoglobulin (HRIG) has a half-life of
approximately 21 days while Equine Rabies Immunoglobulin (ERIG) is 14 days

50
DATES TO REMEMBER

March Rabies Awareness Month in the Philippines by virtue of Executive Order

No. 84, signed by Pres. Joseph Estrada in 1999

September 28 celebrated as World Rabies Day

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Republic Act 9482 also known as Anti-Rabies Act of 2007

An Act Providing for the Control and Elimination of Human and Animal Rabies,
Prescribing Penalties for Violation Thereof and Appropriating Funds Therefor

51
 NATIONAL TUBERCULOSIS CONTROL PROGRAM (NTP)

TUBERCULOSIS (TB)

- An infectious disease caused by the bacteria Mycobacterium tuberculosis

- It is transmitted by a TB patient to another person through coughing, sneezing and
spitting.
- Lungs are commonly affected but it could also affect other organs such as the
kidney, bones, liver and others.
- It is curable and preventable
- Incomplete or irregular treatment may lead to drug-resistant TB or even death
- A major health problem in the Philippines
- In 2010, TB was the 6th leading cause of mortality in the Philippines with a rate of
26.3 deaths for every 100,000 population and accounts for 5.1% percent of total
deaths.
- More males died compared to females.
- More prevalent among males compared to females and among the 25-55 year old
age group
- Higher among the malnourished and diabetics

National TB Control Program (NTP)

I. Case Finding

o Identification and diagnosis of TB cases among individuals with signs and

symptoms presumptive of tuberculosis.
o The objective is the early identification and diagnosis of TB cases

AVAILABLE TESTS FOR DIAGNOSING TB

Direct Sputum Smear Microscopy (DSSM)

o Fundamental to the detection of infectious cases Recommended for case

finding among adults and children who can expectorate
o Primary diagnostic method adopted by the NTP because of the following
reasons:
It provides a definitive diagnosis of active TB
The procedure is simple
It is economical
A microscopy center could be put up even in remote areas
o Serves as one of the bases for categorizing TB cases according to standard
case definition, used to monitor progress of patients with TB while they are
on antiTB treatment and confirm cure at the end of treatment.

Chest X-ray (CXR)

o Used to complement bacteriologic testing in making a diagnosis

52
 o Has low specificity and does not differentiate drug-susceptible from drug-
resistant disease

TB Culture and Drug Susceptibility Test (DST) Using Solid or Liquid Media

o Routine diagnostic test for drug-resistant TB under the NTP

o Used for TB prevalence surveys, drug resistance surveillance, research and
other special cases

Tuberculin Skin Test (TST)

o Basic screening tool for TB infection among children using purified protein
derivative (PPD) tuberculin solution to trigger a delayed hypersensitivity
reaction among those previously infected
o One of the criteria used in determining disease activity among children
o Also known as PPD or Mantoux Test

WHO-endorsed available diagnostic tests like Xpert MTB/RIF and Line-

Probe Assay (LPA) for first line drugs.

o Xpert MTB/RIF assay is a rapid test that detects Mycobacterium

tuberculosis and rifampicin resistance

CLASSIFICATION BASED ON BACTERIOLOGICAL STATUS

1) BACTERIOLOGICALLY-CONFIRMED

- A TB patient from whom a biological specimen is positive by smear microscopy,

culture or rapid diagnostic tests (such as Xpert MTB/RIF).

2) CLINICALLY-DIAGNOSED

- A PTB patient who does not fulfill the criteria for bacteriological confirmation but
has been diagnosed with active TB by a clinician or other medical practitioner who
has decided to give the patient a full course of TB treatment.
- This definition includes cases diagnosed on the basis of CXR abnormalities or
suggestive histology, and extra-pulmonary cases without laboratory confirmation.

CLASSIFICATION OF TB DISEASE BASED ON ANATOMICAL SITE

1) PULMONARY TB (PTB)
- Refers to a case of tuberculosis involving the lung parenchyma. A patient with both
pulmonary and extra-pulmonary TB should be classified as a case of pulmonary TB.

53
 2) EXTRA-PULMONARY TB (EPTB)
- Refers to a case of tuberculosis involving organs other than the lungs (e.g., larynx,
pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones,
meninges).
- Laryngeal TB, though likely sputum smear-positive, is considered an extrapulmonary
case in the absence of lung infiltrates on CXR.

CLASSIFICATION BASED ON HISTORY OF PREVIOUS TREATMENT

a) New case A patient who has never had treatment for TB or who has taken
anti-TB drugs for less than 1 month.
b) Retreatment case- A patient who has been previously treated with anti-TB
drugs for at least 1 month in the past.

CLINICAL SIGNS AND SYMPTOMS OF PRESUMPTIVE TB

Presumptive TB any person whether adult or child with signs and/or symptoms
suggestive of TB whether pulmonary or extrapulmonary, or those with Chest X-ray
findings suggestive of active TB.

1) For patients 15 years old and above

a) Cough of at least 2 weeks duration with or without the following signs and
symptoms:
Significant and unintentional weight loss
Fever
Bloody sputum (hemoptysis)
Chest/back pains not referable to any musculoskeletal disorders
Easy fatigability or malaise
Night sweats
Shortness of breath or difficulty of breathing

b) Unexplained cough of any duration in:

A close contact of a known active TB case
High-risk clinical groups such as those with HIV/AIDS, diabetes, end-stage
renal disease, cancer, connective tissue diseases, autoimmune diseases,
silicosis, patients who underwent gastrectomy or solid organ transplantation
and patients on prolonged systemic steroids.
High risk populations such as elderly, urban poor, inmates and other
congregate settings

2) For patients below 15 years old

a) At least three (3) of the following clinical criteria:
Coughing/wheezing of 2 weeks or more, especially if unexplained
Unexplained fever of 2 weeks or more after common causes such as malaria
or pneumonia have been excluded
Loss of weight/failure to gain weight/weight faltering/loss of appetite

54
 Failure to respond to 2 weeks of appropriate antibiotic therapy for lower
respiratory tract infection
Failure to regain previous state of health 2 weeks after a viral infection or
exanthema (e.g. measles).
Fatigue, reduced palyfulness, or lethargy

b) Any one of the above symptoms in a child who is a close contact of a known
active TB case.
3) Chest X-ray findings suggestive of PTB, with or without symptoms, regardless of
age.

II. Case Holding

o Set of procedures which ensures that patients complete their treatment.

o The objective is to ensure effective and complete treatment of all TB cases
for both adults and children.

DIRECTLY OBSERVED TREATMENT, SHORT COURSE (DOTS)

- The name given to the tuberculosis control strategy recommended by the World
Health Organization (WHO).
- A method developed to ensure treatment compliance by providing constant and
motivational supervision to TB patients.
- DOT works by having a responsible person, referred to as treatment partner,
watch the TB patient take anti-TB drugs every day during the whole course of
treatment.

FIVE KEY COMPONENTS OF DOTS

1) Government commitment
2) Case detection by sputum smear microscopy
3) Standardized treatment regimen of six to eight months observed by a healthcare
worker or community health worker for at least the first two months
4) A drug supply
5) A standardized recording and reporting system that allows assessment of treatment
results

DRUG FORMULATION

1) Fixed-dose combinations
- Two or more first-line anti-TB drugs are combined in one tablet
HR (Isoniazid and Rifampicin)
HRE (Isoniazid, Rifampicin and Ethambutol)
HRZE (Isoniazid, Rifampicin, Pyrazinamide and Ethambutol)

2) Single Drug Formulation (SDF)

- Each drug is prepared individually, either as tablet, capsule, syrup or injectable
(Streptomycin) form.

55
DECIDING WHEN AN ADULT PATIENT IS NO LONGER INFECTIOUS DURING

TREATMENT

1) For bacteriologically-confirmed adult patients

- Sputum microscopy can be done one month after the start of treatment for
purposes of certifying that the patient can return to work/school
- The patient is not longer infectious only after sputum result is smear-negative
- No bacteriologically-confirmed case should be allowed to return to work without a
negative follow-up smear examination.

2) For clinically diagnosed adult patients

- The patient is no longer infectious and can safely return to school/work after two
(2) weeks of appropriate and adequate therapy for as long as treatment compliance
is assured and there is clinical improvement or no clinical deterioration.

TREATMENT MODIFICATIONS FOR SPECIAL SITUATIONS

1) Pregnancy

Most anti-tuberculosis drugs are safe for pregnant women except

Streptomycin.
2) Breastfeeding

A breastfeeding woman afflicted with TB should receive a full course of TB

treatment. Timely and properly applied chemotherapy is the best way to
prevent transmission of tubercle bacilli to the baby.
In lactating mothers on treatment, most anti-tuberculosis drugs will be
found in breastmilk in concentrations equal to only a small fraction of the
therapeutic dose in infants. However, effects of such exposure on infants
have not been established. It is recommended that lactating mothers feed
their infants before taking medications.
3) Oral contraceptives

Rifampicin interacts with oral contraceptive medications with a risk of

decreased protective efficacy against pregnancy.
4) Liver Disease or History of Liver Disease

Isoniazid, Rifampicin and Pyrazinamide are all associated with hepatitis.

Pyrazinamide is the most hepatotoxic.

III. Prevention of TB

a. Depends largely on preventing exposure and infection.

b. Can be achieved through TB infection control, universal use of BCG and
Isoniazid Preventive Therapy (IPT).
1) TB Infection Control
i. Early detection and treatment of TB, and prompt screening of
household contacts
ii. Practice cough etiquette

56
 Cough or sneeze on a hanky or tissue
When someone nearby sneezes or coughs, cover nose and
mouth
Wash hands after coughing or sneezing
iii. Minimizing time spent by infectious TB patient in crowded public
places
iv. Opening windows and removing any obstruction to ventilation in rooms
where TB patient sleeps or spends much time
2) Universal Use of BCG
v. The BCG (Bacillus Calmette-Guerin) is given at birth or anytime after
birth.
3) Isoniazid Preventive Therapy (IPT)

IV. Recording and Reporting

c. Important in the implementation of a successful TB control program

DATES TO REMEMBER

March 24 World TB Day

This annual event commemorates the date in 1882 when Dr. Robert Koch
announced his discovery of Mycobacterium tuberculosis, the bacillus that
causes TB.

August National TB Awareness Month in the Philippines

August 19 National Tuberculosis Day in the Philippines by virtue of

Proclamation No. 840, s. 1996

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Republic Act No. 10767 also known as Comprehensive Tuberculosis Elimination

Plan Act
An Act Establishing a Comprehensive Philippine Plan of Action to Eliminate TB
as a Public Health Problem and Appropriating Fund Therefor

Republic Act No. 1136

An Act Reorganizing the Division of Tuberculosis in the Department of Health

Administrative Order No. 2015-0029 - Revised Policies and Guidelines on

Hospital TB-DOTS under the National TB Control Program

Administrative Order No. 2008-0022 - Policies and Guidelines in the

Collaborative Approach of TB and HIV Prevention Control

57
 HUMAN IMMUNODEFICIENCY VIRUS (HIV)/ ACQUIRED IMMUNE
DEFICIENCY SYNDROME (AIDS)

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

- A retrovirus that causes AIDS by infecting T-helper cells, sometimes referred to
as the CD4+lymphocyte, of the immune system.
- HIV can ONLY infect human
- There is still no cure for HIV but there are medicines available to delay the
progression of the disease
- One cannot tell if a person is HIV-positive based on outward appearance alone. If
the person is still at the asymptomatic stage, he may look healthy and fit.

FOUR STAGES OF HIV INFECTION

a) FIRST STAGE - Primary HIV infection or the window period

- Lasts from six weeks to six months
- Often accompanied by a short flu-like illness
b) SECOND STAGE - Clinically asymptomatic stage
- Lasts for an average of ten years
- One is free from major symptoms during this period, although there may be swollen
glands.
- Characterized by very low levels of HIV in the peripheral blood, but a person remains
infectious
c) THIRD STAGE - Symptomatic HIV infection
- Reached when HIV has severely damaged the immune system
- Symptoms begin to show as the immune system breaks down. Most of the symptoms
are mild at first, but they get worse as the immune system progressively weakens
- The advent of certain opportunistic infections characterizes this stage
d) FINAL STAGE - AIDS

ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

- The terminal stage of HIV infection

- Characterized by a decrease in the number of T-helper cells, which causes the
immune systems irreversible breakdown and leaves the body susceptible to a variety
of potentially fatal infections
- The collection of symptoms and infections associated with acquired deficiency of
the immune system
- Because a persons immune system is severely compromised, death becomes
imminent.

58
FACTS AND FIGURES

- The first case of HIV in the Philippines was reported in 1984

- From 1984 to February 2017, there were 41,315 total reported cases in the
Philippines
- From January to December 2016:
26 people are diagnosed with HIV per day
There were 1,113 AIDS cases
9 out of 10 are asymptomatic
63 women living with HIV are pregnant
There were 9, 264 total reported cases of HIV
- In February 2017, there were 849 reported new HIV anti sero-positive individuals.
- The following regions have the most number of reported cases in February, 2017:
a) National Capital Region (NCR) 310 cases
b) Region 4A- 129 cases
c) Region 2- 102 cases
d) Region 7- 79 cases
e) Region 11- 52 cases
f) Rest of the country- 177 cases

FOUR BODY FLUIDS KNOWN TO TRANSMIT HIV

- Blood
- Semen
- Vaginal/Cervical Fluid
- Breastmilk

MODES OF TRANSMISSION
a) SEXUAL CONTACT
Primary mode of HIV transmission
Having multiple sexual partners increases the risk of HIV infection, for a single
act of unprotected sex alone could result in contracting the virus

b) INFECTED BLOOD AND BLOOD PRODUCTS

HIV-infected blood could be present in any used needle or instrument that has
not been properly sterilized
People who inject drugs are considered to be at risk if they share needles
Through blood, blood products received during blood transfusion or organ
transplants

c) MOTHER TO CHILD
An HIV-infected mother could transmit the infection to the baby during
pregnancy, normal delivery or breastfeeding.
She can infect the baby in her womb through her blood.

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 The baby is more at risk if the mother has been recently infected or is in the
later stage of AIDS.

ACTIVITIES THAT DO NOT ALLOW HIV TRANSMISSION

- Casual contacts like sharing of food and utensils, shaking hands, hugging or kissing,
coughing, sneezing, using public phone, visiting a hospital.
- Feces, urine, saliva, sweat, tears
- Donating blood
- Sharing toilets
- Insect bites
- Swimming pools

REMEMBER
- Since HIV cannot be transmitted through casual contacts, there is no need to
stigmatize and discriminate against HIV-positive individuals

PERSONS AT RISK FOR CONTRACTING HIV

a) Anyone who engages in unprotected sexual activity with an infected partner
b) Recipients of transfused blood or blood components
c) I.V drug abusers
d) Children (perinatal) of mothers with HIV
e) Healthcare workers exposed to HIV by needle stick (The incidence for healthcare
workers exposed to HIV by needle stick is estimated to be less than 1%)

THE ABCDE OF PREVENTION

ABSTINENCE
BE FAITHFUL
CORRECT AND CONSISTENT CONDOM USE
DO NOT INJECT DRUGS
EDUCATING THE PUBLIC ABOUT HIV AND AIDS

Examples of Opportunistic Infections

Opportunistic infection is an infection or malignancy that attacks the body by taking
advantage of an immune system that has been severely weakened by an advanced HIV
infection.

a) Lung infection
Most patients die as a result of one lung infection or another
TB is an opportunistic infection common patients living with HIVs (PLHIV)

b) Fungal Infections
Fungi can start growing causing thrush in the mouth, skin, intestinal tract or
vagina. The infection can spread throughout the body and result in death.

c) Skin conditions

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 Kaposis sarcoma and shingles are two of the most common opportunistic skin
conditions

DATES TO REMEMBER

December 1 celebrated as World AIDS Day

April 13, 1999 promulgation of the Implementing Rules and Regulations (IRR) of
R.A. 8504

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

Republic Act No. 8504 also known as the Philippine AIDS Prevention and Control
Act of 1998
An act promulgating policies and prescribing measures for the prevention and
control of HIV/AIDS in the Philippines, Instituting a Nationwide HIV/AIDS
Information and Education Program, establishing a comprehensive HIV/AIDS
monitoring system, strengthening the Philippine National AIDS council, and for
other purposes.

- KEY PROVISIONS OF R.A. 8504

a) Article I: Education and Information
The following are the information to be disseminated:
o Definition of HIV and AIDS
o Causes and Modes of Transmission
o Consequences of Infection
o Means of Prevention
b) Article II: Safe Practices and Procedures
c) Article III: Testing, Screening and Counselling
o R.A. 8504 strictly prohibits compulsory HIV testing
o HIV testing should be voluntary and with written informed consent
o All individuals who volunteer to be tested should be given counselling
before and after the test
o There are exceptions to the prohibition of mandatory testing:
Upon court order when the person is charged with any of the
following crimes: administering injurious substances, rape,
qualified seduction and simple seduction
When complying with the provisions of RA 7170 or the Organ
Donation Act
When complying with RA 7719, or the National Blood Services
Act
Upon court order when the determination of ones HIV status is
necessary to resolve relevant issues under the Family Code

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 d) Article IV: Health Support and Services
e) Article V: Monitoring
Why do we have to monitor HIV and AIDS?
o To evaluate the adequacy and efficacy of
countermeasures
o To determine the magnitude and progression of HIV and
AIDS in our country
f) Article VI: Confidentiality
All health practitioners and hospital staff must observe strict medical
confidentiality in handling the medical records of patient living with
HIV (PLHIVs) or those who undergo HIV testing
g) Article VII: Discriminatory Acts and Policies
h) Article VIII: The PNAC (PHILIPPINE NATIONAL AIDS COUNCIL)

Note: The Implementing Rules and Regulations (IRR) of R.A. 8504 stipulate that the
deceased PLHIV should be buried 24 hours after death.

Executive Order No. 39 created the Philippine National Aids Council (PNAC)
which was to serve as a presidential advisory body on matters related to HIV and
AIDS

DOLE Department Order No. 102-10 s. 2010 - Guidelines for the

Implementation of HIV and AIDS Prevention and Control in the Workplace
Program

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 SEXUALLY TRANSMITTED INFECTION (STI)

WHAT IS SEXUALLY TRANSMITTED INFECTION OR STI?

- An infection primarily transmitted through sexual contact, but may also be

transmitted through non-sexual means like skin-to-skin contact, hand to eye and
mother to child as well as through blood transfusions or shared needles.
- They may be caused by bacteria, viruses, or parasites.
- Most STIs are curable, but not chronic hepatitis, genital herpes and HIV
- Primarily due to the stigma and discrimination attached to STI, however, access to
medical services remains low which can lead to lifetime complications such as
sterility or even death

SIX COMMON SIGNS AND SYMPTOMS OF STIs

a) Pain when passing urine

b) Severe itchiness
c) Pain during sexual intercourse
d) Yellowish or abnormal discharge
e) Ulcerations
f) Abdominal pain

TWO MAIN GROUPS OF STI

a) Bacterial STI
- Caused by bacteria and are curable with antibiotics
- Many bacterial STI do not show any symptoms, they are left untreated for a long
time
- Extended infection can lead to pelvic inflammatory disease (PID), an infection of
the female reproductive organs (ex: uterus, fallopian tubes and ovaries)
- Can increase the chance of spreading the infection to other people

b) Viral STI
- Caused by viruses
- Have no known cure
- Once a person contracts a viral STI, he or she has it for life
- Though this type of infection cannot be cured, safer sex practices can help to
ensure that viral STIs are not transmitted to anyone else
- The symptoms can alleviated by medical treatment

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COMMON TYPES OF BACTERIAL STI

1) Gonorrhea
Caused by bacteria called Neisseria gonorrheae
Usual incubation period is 3 to 7 days
Can be spread through sexual contact
Can affect genitals, throat and anus
Symptoms:
o Yellowish/purulent discharge (tulo)
o Pelvic inflammation in women
o Scrotal swelling in men
Complications:
For males:
o May result in sterility when scar tissue blocks the reproductive
tract
o Infection of other organs such as the heart or joints
For females
o Eye infection, which may lead to blindness; infection may also be
transmitted to babies
o Pelvic inflammation

2) Chlamydia
Caused by Chlamydia trachomatis
Can infect the cervix, urethra, rectum, throat and eyes
Also known as the silent STI
Symptoms:
o Pelvic inflammation
o Discharge
o Scrotal swelling in men
Complications:
o May cause sterility

3) Syphilis
Caused by spirochete Treponema pallidum
Chronic systemic disease (9-90 days)
The organism moves through skin or mucus membrane and into the bloodstream
Can be transmitted through mother to child, blood transfusion, sexual contact
SYMPTOM: Lesion
Complications:
o May cause paralysis, insanity and death
o May be transmitted to babies

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COMMON TYPES OF VIRAL STI

1)Genital Warts
Caused by human papilloma virus (HPV)
Transmitted directly from skin to skin during sexual contact
Symptoms:
o Lesions
o Warty growths
HPV can eventually lead to cervical cancer in women

2) Herpes
Caused by herpes simplex virus of which there are two types:
o HSV-type 1 causes fever blisters on the mouth or face (oral herpes)
o HSV-type 2 usually affects the genital area (genital warts)
Incubation period is 2-12 days
Genital herpes spread through anal, oral, vaginal sex as well as through kissing
and skin-to-skin contact
It can also be transmitted with or without the presence of sores or other
symptoms
Symptoms:
o Multiple, painful shallow ulcers
o Painful urination
Pregnant women with genital herpes can cause potentially fatal infections in their
infants. Thus, women with active genital herpes at the time of giving birth
undergo a caesarean-section (CS) delivery to prevent the baby from getting
infected.
People with herpes may be more susceptible to HIV infection, and HIV-infected
individuals with herpes may be more infectious.

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 DANGEROUS DRUGS CAMPAIGN
DRUGS

Drugs are chemicals that affect a person in such a way as to bring about
physiological, emotional, or behavioral change.

DANGEROUS DRUGS

Those that have high tendency for abuse and dependency, these substances may be
organic or synthetic, and pose harm to those who use them.

DRUG ABUSE

Exists when a person continually uses a drug other than its intended purpose. This
continued use can lead to drug dependence, a state of physical and psychological
dependence or both on a dangerous drug.

DRUG ADDICTION

A complex, and often chronic, brain disease. It is characterized by excessive drug

craving, seeking, and use. Addiction is caused by brain changes caused by constant
drug use.

DEPENDENCY

This is the state of physical and psychological dependence, or both, on a dangerous

drug, or drugs, experienced by a person following the use of that substance on a
periodic or continuous basis. A person dependent on drugs will experience
withdrawal reactions (also known as cold turkey, symptoms that occur after long-
term use of a drug is reduced or stopped abruptly) after abstaining from drugs.

DRUG ABUSE BY THE NUMBERS

Estimated Drug Users in the Philippines: 1.3 Million

Profile of Drug Users:
o Mean Age: 20-29 years old
o Ratio of Male is to Female Users: 10:1
o Civil Status: Married
o Employment Status: Employed
o Educational Attainment: High School Level
Nature of Drug Use: Poly drug use
Commonly Abused Substances:
1) Methamphetamine Hydrochloride (Shabu)
2) Cannabis (Marijuana)
3) Inhalants (Contact Cement)

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MOST COMMONLY ABUSED SUBSTANCES AND THEIR ILL EFFECTS

1) Methamphetamine Hydrochloride (Shabu)

Methamphetamine hydrochloride is found to have harmful effects to the brain. It

changes how the brain functions. Studies have shown that methamphetamine
abusers have reduced motor skills and impaired verbal learning as a result of
alterations in the activity of the dopamine, a neurotransmitter involved in reward,
motivation, experience of pleasure and motor function.
Street names: shabs, ice, meth, crystal, kristal, basura, tawas
Other adverse effects of methamphetamine:
o Extreme weight loss
o Severe dental problems (meth mouth)
o Anxiety
o Confusion
o Insomnia
o Mood disturbances
o Violent behaviour

2) Cannabis Sativa (Marijuana)

Marijuana use impairs a person's ability to form new memories and to shift focus.
Its active component, tetrahydrocannabinol (THC) also disrupts coordination and
balance, posture, and reaction time (experience commonly referred to as spacing
out). Thus, chronic marijuana use significantly reduces a persons capacity to learn,
carry-out complicated tasks, participate in sports, driving and operating other
machineries. Studies also show that marijuana use can lead to lung cancer and
other problems in the respiratory and immune systems.
Street names: weed, jutes, pot, grass, damo, chongke
Health problems that come with the use of marijuana include:
Problems with memory and learning
Distorted perception (sights, sounds, time, touch)
Trouble with thinking and problem solving
Loss of motor coordination
Increased heart rate and palpitations

3) Inhalants

The effects of inhalants are similar to that of alcohol, including slurred speech,
lack of coordination, euphoria and dizziness. Inhalant abusers may also experience
lightheadedness, hallucinations, and delusions.
Harmful irreversible effects of inhalants include:
o Hearing loss
o Limb spasms
o Central nervous system or brain damage
o Bone marrow damage

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CLASSIFICATION OF DRUGS BASED ON THEIR PHARMACOLOGICAL EFFECTS

a) Stimulants
o Drugs which increase alertness and physical disposition
o Examples: amphetamine, cocaine, caffeine and nicotine

b) Hallucinogens (also called psychedelics)

o Drugs which affect sensation, thinking, self-awareness and emotion
o Changes in time and space, delusions and hallucinations that may be mild or
overwhelming depending on dose and quality of drugs
o Examples: LSD, mescaline, marijuana

c) Sedatives
o Drugs which may reduce anxiety and excitement
o Examples: barbiturates, non-barbiturates, tranquilizers and alcohol

d) Narcotics
o Drugs that relieve pain and often induce sleep
o Examples: opium and its derivatives such as morphine, codeine and heroin

SIGNS OF DRUG ABUSE

The following are common signs of drug revealed by individual using drugs. While not
all of these signs mean that one person is involved in drugs and there could be some other
physical or emotional problem that is causing these behaviors, there is high chance that
drug use may be a possibility:

declining interest in school or work

suddenly changes friends (hangs out with individuals known for their drug use)
becomes pessimistic, irritable and anxious all the time
asks to be left alone a lot
is always tired (or makes it as an excuse to be left alone)
becomes careless and often becomes involved in accidents
becomes implicated in a lot of fights
frequent mood swings
sudden change in appearance and conduct (red or puffy eyes, weight changes,
constant complaints of headaches or stomachaches, shaking, incessant cough,
brown stains on fingertips, stumbling, or a constant runny nose)
loss of interest in hobbies or sports
exhibits poor judgment
finds it difficult to concentrate

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DATES TO REMEMBER

THIRD (3RD) WEEK OF NOVEMBER Observed as Drug Abuse Prevention and

Control Week in the country

GOVERNING LAWS (RA, EO, PD, AO, MEMORANDUMS, ORDERS)

REPUBLIC ACT NO. 9165 also known as the Dangerous Drugs Act of 2002
AN ACT INSTITUTING THE COMPREHENSIVE DANGEROUS DRUGS ACT OF
2002, REPEALING REPUBLIC ACT NO. 6425, OTHERWISE KNOWN AS THE
DANGEROUS DRUGS ACT OF 1972, AS AMENDED, PROVIDING FUNDS
THEREFOR, AND FOR OTHER PURPOSES.

DepEd Memorandum No. 200 s. 2016

STRENGTHENING THE NATIONAL DRUG EDUCATION PROGRAM IN SCHOOLS

NATIONAL DRUG EDUCATION PROGRAM (NDEP)

- A comprehensive educational program that provides for a holistic approach to the
problem of drug abuse.
- Implemented in the schools to create awareness on the ill effects of abusing drugs
and to develop among pupils and students positive behavior and life skills to resist
drugs.
- Based on DepEd Memo No. 200 s. 2016, the school heads are fully responsible for
its effective implementation.
- It has five components:
a) Curriculum and instruction
b) Co-curricular and ancillary services
c) Teacher and staff development
d) Parent education and community outreach
e) Research, monitoring and evaluation

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 DENTAL PROGRAMS (ORAL HEALTH AWARENESS WEEK/NATIONAL
DENTAL HEALTH MONTH/ BRIGHT SMILES, BRIGHT FUTURES
PROGRAM)
Rationale:

The month-long activities are designed to emphasize the primary role the schools
play in the governments effort to promote oral health, its direct link to general health and
well- being, and its role towards improving learning outcomes and reducing absenteeism.

The Bright Smiles, Bright futures program aims to ensure the implementation of the
Tooth brushing Habit Campaign in the morning or after meals, to ensure that toothbrushes
and toothpastes provide are kept in classroom and not brought home by the students, that
is the reason why toothbrush holders must be provided in each classroom for storage. With
the assistance and support of the parents and teachers, the students took benefit upon
the distribution and utilization of Colgate toothbrushes, toothpastes and BSBF new oral
health education materials. Rest assured that the students can say goodbye to cavities and
hello to healthy teeth. The toothbrushes and toothpaste were regularly monitored by the
dental team during school visits. It is to ensure that tooth brushing habits are being
implemented in the school premises regularly.

Description:

DENTAL CARIES

There are four main criteria required for caries formation:

a. a tooth surface (enamel or dentin)

b. caries- causing bacteria
c. fermentable carbohydrates (such as sucrose)
d. time

The bacteria most responsible for dental cavities are:

a. Stretococcus mutans
b. Streptococcus sobrinus and
c. lactobacilli

Tooth decay disease is caused by specific types of bacteria that produce acid in the
presence of fermentable carbohydrates such as:

a. sucrose
b. fructose
c. glucose

Most plaque-retentive areas:

a. between teeth and

b. inside pits and fissures on chewing surfaces

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 Some foods have an acidic pH of 5.5 or lower which can result in demineralization in
the absence of bacteria. This is known as erosion, rather than caries, because the
acid is not bacterial in origin.
Amelogenesis imperfect- a disease in which the enamel does not fully form or forms
in insufficient amounts and can fall of a tooth. In both cases, teeth may be left more
vulnerable to decay because the enamel is not able to protect the tooth.

Wider variety of bacteria that can cause root caries includes:

a. Lactobacillus acidophilus
b. Actinomyces spp.,
c. Nocardia spp., and
d. Streptococcus mutans.

Bacteria collect around the teeth and gums in a sticky, creamy-coloured mass called
plaque, which serves as a biofilm. Some sites collect plaque more commonly than
others, for example sites with a low rate of salivary flow (molar fissures). Grooves
on the occlusal surfaces of molar and premolar teeth provide microscopic retention
sites for plaque bacteria, as do the interproximal sites. Plaque may also collect above
or below the gingiva where it is referred to as supra- or sub-gingival plaque,
respectively.

Medical conditions that reduce the amounts of saliva produced by salivary glands:
a. Sjogrens syndrome
b. Diabetes mellitus
c. Diabetes insipidus
d. Sarcoidosis.

Medications that can impair salivary flow:

a. Antihistamines
b. Antidepressant

Tobacco use is a significant risk factor for periodontal disease, which can cause the
gingiva to recede. As the gingiva loses attachment to the teeth due to gingival
recession, the root surface becomes more visible in the mouth. If this occurs, root
caries is a concern since the cementum covering the roots of teeth is more easily
demineralized by acids than enamel. Currently, there is not enough evidence to
support a casual relationship between smoking and coronal caries, but evidence does
suggest a relationship between smoking and root-surface caries.

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 Forms are available for risk assessment for caries when treating dental cases; this
system using the evidence-based Caries Management by Risk Assessment (CAMBRA).
It is still unknown if the identification of high-risk individuals can lead to more
effective long-term patient management that prevents caries initiation and arrests
or reserves the progression of lesions.

Mode of Transmission:

o Mutans streptococci are transmitted through saliva, most frequently

the mothers, to the infant.
o When a mother has a high count of mutans streptococci in her mouth,
the baby has a high count of the same bacteria in his or her mouth.
o Women should be certain that their own mouths are healthy.
o When the number of caries-causing bacteria in the mouth increases,
the risk of dental caries also increases.

GUM DISEASE

Periodical disease, also called gum disease, is mainly caused by bacteria from plaque
and tartar build up. Other factors that have the potential to cause gum disease may include:

Tobacco use
Clenching or grinding your teeth
Certain medications
Genetics

Types of Gum Disease Include:

Gingivitis - The beginning stage of gum disease and often undetected. This stage of the
disease is reversible.

Periodontitis - Untreated gingivitis may lead to this next stage of gum disease. With many
levels of periodontitis, the common outcome is chronic inflammatory response, a condition
when the body breaks down the bone and tissue in the infected are of the mouth, ultimately
resulting in tooth and bone loss.

Signs of Gum Disease Include:

Red, bleeding, and/or swollen gums

Bad Breath
Mobility of the teeth
Tooth sensitivity caused by receding gums
Abscessed teeth
Tooth loss

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Disease can be easily treated if it is diagnosed in the early stages. It is important to notify
your dentist if you have any of these following warning sign of gum disease:

1. Your gums bleed easily.

2. Your gums are very red, tender and/or swollen.
3. You can see pus in between your teeth and gums when they are pressed,
4. Your gums seem to be pulling away from your teeth.
5. You have chronic bad breath or a bad taste in your mouth.
6. You notice a change in your bite or in the way your teeth fit together,
7. You teeth are loose or they are separating.
8. The fit of your partials or dentures have changed.

Treatments for Gum Disease

Depending on the type of gum disease, some of the available treatment options are:

Removal of plaque and calculus by way of scaling done by your dental hygienist or
dentist.
Medications such as chlorhexidine gluconate, a mouth rinse prescribed by your
dentist or hygienist to help kill the bacteria in your mouth, along with frequent
cleaning.
Surgery may be necessary in certain cases to stop, halt, or minimize the progression
of periodontal disease. Surgery is also used to replace bone that was lost in advances
stages of the disease.

Date of Celebration:

Oral Health Awareness Week every month of October

National Dental Health Month every month of February
Bright Smiles Bright Futures between months of September-November (depending
on the delivery of Colgate products in the Division)
Memorandums:
o Bright Smiles Bright Futures- DepEd Memo no. 394.s 2007

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