2 | Community Health Nursing 1 1

PREFACE
  Nursing is a difficult course to teach especially in these trying times when it is not allowed
to conduct face-to-face discussions with the students especially in terms of skills and
attitude development. However, learning must not stop despite the challenges that are
encountered. As a result, the faculty of the Samar State University – College of Nursing and
Health Sciences developed a learning packet to provide a guide for a solid concept and
focus on the course in Nursing Care Management 104 (Community Health Nursing 1).
Contents are based from different books, journals, and studies which will serve as a
student guide for the foundational learning in terms of providing care for clients in the
community setting. Specifically, this learning packet discusses the DOH Programs that are
implemented at present in national, regional, and local levels. It focuses on the programs
related to individual and family health.
You are given three weeks to study the materials and answer all the assessments
attached. Always make sure to provide the needed information in every answer sheet for
identification. You may detach the answer sheet to be collected after the three week period.
No photo nor reproduction of this material should be posted in any online platforms.
References such as videos and images are linked with URLs may be accessed for the
benefit of students’ additional learning in terms of skills and demonstration.

Lawrence Quincy P. Quiano

(CONHS – Instructor)

You may reach me through:

Cellphone No.: 09175052153
E-mail: [email protected]
FB Messenger: Lawrence Quincy Piczon Quiano

UNIT I: DOH Programs Related to Family Health

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1.0 Intended Learning Outcomes

At the end of this chapter, the learners will be able to:
 Discuss the importance of the different DOH Programs implemented in the
community.
 Identify studies and literatures supporting the answers to research-based activities.
 Identify the congenital disorders included in the Newborn Screening Package based
on the signs and symptoms presented.
 Formulate or plan a series of activities for the community from one of the programs
implemented by the DOH.

1.1 Introduction
The Department of Health (DOH) is the principal health agency in the Philippines
and as a national health policy-maker and regulatory institution, they are in charge of the
overall technical authority on health. Their vision is “Filipinos are among the healthiest people
in Southeast Asia by 2022, and Asia by 2040”. While their mission is “To lead the country in the
development of a productive, resilient, equitable, and people-centered health system”.
The Department has three major roles in the health sector: (1) leadership in health;
(2) enabler and capacity builder; and (3) administrator of specific services. As part of their
roles and in relation to the attainment of health-related Millenium Development Goals, the
implementation of the Kalusugang Pangkalahatan (KP)/Universal Health Care was
launched to address the gaps and challenges of health inequity, reduce child morbidity,
improve maternal health, and morbidity and mortality from TB, malaria, and the
prevalence of HIV/AIDS, in addition to being prepared for emerging disease trends, and
prevention and control of noncommunicable diseases.

Achieve health-
related
Millennium
Improve financial Development
risk protection Goal targets Improve access
through
to quality health
improvement in
care facilities
NHIP benefit
delivery

Improved
health
status of
Filipinos

Figure 1 Kalusugan Pangkalahatan Strategic Thrusts

DOH’s implementation of the KP through its programs based on the MDGs will be
further discussed in the following sub-chapters to better understand the importance of each
program in attaining the goals set in improving the health of Filipinos.
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1.2 Topics/Discussion (with Assessment/Activities)

1.2.1 EXPANDED PROGRAM ON IMMUNIZATION

The Program was launched in July 1976 in cooperation with the World Health
Organization and United Nations International Children’s Fund (UNICEF) to ensure that
infants/children and mothers have access to routinely recommended vaccines. There are
six vaccine-preventable diseases included in the EPI: TB, poliomyelitis, diphtheria, tetanus,
pertussis, and measles.
Some of the legal basis for the program launched by the DOH are the following:
 Presidential Decree No. 996 (September 16, 1976) “Providing for compulsory basic
immunization for infants and children below eight years of age”.
 Republic Act 7846 (December 30, 1994) “An Act requiring compulsory immunization
against Hepatitis B for infants and children below eight (8) years old. It is also
provided for Hepatitis B immunization within 24 hours after birth or babies of
women with Hepatitis B (Congress of the Philippines, 1994a).
 Presidential Proclamation No. 1066 (August 26, 1997) “Declaring a national tetanus
elimination campaign starting 1997”.
 Presidential Proclamation No. 4 (July 29, 1998) “Declaring the period from
September 16 to October 14, 1998 as the Ligtas Tigdas Month” and launching the
Philippines Measles Elimination Campaign.
 Republic Act 10152 (June 21, 2011) “An Act providing for mandatory basic
immunization services for infants and children, repealing for the purpose
Presidential Decree No. 996, as amended”. Under this Act, basic immunization shall
be given for free at any government hospital or health center to infants and children
up to five (5) years of age.
The objective of the Expanded Program on Immunization was to reduce the
morbidity and mortality among infants and children against the most common vaccine-
preventable diseases. Specific goals were set by the DOH to:
1. Immunize all infants/children against the most common vaccine-preventable
diseases.
2. Sustain the polio-free status of the Philippines.
3. Eliminate measles infection.
4. Eliminate maternal and neonatal tetanus.
5. Control diphtheria, pertussis, hepatitis B, and German measles.
6. Prevent extrapulmonary TB among children.
IMMUNIZATION SCHEDULE
Immunization is an essential intervention for eligible women and children, services
are available in all facilities and institutions nationwide. Wednesday is the designated day
of the week for immunization in government facilities unless otherwise revised.
Receiving antigens at the earliest possible time reduces the risk or chances of the
child getting infected or sick from immunizable diseases such as giving Hepatitis B vaccine
reduces the chance of the child becoming a carrier and measles vaccine is 85% effective
according to the study of Sudfeld et al. (2010).
In 2012, two new vaccines were introduced and included as part of the EPI. The
rotavirus vaccine and Haemophilus influenza B (HiB) vaccine. Rotavirus mainly affects the
large intestine causing severe diarrhea in infants and children with statistics showing 30%
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of diarrhea-related hospitalization are caused by Rotavirus (DOH, 2012b). HiB bacillus is

responsible for serious illnesses such as pneumonia and meningitis effecting mostly
children aged five and below with the most vulnerable age ranging between 4-18 months
(DOH, 2012c).
Infants and children are vaccinated according to the schedule and manner
prescribed by the DOH found in the table below.

ANTIGEN AGE DOSE ROUTE SITE

BCG Vaccine At birth 0.05 mL Intradermal Right Deltoid region
Hepatitis B Vaccine At birth 0.5 mL Intramuscular Anterolateral thigh
muscle
DPT-HepB-Hib 6, 10, 14 weeks old 0.5 mL Intramuscular Anterolateral thigh
(Pentavalent) muscle
Oral Polio Vaccine 6, 10, 14 weeks old 2 drops Oral Mouth
Anti-Measles 9-11 months 0.5 mL Subcutaneous Outer part of the
Vaccine (AMV1) arm
Measles-Mumps- 12-15 months 0.5 mL Subcutaneous Outer part of the
Rubella Vaccine arm
(AMV2)
Rotavirus Vaccine 6, 10 weeks old 1.5 mL Oral Mouth
Figure 2: Schedule and manner of administration of infant immunization
Source: Expanded Program on Immunization Manual, revised edition 1995, Department of Health

There are consideration to be taken in relation to the schedule and manner of administering
immunizations:
1. Single use syringe and needle per client is to be used.
2. Regardless of the time that has elapsed between doses, there should be no restart of
the vaccination from the first dose.
3. All EPI antigens are safe and effective even when administered simultaneously at
the same session considering that it should be at different site of administration.
However, if more than 1 injection is to be administered on the same site, there
should be at least 2.5-5.0 cm distance to prevent overlapping of local reactions.
Vaccine should never be mixed with other vaccine in a single syringe, or to use fluid
vaccine for reconstitution of freeze-dried vaccine.
4. Recommended sequence of the coadministration of oral vaccines in OPV first, then
Rotavirus vaccine, and other appropriate vaccines.
5. OPV administration is dropping the vaccine straight from the dropper onto the
mouth, making sure that it will not touch the tongue.
6. Only monovalent Hepatitis B vaccine should be used for the birth dose and not
pentavalent vaccine.
7. Children who have not received AMV1 or if the parents or caregivers do not know if
the child has received any, shall be given AMV1 as soon as possible and followed by
AMV2 a month after.
8. Children entering day care, preschool, and grade 1 shall be screened for measles
immunization, and for those identified to have not received the vaccine shall be
referred to the nearest health facility.
9. First dose of Rotavirus is administered only to infant aged 6 weeks to 15 weeks.
Followed by second dose from 10 weeks to a maximum of 32 weeks.
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10. Administer entire dose of Rotavirus vaccine slowly down one side of the mouth
between the cheeks and the gums with the tip of the applicator directed toward the
back of the mouth. Prevent spitting by stimulating the rooting and sucking reflex in
infants or stroking the throat in a downward motion to stimulate swallowing in
infants aged 5 months or older.
EPI VACCINES
Preparations used in EPI are either inactivated (killed) microorganisms, attenuated
microorganisms, fragments from microorganisms like Hepatitis B vaccine or toxoids.
Attenuated vaccines are live microorganism which have been altered so they are no longer
pathogenic but antigenic and toxoids are inactivated or altered bacterial exotoxins.

Vaccine Contents Form

BCG (Bacillus Calmette Guerin) Live, attenuated bacteria Freeze-dried, reconstituted with
special diluent

Hepatitis B vaccine RNA-recombinant, using Hepatitis B Cloudy, liquid, in an auto-disable

surface antigen injection syringe

DPT-HepB-Hib Diptheria toxoid, inactivated Liquid, in an auto-disable injection

(Pentavalent vaccine) pertussis bacteria, tetanus toxoid, syringe
recombinant DNA surface antigen,
and synthetic conjugate of Hib
bacilli.

Oral polio vaccine Live, attenuated virus Clear, pinkish liquid

Anti-measles vaccine (AMV1) Live, attenuated virus Freeze-dried, reconstituted with
special diluent

MMR vaccine (AMV2) Live, attenuated viruses Freeze-dried, reconstituted with

special diluent

Rotavirus vaccine Live, attenuated virus Clear, colorless liquid, in a container

with applicator

Tetanus toxoid Weakened toxin Clear, colorless liquid, sometimes

slightly turbid

Figure 3: Vaccine, their contents and form

Source: Expanded Program on Immunization Manual, revised edition 1995, Department of Health

MAINTAINING POTENCY
Vaccines confer immunity only when they are potent, and to retain potency, they
must be properly handled and transported. The cold chain is a system for ensuring the
potency of the vaccine from the time of manufacture to the time it is given to an eligible
client. The Cold Chain Officers are the ones directly responsible in cold chain management.
This means that they are responsible in maintaining the cold chain equipment and supplies.
EPI vaccines have the following cold chain requirements:
 OPV has to be stored in freezer, or during scheduled immunization day OPV must
be in a vaccine bag directly in contact with the cold packs. Maintaining a
temperature between -15 to -25oC.
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 Measles, MMR, and Rotavirus vaccines must be stored in refrigerator at +2 to +8 oC

and be stocked neatly on the refrigerator shelves and not on the refrigerator door
shelves.
 Hepatitis B, Pentavalent, Rotavirus vaccines, and TT are damaged by freezing. Wrap
these in a paper bag before putting in the vaccine bag with cold packs.
 Diluents are kept cold in the lower or door shelves of the refrigerator.
Other considerations to maintain potency include:
o Observe First Expiry-First Out (FEFO) policy.
o Comply with recommended duration of storage and transport. Health centers
and RHUs with refrigerator, storage may not exceed 1 month, and using
transport boxes, should only be kept only to a maximum of 5 days.
o Take note of vaccine vial monitor (VVM) and act accordingly. VVM is heat
sensitive and registers cumulative heat exposure.

Figure 4 Vaccine Vial Monitor (Photo taken from:

https://web.facebook.com/Mednotess/posts/1287849981605208:0?_rdc=1&_rdr

o Abide by the open-vial policy of the DOH. A nurse can open a multidose vial
for one or two-clients if necessary and for reasons that the client cannot come
back for the scheduled immunization session. Multidose liquid vaccines such
as OPV, Pentavalent, Hepatitis B vaccine, and Tetanus Toxoid may be used
for up to a maximum of 4 weeks following the standard sterile procedure,
and following conditions are met:
 Expiry date has not passed
 Vaccine has not been contaminated
 Vials are stored under appropriate cold chain conditions
 Vaccine vial septum has not been submerged in water
 VVM vial has not reached the discard point
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o Reconstitute freeze-dried vaccines with the diluents supplied with them and
discard 6 hours after reconstitution or after the immunization session,
whichever comes sooner.
o Protect BCG from sunlight and Rotavirus vaccine from light.
SIDE EFFECTS AND ADVERSE REACTIONS
BCG immunization that comes with inflammatory reaction within 2-4 days after
vaccination may indicate previous exposure to tuberculosis and no management is needed.
Deep abscess at the site of injection may be due to subcutaneous or deeper injection and
may be referred to physician for incision and drainage. Indolent ulcerations which persist
after 12 weeks may be treated with INH powder.
Hepatitis B vaccine with local soreness at the injection site, no treatment is
necessary.
For the Pentavalent vaccine, fever usually lasts for a day, advise to give antipyretic.
Fever beyond 24 hours may be of concern as this may be due to other causes. For local
soreness, reassure parents that it will disappear after 3-4 days. Abscess after a week or more
indicates injection was not deep enough or needle may not be sterile, incision and drainage
may be necessary. Convulsions may be very rare and occurs in children older than 3
months, caused by pertussis vaccine, proper management of convulsion should be
considered and pertussis vaccine should not be given anymore.
Anti-measles vaccine may present fever 5-7 days after vaccination with appearance
of mild rash. MMR may produce local soreness, fever, irritability, and malaise in some
children. For both vaccines, reassure parents and advise to give antipyretic. Rotavirus
vaccine may present with mild vomiting, diarrhea, fever, and irritability in children,
instruct parents to give antipyretic and Oresol.
For Tetanus Toxoid, client may have local soreness on the injection site, advise to
apply cold compress and no other treatment is needed.
CONTRAINDICATIONS
There are no contraindications to immunizations in general. Sending children away
and telling mothers to bring them back when well enough is a bad practice which delays
immunization. Few absolute contraindications in EPI vaccines include not giving:
 Pentavalent vaccine to children over 5 years of age
 Pentavalent vaccine to a child with recurrent convulsions or another active
neurological disease of the central nervous system
 Pentavalent vaccine to a child who has had convulsions or shock within 3 days of the
most recent dose.
 Rotavirus vaccine when a child has a history of hypersensitivity to a previous dose
of the vaccine, intussusceptions, or intestinal malformation, or acute gastroenteritis
 BCG to a child who has signs and symptoms of AIDS or other immunodeficiency
conditions or who are immunosuppressed.
Some conditions which are considered false contraindications, and are seen in
children, health workers may continue with the appropriate immunizations:
 Malnutrition, an indication that the child needs protection conferred by
imuunization
 Low grade fever
 Mild respiratory infection
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 Diarrhea. Children with diarrhea should still be given with OPV dose during visit.
However, the dose is not counted and the child should return when the next dose is
due.
Activity #1: Why is it important to adhere with the timely administration of vaccines on
the Immunization Program? (Support your answer with at least 1 study, may it be a
research study, published journal, or article from reliable sources and attach the URLs).
Write your answers on the last pages provided for the activities in this learning packet.

1.2.2 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

Pneumonia was the third leading cause of infant’s death, while diarrhea and
gastroenteritis of presumed infectious origin ranked tenth in years 2004-2006. The top three
leading causes of mortality among children aged 1-4 years were (1) pneumonia, (2)
accidents, (3) diarrheas and gastroenteritis of presumed infectious origin.
In 1998, on a global scale, more than 50 countries still had childhood mortality rate
of more than 100 per 1000 live births. In developing countries, more than 10 million
children die each year before they even reach 5 years old. 7 in 10 of these deaths are due to
acute respiratory infections, diarrhea, measles, malaria, or malnutrition and often a
combination of these conditions.
The WHO/UNICEF developed a strategy of Integrated Management of Childhood
Illness (IMCI) in 1992. With its main objective of reducing mortality and morbidity
associated with major causes of childhood illness. The strategy offers simple and effective
methods for child survival, healthy growth and development based on combined delivery
of essential interventions at community levels. The strategy includes three main
components:
1. Improvement in case management skills and health care staff.
2. Improvements in the health care system needed for effective management of
childhood illness.
3. Improvements in family and community practices.
IMCI CASE MANAGEMENT
The guidelines set in the IMCI is to be used by health care workers in the
management of sick children from 1 week to 5 years of age. These are based on expert
clinical opinions and research results. Using an integrated approach, the protocol guides
health care workers in:
 Assessing signs that indicate severe diseases.
 Assessing a child’s nutrition, immunization, and feeding.
 Teaching parents how to care for a child at home.
 Counselling parents to solve feeding problems.
 Advising parents about when to return to a health facility.
The entire IMCI case management process involves the following elements:
1. Assess by checking for danger signs by asking questions about common conditions,
examining the child, and checking nutrition and immunization status. This also
includes checking the child for other health problems.
2. Classify a child’s illnesses using a color-coded triage system since many children
presents more than one condition. Each illness is classified according to whether it
requires:
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a. Urgent prereferral treatment and referral (pink),

b. Specific medical treatment and advice (yellow),
c. Simple advice on home management (green).
3. Identify specific treatments for the child. If children require urgent referral, give
essential treatment before transfer. If a child needs treatment at home, develop an
integrated treatment at home, develop an integrated treatment plan for the child and
give the first dose of drugs in the clinic.
4. Treatment should include instructions for mothers or caretakers in giving oral drugs,
how to feed and give fluids during illness, and treating local infections at home. Ask
mothers to return for follow-up on a given date, and teach on recognizing signs that
indicate that the child should return sooner than the scheduled date.
5. Counsel parents for any feeding problems.
6. Give follow up care when child is brought for follow-up as requested and reassess
for new problems if necessary.

Activity #2: In your own words and understanding of the topic discussed, why is it
important to implement IMCI in all community health care settings? Write your answers
on the last pages provided for the activities in this learning packet.

For all sick children aged 1 week up to 5 years who are brought to a first-level health facility.

ASSESS the child: Check for danger signs. Ask about main symptoms, and if reported, assess further. Check
nutrition and immunization status. Check for other problems.

CLASSIFY the child’s illnesses: Use a color-coded triage system to classify the child’s main symptoms and
the child’s nutrition or feeding status

IF NO URGENT REFERRAL
IF URGENT REFERRAL
Is needed or possible
Is needed and possible
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IDENTIFY URGENT PRE-REFERRAL 1
IDENTIFY TREATMENT:
TREATMENTS needed for the child’s
needed for the child’s
classifications: Identify specific medical
10
classifications treatments and/or advice

TREAT THE CHILD: Give urgent pre- TREAT THE CHILD: Give the first dose of oral
referral treatments needed drugs in the clinic and/or advise the child’s
caretaker. Teach the caretaker how to give
oral drugs and how to treat local infections
at home. If needed, give immunizations.

REFER THE CHILD: Explain to the child’s

caretaker the need for referral. Calm the
caretaker’s fears and help resolve any
problems. Write the referral note. Give COUNSEL THE MOTHER: Assess the child’s
instructions and supplies needed to care for feeding, including breastfeeding practices,
the child on the way to the hospital. and solve problems, if present. Advise about
feeding and fluids during illness and about
when to return. Counsel the mother about
her own health.

CLASSIFY the child’s illnesses: Use a color-coded triage system to classify the child’s main symptoms and
the child’s nutrition or feeding status

Figure 5 Summary of the integrate management process

Source: Handbook IMCI Integrated Management of Childhood Illness, WHO, 2005a

1.2.3 ESSENTIAL INTRAPARTUM AND NEWBORN CARE

These are evidenced-based practices recommended by the Department of Health,
Philippine Health Insurance Corporation (PhilHealth), and the World Health Organization
as standards of care in all deliveries handled in health units and in public and private
hospitals. Package content are based on hospital reforms initiatives, model centers of
excellence, education reforms, and social marketing. Within the first year of
implementation, 16000 health workers were trained in roughly 50 centers through capacity-
building throughout the country and resulted to a healthier newborns, increased
satisfaction of mothers, and overall facility cost savings.
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There are four (4) time-bound interventions involved in the essential intrapartum
and newborn care:
1. Immediate and thorough drying – use a clean dry cloth in wiping the face, eyes,
head, front and back, arms and legs of the newborn thoroughly. This prevents
hypothermia for the newborn’s survival.
2. Early skin-to-skin (STS) contact – if newborn is crying and breathing normally,
avoid manipulation or interventions such as suctioning as it may cause trauma or
introduce infections. Place the newborn in prone position on the abdomen or on the
chest of the mother while covering the back with a blanket and the head with a
bonnet. This prevents hypothermia, hypoglycaemia, and sepsis, increase
colonization with protective bacterial flora, and improved breastfeeding initiation
and exclusivity.
3. Properly timed clamping and cutting of cord – when the pulsation of the cord stops,
that is the best time to clamp and cut the cord (typically about 1-3 minutes). Apply
umbilical clamps tightly around the cord at 2cm and 5cm from the abdomen, then
cut in between clamps with sterile instrument. Avoid milking the cord. Ensure
oxytocin (10 IU) is given to the mother after cord clamping. Decreases risk of anemia
in 1 out of 7 term newborns, and 1 in every 3 preterms. Also decreases brain
(intraventricular) haemorrhage in 1 out of 2 preterms.
4. Non-separation of newborn from the mother for breastfeeding initiation and
rooming-in – observe for feeding cues such as opening mouth, licking tonguing, and
rooting, advise mother to encourage to perform breastfeeding while counselling on
the proper position and attachment. Newborns should be roomed-in with their
mothers. Breastfeeding in the first hour of life prevents an estimated 19.1% of all
neonatal deaths.
With the implementation of the EINC in all health care facilities in the country,
there were practices that should no longer be performed inside the delivery rooms since it
does not improve maternal and newborn health:
1. Routine suctioning of secretions if the baby is crying and breathing normally.
2. Putting newborn in a cold or wet surface.
3. Wiping off vernix caseosa.
4. Foot printing.
5. Bathing earlier than 6 hours of life
6. Unnecessary separation of newborn for reasons of weighing, anthropometric
measurements, and immunization.
7. Transferring newborns to nursery or neonatal intensive care units without any
indications.
All healthcare professionals in government and private hospitals, even those in the
administrative offices, barangay officials, barangay health workers, community
volunteers and groups are enjoined to ensure proper information is disseminated to
pregnant women and women in the reproductive age group. Following these standards
set will be evident in the reduction in neonatal morbidity and mortality.

Activity #3. Refer to the ACTIVITY/ANSWER SHEET on the last portion of this
learning packet.
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1.2.4 NEWBORN SCREENING (NBS)

A public health program for the early detection of congenital metabolic disorders
that may lead to mental retardation or even death if left undetected and untreated.
Newborns with congenital metabolic disorders may appear or look normal at birth and
may go undetected until the onset of signs and symptoms which may already be
irreversible. The goal of newborn screening is to give all newborns a chance to live normal
lives and safeguard them to reach their full potentials.
In 1996, there were only 24 NBS facilities during its pilot testing and by November
2018, there 7062 testing facilities nationwide. A screening center runs all tests included in
the NBS program, provides recall or follow-up for infants positive in any and all heritable
disorders, has trained personnel and staff to supervise the program, and submits to
periodic announced and unannounced inspections to evaluate and ensure quality NBS
performance.

Managing NBS Performance of

supplies tests

Follow-up/recall of
Training / NBS Centers positive screened
Orientation Responsibilities and confirmed
patients

Coordination with
DOH ROs
Monitoring and
Evaluation

Recognition of the importance of NBS was the enactment of the Republic Act 9288
(Newborn Screening Act of 2004) which states that it is the obligation of healthcare
practitioners to inform the parents or legal guardians of the newborn of the availability,
nature, and benefits of NBS. If the parents or legal guardians refuse, they shall
acknowledge in writing understanding that refusal of testing places the newborn at risk for
mental retardation or death of undiagnosed heritable conditions. Likewise, a copy of this
refusal shall be made part of the newborn’s medical record and be indicated in the NBS
database.
There are six (6) disorders included in the routine NBS panel in the country. These
are the following:
1. Congenital Hypothyroidism (CH) – the newborn is born with inability to produce
enough thyroid hormone caused by a defective gland. Thyroid hormone is
 2 | Community Health Nursing 1 13

important in brain development, if untreated, could lead to intellectual disabilities

and growth problems. Signs and symptoms may not appear in the first week of life,
but with severe CH, poor feeding, excessive sleep, constipation, weak cry, and
jaundice may present.
2. Congenital adrenal hyperplasia (CAH) – rare inherited disorder characterized by the
inability of the adrenal gland to secrete cortisol or aldosterone, or both because of a
missing or malfunctioning of the enzyme 21-hydroxylase (21-OH). Some symptoms
may appear as poor feeding, drowsiness or listlessness, vomiting, diarrhea,
dehydration, low blood pressure, and low blood salt. Without treatment this could
lead to confusion, irritability, rapid heart rate, coma, or death due to shock.
3. Galactosemia – means galactose in blood, an inherited disorder in which the body is
unable to metabolize galactose and the person is unable to tolerate any form of milk.
GALT gene is the one that provides instruction in the production of galactose-1-
phosphate uridyl tranferase which enables the body to process the simple sugar
called galactose. Signs and symptoms may result to liver dysfunction, susceptibility
to infections, failure to thrive, and cataracts.
4. Glucose-6-phosphate-dehydrogenase (G6PD) deficiency – a genetic defect mostly
affecting males, in which the body does not have enough enzyme (G6PD) to protect
the RBCs from breaking down when the body is exposed to certain medication or
drugs, food, severe stress or infection. Signs and symptoms include paleness,
extreme tiredness and dizziness, rapid heart rate, fast breathing, jaundice, and dark
tea-colored urine.
5. Maple Syrup Urine Disorder (MSUD) – inability to break down certain parts of
proteins like the amino acids leucine, isoleucine, and valine, which then leads to
build up in blood. The urine is characterized by the smell of maple syrup. In most
severe form, it can cause brain damage during times of physical stress, including
infection, fever, and not eating for a long time.
6. Phenylketonuria (PKU) – an inherited disorder that causes amino acid
phenylalanine to build up in the body because of a defect in the genes that creates
enzymes to breakdown the said amino acid. A person with this disorder can have a
dangerous build up with intake of foods with protein or aspartame found in
artificial sweeteners. Newborns with PKU may not show any symptoms, however,
if without treatment may develop signs within few months and this includes: musty
odor of breath, skin, or urine, seizures, microcephaly, hyperactivity, delayed
development, intellectual disability, behavioural, emotional, and social problems,
and psychiatric disorders.

NBS TESTING
Newborn screening is done at least 24 hours from birth but not later than 72 hours.
Newborns in the intensive care may be exempted to ensure survival but should be tested
by 7 days of age. A few drops of blood is drawn by pricking the heel, blotched on a special
absorbent card and dried for at least 4 hours. The procedure may be done by a physician,
nurse, midwife, or medical technologist with proper training.
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Activity #4. Refer to the ACTIVITY/ANSWER SHEET on the last portion of this
learning packet for a Short Quiz.

1.2.5 BASIC EMERGENCY OBSTETRIC AND NEWBORN CARE (BEmONC) /

COMPREHENSIVE EMERGENCY OBSTETRIC AND NEWBORN CARE (CEmONC)
The Maternal Newborn Child Health and Nutrition (MNCHN) has core service
package that consists of health services that are both preventive and curative centered in
lowering the risk and respond to the direct causes of maternal and neonatal deaths,
likewise, improving women’s and children’s health. For women, this consists of services
before and after pregnancy, including essential newborn care during the first week of life.
For children, services include health care for newborn until adolescent stage.
Services must be made available and readily accessible to the target population. To
ensure the mother’s and newborn’s safety, standards of care must be followed and met in
all facilities within the MNCHN delivery network.
(BEmONC) - these are upgrade or enhanced Barangay Health Station (BHS), Rural Health
Unit (RHU), District and Community Hospitals while (CEmONC) are departmentalized
district, provincial, and regional hospitals, both are required to provide the following
services:
1. Pre-pregnancy package provisions:
a. Micronutrient supplementation such as Iron folate 60mg tablets daily,
Vitamin A 5,000 IU every week (multivitamins supplement if Vitamin A is not
available), and promotion on the use of iodized salt
b. Tetanus toxoid immunization following the recommended schedule
c. Family planning- IEC and FP counseling and provision of contraceptives
d. Provision of oral health services
e. Counseling on STI/HIV/AIDS, nutrition, personal hygiene, and the
consequences of abortion
f. STI screening using syndromic approach
g. Adolescent and youth health services including peer and professional
counselling and RH education
h. Promotion of healthy lifestyle including advice relative to smoking cessation,
healthy diet, regular exercise, and moderate alcohol intake
i. Management of lifestyle related diseases like diabetes, CVD, etc.
j. Prevention and management of other diseases including tuberculosis,
malaria, schistosomiasis, and anemia.
 2 | Community Health Nursing 1 15

2. Complete pre-natal package

a. Provision of eight essential antenatal care services
 Monitoring of height and weight
 Taking the blood pressure
 Screening and blood testing (CBC, BT, UA, VDRL or RPR, HbSAg,
blood sugar screening, PT, cervical cancer screening)
 Micronutrient supplementation (iron folate and Vitamin A)
 Malaria prophylaxis where appropriate
 Deworming
 Birth planning
b. Promotion of exclusive BF, newborn screening, BCG and Hepatitis B birth
dose
c. Counselling on use of modern FP and contraception including surgical
procedures
d. Laboratory screening and medical management of STI-HIV cases and their
complications
e. Counselling on health lifestyle with focus on smoking cessation, healthy diet
and nutrition, regular exercise, STI control, HIV prevention and oral health
f. Prevention and management of early bleeding in pregnancy
g. Administration of antenatal loading dose of steroids for threatened premature
delivery
h. Early detection and management of signs of complications of pregnancy
i. Measurement of fundic height against the age of gestation, fetal heart beat,
and fetal movement count, to assess the adequacy of fetal growth and well-
being
j. Prevention and management of other conditions as indicated:
 Hypertension
 Diabetes
 Anemia
 Tuberculosis
 Malaria
 Schistosomiasis
 STI/HIV/AIDS
k. Provision of other support services
 Antenatal registration through active tracking by the WHTs
 Birth planning
 Home visits and follow up
 Safe blood supply
 Transportation and communication support services
3. Complete childbirth package
a. For mothers:
 Monitoring of VS and progress of labor using partograph
 Identification of early signs and symptoms and administration of
appropriate management of prolonged labor, hypertension, abnormal
presentation, bleeding
 2 | Community Health Nursing 1 16

 Active Management of Third Stage of Labor

 Provision of immediate post-partum nursing care
1. Perineal wash
2. Changing of hospital gown
3. Checking VS
4. Rooming-in
5. (CEmONC) – return to ward if baby is preterm and needs to be
confined at the NICU. Advise should be given on scheduled
breastfeeding.
b. For newborns:
 Drying to keep the baby warm
 Provision of appropriate thermal care through skin-to-skin contact,
delivery room temperature between 25-28 degrees centigrade and
wrapping newborn with clean, dry cloth
 Immediate latching on and initiation of BF within the first hour of birth
 Non-immediate cord clamping (1-3 minutes of after pulsation stops)
Should complications occur, a BEmONC provider facility must be able to administer
the following emergency care services:
 Parenteral administration of oxytocin in the third stage of labor
 Parenteral administration of loading dose of anti-convulsant
 Parenteral administration of initial dose of antibiotics
 Assisted vaginal delivery during imminent breech delivery
 Manual removal of placenta
 Removal of retained placental products
 Administration of loading dose of steroids for premature labor
 Administration of intravenous fluids, blood volume expander, and/or blood
transfusion
 Newborn resuscitation
 Treatment of neonatal sepsis as necessary
 Oxygen support for newborns
Should complications occur, a CEmONC provider facility must be able to administer the
following emergency care services:
 Caesarean section
 Blood transfusion
 Management of newborn complications
4. Complete Post-Partum and Post-Natal package
a) For mother:
 Post-partum check up including identification of early signs and
symptoms of PP complications like haemorrhage, infection, and
hypertension
 Micronutrient supplementation
 Counselling on proper nutrition, benefits of exclusive BF up to six
months, benefits of STS contact, and essential neonatal care. For
CEmONC: a special neonatal care for preterm and problematic
babies.
 2 | Community Health Nursing 1 17

 Laboratory screening and medical management of STI-HIV cases

and their complication
 Provision of FP services and contraception including surgical
procedures
 Prevention and management of other diseases
b) For newborns:
 Post-natal care required within 24 hours after birth includes: cord
care, BF, Vitamin K injection, eye prophylaxis, delayed bathing,
BCG and Hepatitis B vaccine, NBS
 Counselling on post-partum/post-natal check up, home care, and
immunization
5. Provision of other support services
a) Birth registration
b) Safe blood
c) Transportation and communication
In addition, the CEmONC facilities shall provide comprehensive emergency
postnatal care that include life support management for:
1. Low birth weight newborns
2. Premature newborns
3. Sick newborns (sepsis, fetal alcohol syndrome, asphyxia, severe birth trauma, severe
jaundice, and others).

1.2.6 NUTRITION
Nutrition is important in the growth and development of individuals. Improving
nutrition results to a healthy infant, child and maternal health, strong immune system, safer
pregnancy and childbirth, lower risk of non-communicable diseases, and promotes
longevity.
Malnutrition presents a threat to the health of individuals. Undernutrition and
obesity is a burden especially those in the low and middle income countries. The
Department of Health employed the Nutritional Guidelines for Filipinos to improve the
nutritional status, productivity, and quality of life through the adoption of these guidelines
of desirable dietary practice and healthy lifestyle.
1. Eat a variety of food every day. (Rationale: no single food provides all the nutrients
our body needs. Choosing a variety of foods from all food groups is the first step in a
well-balanced diet.)
2. Breastfeed infants exclusively from birth up to 6 months, then giving appropriate
foods while continuing breastfeeding. (Rationale: intended to promote
breastfeeding and continuance for as long as two years. This will ensure an
adequate, complete, and safe food for the infants. This also advocates appropriate
complementary food in addition to breastmilk once the infant is ready for solid food
intake. Malnutrition usually occurs between the ages of 6 months to 2 years.)
3. Maintain children’s normal growth through proper diet and monitor their growth
regularly. (Rationale: this is a simple way to monitor the growth of children and
assess nutritional status).
4. Consume fish, lean meat, poultry, or dried beans.
5. Eat more vegetables, fruits, and root crops.
 2 | Community Health Nursing 1 18

6. Eat foods cooked in edible/cooking oil daily.

7. Consume milk, milk products, or other calcium-rich foods such as small fish and
dark green leafy vegetables everyday. (Rationale 4,5,6,7: this is intended to address
deficiencies in the current Filipino dietary patterns. Meat, fish, poultry, and beans
provide protein and dietary energy, as well as iron and zinc lacking in a Filipino
diet. Vegetables, fruits, and crops provide dietary fibers, vitamins, and minerals.
These provide defense against chronic degenerative diseases. Foods cooked in edible
oils provide the calorie deficiency lacking. Milk, dairy products and other calcium-
rich foods provide the needed calcium for healthy bones, protein, and other
nutrients for growth.)
8. Use iodized salt, but avoid excessive intake of salty foods. (Rationale: intended in
prevention of iodine deficiency which is the major cause of mental and physical
underdevelopment. At the same time, warns the excessive intake of salty foods to
prevent hypertension in high-risk individuals.)
9. Eat clean and safe food. (Rationale: intended to prevent food-borne diseases)
10. For a healthy lifestyle, good nutrition, exercise regularly, do not smoke, and avoid
drinking alcoholic beverages. (Rationale: promotes healthy lifestyle through regular
exercise, abstinence from smoking and alcoholic beverages may be in moderation.
All these directly or indirectly relates to good nutrition).
NUTRIENTS IN FOOD
Nutrients are chemical substances in food that keeps the body healthy and
nourished with the materials needed for growth and development, and provide energy for
work and physical activities. Major nutrients include the macronutrients proteins, fats, and
carbohydrates, and micronutrients such as Vitamins (A,D,E,K), B complex, Vitamin C, and
minerals such as calcium, iron, iodine, zinc, fluoride and water.
 PROTEINS – essential for growth and body repair since they are the body’s building
blocks. Proteins also function as enzymes and hormones in body processes, and a
source of energy. Deficiency in protein results to a failure in growth and
development. Protein comes from animal sources such as fish, poultry, meat, eggs,
and milk. Rice is also a major source of protein except that the quality is not high.
Some meat substitutes and source of protein include, beans, soy, legumes, and other
dried beans.
 CARBOHYDRATES – main source of energy providing 40-80 percent of total energy
intake. In the Philippines, carbohydrate accounts for 74% of total energy intake
(Villavieja, 1996). Carbohydrates spare protein from being used as energy so that it
can work on building and repairing body tissues and regulating body processes.
There are three major types of dietary carbohydrates:
o Monosaccharides – glucose and fructose
o Disaccharides – sucrose, maltose, lactose
o Polysaccharides – starch and dietary fibers
 FATS – refers to a family of compounds called “lipids” which are water-insoluble.
Beneficial if consumed in the right amount and the right type. Fats help absorb,
transport, and store fat-soluble Vitamins A, D, E, and K. Classified according to the
predominant type of fatty acids they contain: saturated, monounsaturated, and
polyunsaturated. Intake of large amount of saturated fats is involved in the
development of degenerative diseases, cardiovascular diseases, and certain cancers.
 2 | Community Health Nursing 1 19

 VITAMINS – are classified as fat and water soluble. Vitamins have specific roles and
functions in the body:
VITAMINS FUNCTIONS
Vitamin A Maintain normal vision, skin health, bone and tooth growth,
reproduction and immune function; prevents
xerophthalmia.
Thiamine Help release energy from nutrients, support normal appetite
and nerve function, prevents beri-beri.
Riboflavin Help release energy from nutrients, support skin health,
prevent deficiency manifested by crack and redness at
corners of the mouth, inflammation of tongue, and
dermatitis.
Niacin Helps release energy from nutrients, support skin, nervous
and digestive system, prevents pellagra.
Biotin Help in energy and amino acid metabolism, help in
synthesis of fat glycogen.
Pantothenic Help in energy metabolism.
Folic acid Helps in the formation of DNA and new blood cells
including RBC, prevents anemia.
Vitamin B-12 Helps in the formation of the new cells; maintain nerve cells,
assist in the metabolism of fatty acids and amino acids.
Vitamin C Help in the formation of protein, collagen, bone, teeth
cartilage, skin and scar tissue; facilitate in the absorption of
iron in the GI tract; involve in amino acid metabolism;
increases resistance to infection; prevent scurvy.
Vitamin D Help in the mineralization of bones by enhancing absorption
of calcium.
Vitamin E Strong anti-oxidant; help prevent arteriosclerosis; protect
neuro-muscular system; important for normal immune
function.
Vitamin K Involve in the systhesis of blood clotting proteins and a bone
protein that regulates blood calcium level.

 MINERALS – divided into macrominerals and microminerals. These are involved in

many of the bio-chemical processes within the body. A large variety of essential
compounds in the body include mineral atoms or ions as part of their structure.
MINERALS FUNCTIONS
Calcium Mineralization of bones and teeth, regulator of many bio-
chemical processes of the body, involve in clotting, muscle
contraction and relaxation, nerve functioning, blood
pressure and immune defenses.
Chloride Maintain normal fluid and electrolyte balance.
Iodine As part of the two thyroid hormones, iodine regulates
growth, physical and mental development and metabolic
rate.
Iron Essential in the formation of blood. Involved in transport
and storage of oxygen in the blood and is a co-factor bound
to several non-hemo enzymes required for the proper
functioning of cells.
Magnesium Mineralization of bones and teeth, building of proteins,
muscle contraction, nerve impulse transmission,
maintenance and functioning of immune system.
 2 | Community Health Nursing 1 20

Phosphorus Used in energy transfer and maintenance of acid-base

balance.
Sodium Maintain normal fluid and electrolyte balance, assists nerve
impulses.
Zinc Essential for normal growth, development, reproduction,
and immunity.

 WATER – regulates temperature, transport electrolytes and other nutrients, excrete

wastes products from lungs, skin, and kidneys. Lubricates joints and cushion the
nervous system. Absence of water causes death more quickly than absence of any
other nutrients. For good health, water must be consumed everyday to replace
continuous loss of water in urine, perspiration, exhaled air, and feces.
NUTRIENT REQUIREMENTS AND BALANCED DIET
The macronutrients namely: protein, carbohydrates, and fats provide energy. The
desirable contribution of total energy intake should range from:
 55-70% carbohydrates
 20-30% fats
 10-15% proteins
The nutrients intake should meet the Recommended Dietary Allowances. These are
the levels of daily intakes of energy and essential nutrients considered adequate to
maintain health and promote reasonable level of reserves in body tissues of nearly all
healthy persons afflicted with diseases, traumatic stresses or nutrient inadequacies. The
recommended amounts depend on one’s body size, age, sex, physiological state, and level
of physical activity.
A balanced diet is one that contains all the nutrients and other substances found
naturally in food, in proper amount and proportions needed by the body to function well.
Eating a diet that includes a wide variety of foods in the right amount chosen from different
food groups helps individuals to meet the RDA.

1.2.7 MENTAL HEALTH PROGRAM

Mental health and well-being is a concern of all. Addressing concerns related to
MNS contributes to the attainment of the SDGs. Through a comprehensive mental health
program that includes a wide range of promotive, preventive, treatment and rehabilitative
services; that is for all individuals across the life course especially those at risk of and
suffering from MNS disorders; integrated in various treatment settings from community to
facility that is implemented from the national to the barangay level; and backed with
institutional support mechanisms from different government agencies and CSOs, we hope
to attain the highest possible level of health for the nation because there is no Universal
Health Care without mental health.
Its vision: “A society that promotes the well-being of all Filipinos, supported by
transformative multi-sectoral partnerships, comprehensive mental health policies and
programs, and a responsive service delivery network”. And mission: “To promote over-all
wellness of all Filipinos, prevent mental, psychosocial, and neurologic disorders, substance
abuse and other forms of addiction, and reduce burden of disease by improving access to
quality care and recovery in order to attain the highest possible level of health to participate
fully in society.
PROGRAM COMPONENTS
 2 | Community Health Nursing 1 21

1. Wellness of Daily Living

 All health/social/poverty reduction/safety and security programs and the
like are protective factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention and Control of Diseases, Family
wellness programs, etc.
 School and workplace health and wellness programs
2. Extreme Life Experience
 Provision of mental health and psychosocial support (MHPSS) during
personal and community wide disaster
3. Mental Disorders
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction
 Provision of services for mental, neurologic and substance use disorders at
the primary level from assessment, treatment and management to referral;
and provision of psychotropic drugs which are provided for free.
 Enhancement of mental health facilities under HFEP

1.2.8 OTHER PROGRAMS

 NON-COMMUNICABLE DISEASES – include heart diseases, stroke, cancer,
diabetes, and chronic lung diseases contributes for almost 70% of all deaths
worldwide. These diseases are considered as lifestyle related. The rise of NCD has
been driven by four major risks: tobacco use, physical inactivity, harmful use of
alcohol, and unhealthy diets. The Department of Health envisions a Philippine free
from the avoidable burden of NCDs. The mission is to ensure sustainable health
promoting environments and accessible cost-effective, comprehensive, equitable,
and quality health care services for the prevention and control of NCDs. Objectives
of the program include:
o To raise the priority accorded to the prevention and control of non-
communicable diseases in national, regional and local health and
development plans 
o To strengthen leadership, governance, and multisectoral actions for the
prevention and control of non-communicable diseases
o To reduce modifiable risk factors for non-communicable diseases and
underlying social determinants through creation of health-promoting
environments
o To strengthen health systems and increase access to quality medicines,
products and services, especially at the primary health care level, towards
attainment of universal health coverage
o To promote and support research and development for the prevention and
control of non-communicable diseases
o To monitor the trends and determinants of non-communicable diseases and
evaluate progress in their prevention and control
 EMERGING AND RE-EMERGING INFECTIOUS DISEASE PROGRAM –
Philippines has seen and experienced many outbreaks of emerging diseases and
continues to be susceptible of re-emerging infectious diseases such as tuberculosis,
leptospirosis, dengue, and meningococcemia. There are several determinants
 2 | Community Health Nursing 1 22

contributing to the emergence of novel infectious diseases and resurgence of

controlled or eradicated diseases in the country. These factors are: (1) demographic
factors, (2) international travel, tourism, and increased OFWs, (3) socio-economic
factors, and (4) environmental factors. Emerging and re-emerging infectious diseases
are unpredictable and create a gap between planning and concrete action. Therefore,
there is a need to develop a pro-active system to ensure preparedness and response
in anticipation to negative consequences that may result in pandemic proportions of
diseases. DOH envisions a health system that is resilient, capable to prevent, detect
and respond to the public health threats caused by emerging and re-emerging
infectious diseases. Its mission is to provide and strengthen an integrated,
responsive, and collaborative health system on emerging and re-emerging infectious
disease towards a healthy and bio-security country.
 NATIONAL FAMILY PLANNING PROGRAM – access to a safe, voluntary family
planning is a basic human right. It is central to gender quality and women’s
empowerment, and it is a key factor in reducing poverty. The Department of Health
envisions “for Filipino women and men achieve their desired family size and fulfil the
reproductive health and rights for all through universal access to quality family planning
information and services”. The department is committed to provide responsive policy
direction and ensure access of Filipinos to medically safe, legal, non-abortifacient,
effective, and culturally acceptable modern family planning (FP) methods. The
passage of the RPRH Law in 2012 is considered as a landmark legislation in the
country’s law-making history, and has laid down the legislative foundation in
achieving reproductive health and rights of all Filipinos towards better health
outcomes and socioeconomic growth. President Duterte issued an Executive Order
(EO) No. 12, entitled Attaining and sustaining “Zero Unmet Need for Modern Family
Planning” through the strict implementation of the Responsible Parenthood and
Reproductive Health Act, providing funds therefor, and for other purposes  in January of
2017. The Order intensifies and accelerates the implementation of critical actions
necessary to address the unmet need of Filipinos for modern family planning
(mFP).There several program components and these include:
o Component A: Provision of free FP commodities that are medically safe, legal,
non-abortifacient, effective, and culturally acceptable to all in need of FP
services.
o Component B: Demand generation through community-based management
information system.
o Component C: Family planning in hospitals and other health facilities.
o Component D: Financial security in family planning.
Visit https://doh.gov.ph/family-planning
 NATIONAL TB PROGRAM - the National TB Control Program, organized in 1978
and operating within a devolved health care delivery system, is one of the public
health programs being managed and coordinated by the Infectious Diseases for
Prevention and Control Division (IDPCD) of the Disease Prevention and Control
Bureau (DPCB) of the Department of Health (DOH). The program's TB diagnostic
and treatment protocols and strategies, issued through the Manual of Procedures,
are in accordance with the policies of World Health Organization (WHO) and the
International Standards for TB Care (ISTC). Its last strategic plan was the 2010-16
 2 | Community Health Nursing 1 23

Philippine Plan of Action to Control TB or PhilPACT. DOH vision: “A tuberculosis-

free Philippines”. The goal includes reducing TB mortality by 95% and TB incidence
by 90%. There are several objectives targeted by the department by 2022 and these
are:
o Improve the utilization of TB care and prevention services by patients and
communities.
o Reduce catastrophic cost of TB-affected households accessing DOTS facilities
to 0%.
o Ensure adequate and competent human resources for TB elimination efforts.
o Improve the use of TB data for effective TB elimination efforts.
o Enhance quality of all TB care and prevention services.
o Increase to at least 90% of DOTS facilities that are providing expanded
integrated patient centered TB care and prevention services.
o Enhance the political stewardship through high-level political commitment of
national government agencies and LGUs to implement localized TB
elimination plan in coordination with different sectors.
 HIV/STI PREVENTION PROGRAM – these are infections that are transmitted
from person to person through sexual activity or contact. Having STIs increases a
person’s risk of contracting HIV. Behaviors of individuals mainly affect the risk of
contracting STIs or HIV. The DOH program aims to reduce the transmission of HIV
and STI among the Most at Risk Population and General Population and mitigate its
impact at the individual, family, community level. Some of the program activities
included in the program:
o Availability of free voluntary HIV Counseling and Testing Service
o 100% Condom Use Program (CUP) especially for entertainment
establishments
o Peer education and outreach
o Multi-sectoral coordination through Philippine National AIDS Council
(PNAC)
o Empowerment of communities
o Community assemblies and for a to reduce stigma
o Augmentation of resources of social Hygiene Clinics
o Procured male condoms distributed as education materials during outreach

POST UNIT ASSESSMENT

Using your journal, write down all the relevant points of each program discussed
and compare your notes from the provided module. Honesty on this activity is important
for the instructor and the students to check what has been learned to date. (Reminder: Keep
journals safe and intact as the instructors might ask you to submit it on or before the end of
the semester).

1.3 References
Famorca, Z., Nies, M., Mcewen, M. (2013). Nursing Care of the Community Elsevier
(Singapore) Pte. Ltd
 2 | Community Health Nursing 1 24

Maglaya, Araceli (2004). Nursing Practice in the Community 4 th Edition. Argonauta

Corporation.
https://kidshealth.org/en/parents/g6pd.html#:~:text=G6PD%20deficiency%20is%20a
%20genetic,blood%20that%20could%20harm%20them.
http://caro.doh.gov.ph/wp-content/uploads/2014/09/EINC.pdf
http://caro.doh.gov.ph/wp-content/uploads/2014/09/NBS.pdf
http://www.ntp.doh.gov.ph/aboutNTP.php
https://ghr.nlm.nih.gov/gene/GALT
https://rarediseases.info.nih.gov/diseases/2424/galactosemia#:~:text=Galactosemia%2C
%20which%20means%20%E2%80%9Cgalactose%20in,build%20up%20in%20the
%20blood.
https://slideplayer.com/slide/7419670/
https://womendeliver.org/case-studies/essential-intrapartum-newborn-care-philippines/
https://www.doh.gov.ph/book/export/html/1125
https://www.doh.gov.ph/lifestyle-related-diseases#:~:text=Non%2Dcommunicable
%20diseases%20(NCDs),the%20result%20of%20unhealthy%20habits.
http://www.doh.gov.ph/sites/default/files/basic-page/chapter-two.pdf
http://www.doh.gov.ph/sites/default/files/basic-page/introduction.pdf
https://www.doh.gov.ph/sites/default/files/publications/maternalneonatal.compressed.
pdf
https://www.doh.gov.ph/sites/default/files/transparency
%20seal/DOHMajorProgramsProjects5KRAs.pdf
https://www.healthychildren.org/English/health-issues/conditions/Glands-Growth-
Disorders/Pages/Congenital--Hypothyroidism-Infants.aspx
http://www.icatt-
training.org/IMCI/AboutIMCI/tabid/84/Default.aspx#:~:text=Development%20of
%20a%20strategy%20of,before%20reaching%20their%20fifth%20birthday.
https://www.mayoclinic.org/diseases-conditions/phenylketonuria/symptoms-
causes/syc-20376302
https://www.newbornscreening.info/Parents/otherdisorders/CAH.html
https://www.rasmussen.edu/degrees/health-sciences/blog/what-is-community-health/
https://www.researchgate.net/publication/41807899_Newborn_Screening_Progress_in_D
eveloping_Countries-Overcoming_Internal_Barriers/figures?lo=1
https://www.shutterstock.com/search/community+health+center
https://www.slideshare.net/moliabdu/cold-chain-52969470
https://www.unfpa.org/family-planning
https://www.who.int/health-topics/nutrition
https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-
(mdgs)

1.4 Acknowledgment
The images, tables, figures and information contained in this module were taken
from the references cited above.

based on books and other references cited by the instructors handling the subject. This is
intended for SSU-CONHS students’ general information for the particular subject and not
suggested as replacement to standard references. Any inaccurate information found may be
communicated directly to the electronic mail provided. [email protected]
 2 | Community Health Nursing 1 25

ACTIVITY/ANSWER SHEET

Name: _____________________________________________________________ LP#: ________

Instructor: _________________________________________

Activity #1
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Activity #2
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 2 | Community Health Nursing 1 26

ACTIVITY/ANSWER SHEET

Name: _____________________________________________________________ LP#: ________

Instructor: _________________________________________

Activity #3 – List down some of the activities or practices that were removed during
delivery since they have not been identified to promote improvement in the maternal and
newborn health:

1._____________________________________
2. _____________________________________
3. _____________________________________
4. _____________________________________
5. _____________________________________

Activity #4 – Without referring to the topic discussed on Newborn Screening, write down
the signs and symptoms associated with each of the following disorder:

1. Congenital Hypothyroidism 2. Congenital Adrenal Hyperplasia

_________________________________ _________________________________
_________________________________ _________________________________
_________________________________ _________________________________

3. G6PD Deficiency 4. Phenylketonuria

__________________________________ _________________________________
__________________________________ _________________________________
__________________________________ _________________________________
 2 | Community Health Nursing 1 27

ACTIVITY/ANSWER SHEET

Name: _____________________________________________________________ LP#: ________

Instructor: _________________________________________

Activity #5 – Plan a program of activities for a community based on one (1) of the programs
implemented by the DOH. You may have it in an invitation form or in a series of activities
but make sure to reflect the important things to be tackled specific to the program
implementation. Use the space provided.