Basic course for coop health promoters

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Basic course for coop health promoters

  1. 1. Basic Course for Co-op Health PromotersWith support from:
  2. 2. PurposeDevelop a corps of confident, competent and committed coop-based health promoters to assist coop members address their health needs by accessing and utilizing the services/products offered by the coop social health enterprise and other healthcare providers.
  3. 3. Objectives1. Discuss the purpose and objectives of the EVAcoh Project and the SHEs in relation to the government’s Universal Health Access Agenda;2. Discuss the coop health promotion process and their role, functions and responsibilities as coop health promoters (CHPs);3. Discuss and demonstrate the key attributes and the essential skills of a CHP;4. Discuss basic maternal and family health messages intended for target clients;5. Prepare a re-entry action plan.
  4. 4. Outputs1. Validated profile of specific client groups2. Validated client targeting, monitoring and reporting forms3. Re-entry plans
  5. 5. ContentModule 1 Universal Health Access and the EVAcoh ProjectModule 2 Co-op Health Promoters – Caring for Co-op MembersModule 3 Health for Mothers and Their FamiliesModule 4 Let’s Make It Happen
  6. 6. Molding the 3C Coop Health Promoter (CHP)
  7. 7. --- end of training overview ---
  8. 8. Module 1:UNIVERSAL HEALTH ACCESS AND THE EVAcoh PROJECT
  9. 9. In this module, we will learn... 1. Health is a BASIC human right! 2. Community health = individual health = community health 3. EVAcoh social health enterprises (SHEs)  community health system  UHA  MDGs
  10. 10. Health as HUMAN RIGHTArticle 25 (of 30 articles)• (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.• (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection
  11. 11. Health?• “Health is a right of every Filipino citizen and the State is duty-bound to ensure that all Filipinos have equitable access to effective health care services” (Philippine 1987 Constitution)
  12. 12. Health?• "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.“ -- WHO
  13. 13. MMR = 162 vs 52!
  14. 14. Better health Responsive health Equitable health outcomes system financing Financial Risk Protection Improving Achieving access to MDGmax quality health facilities Health Service Policy, standards Health Health GovernanceFinancing Delivery and regulation Human Information for Health Resource
  15. 15. Health SystemStrengthening?
  16. 16. <HSS: videoclip>What can cooperatives do?
  17. 17. Source: Setting-up Community Health Programs, 3rd ed. Ted Lankester.
  18. 18. Demand SupplyTarget Groups: women of Health System Strengthening -reproductive age, infant and - what can coops do???children, young people, seniorcitizens, vulnerable and at-riskgroups, etc Health Promotion
  19. 19. Enhancing Access to and Utilization of Maternal and Family Health Services by Underserved Sectors in Eastern Visayas through the Cooperative Enterprise System (a.k.a. Eastern Visayas Area Cooperation for Health or EVAcoh Project)With support from:
  20. 20. Co-operative Code of 2008• 7th Principle: Concern for Community  sustainable development of communities...• Social Audit  social impact and ethical performance
  21. 21. The Challenge ... and Opportunity• 11 Filipino mothers die every day in the Philippines• EV one of the top 5 worst places to be a mother• EV Maternal Mortality Ratio (Deaths per 100, 000 live births) 229.8 (2004)*• EV Total Fertility Rate(number of children within reproductive years) 4.3 (2008) – top 4 regions* compared with 110 in Thailand, 62 in Malaysia and 14 in Singapore; only 62% of births are supervised by skilled personnelChallenge and opportunity…
  22. 22. http://web.evis.net.ph/neda8/index2.php?option=com_content&do_pdf=1&id=131; accessed: 19January2011• 2nd highest region in terms of teen pregnancy• HIV infections rising (Cebu outbreak: 1 in 2 IDUs is infected!)• Worsening poverty in EV: 35.3% in 2003 to 40.7% in 2006• Under-five mortality is second highest (64 deaths) – ARMM (94 deaths) (NDHS, 2008)• Prevalence of Underweight Children (0-6 years old) 18.1 % (2009) Challenge and opportunity…
  23. 23. 1 ObjectiveTo enhance ACCESS to and UTILIZATION of efficient, effective, quality and affordable maternal and family health including family planning and HIV prevention services to underserved groups in selected communities in Eastern Visayas.
  24. 24. ACCESS (A) = a1 + a2 + a3 + a4 available affordable access adequate acceptable
  25. 25. 3 Performance Indicators1. Improved level of KASP of target population2. Increased percentage of co-op women, girls and men accessing health services3. Increased percentage of coverage (by area, by type of client groups) and reach of health service/s provided by co-operatives What we intend to accomplish …
  26. 26. Self-reliant, healthy and prosperous family (and communities) Our Response: The 3rd Leg Coop Sector- Government Sector- based based Healthcare HealthcareBusiness Sector-based Healthcare
  27. 27. COOPERATIVE-BASED HEALTH SYSTEM STRENGTHENING FOR MFH Access to Coop-operated MFH facilities/programs efficient and effective maternal and family Business-operated MFH health Women, young facilities/programs including girls and men family planning and HIV Government-operated prevention MFH facilities/programs services CLIENTELE GROUPS SERVICE POINTS OBJECTIVE PRINCIPLES: community ownership; gender equity; continuum of quality care APPROACHES: primary health care approach; CO/CD approach; social enterprise approachSTRATEGIES: behavior change communication; coop-based service delivery; linkaging & networking
  28. 28. --- end of module 1 ---
  29. 29. Module 2CO-OP HEALTH PROMOTERS:CARING FOR CO-OP MEMBERS
  30. 30. In this module, we will learn...1. Elements of a client-focused coop health promotion process.2. Essential qualities and attributes of an effective coop health promoter.3. Some techniques, tools and tips for coop health promoters.
  31. 31. Elements of Co-op Health Promotion: principles, steps, stakeholdersA. Principles: A.C.T. adult learning theory and practice (ALT) Alt community self-reliance the continuum of care Csr Tcc
  32. 32. Adult learning ...
  33. 33. Self-reliance?(1)...“Let’s reflect on it” 1. Describe each frame. 2. What are the key messages of each? 3. Which one do you prefer? 4. Why?
  34. 34. Self-reliance: how?
  35. 35. Self-reliance? (2)...“Let’s reflect on it”
  36. 36. Release = Self-reliance Go to the people Live among them Learn from them Plan with them Work with them Start with what they know Build on what they have Teach by showing Learn by doing Not a showcase But a pattern Not odds and ends but a system Not to conform but to transform Not relief but release. -- Dr. James Yen
  37. 37. What are the dimensions and importance of the Continuum of Care?The first dimension of the Continuum of Care is time - from pre-pregnancy, throughpregnancy, childbirth, and the early days and years of life
  38. 38. The second dimension of the Continuum of Care is place - linking the various levels of home, community,and health facilities (Figure 2. Connecting care giving between households and health facilities to reducematernal, newborn, and child deaths).
  39. 39. Continuum of Care 3rd dimension: Stages of health issue Prevention Support Diagnosis Care Treatment
  40. 40. B. Steps: How to -- Demand Side = ADPIE:AD: assess and diagnose1. understand the client and his/her context or situation PI: plan and implement2. work with the client in planning and pursuing his/her health aspirationsE: evaluate3. assess/evaluate with the client his/her progress THENencourage him/her to move forward or help resolve issues
  41. 41.  How to -- Supply Side:1. know your SHE  2. map-out other health care providers  3. set-up linkage/referral system  4. evaluate and address concerns
  42. 42. C. Key Stakeholders:CHP, Provider & Client
  43. 43. CHP’s role = “BRIDGE” Demand Supply (mother & families) (SHE ++)B.R.I.D.G.E. = Bringing-out Responsible Individuals Dedicated to Grassroots Empowerment
  44. 44. CHP: Duties – C.P.P.1. collect, analyze and keep information about co-op members2. provide correct, appropriate and timely health information and referral services to members3. promote the services and products offered by the social health enterprise
  45. 45. CHP: Responsibilities – I.P.C.1. Identify and work with co-op members and access utilize their families to & health services/products2. Plan, implement, monitor and evaluate assistance to members3. Contribute to SHE targets in terms of client reached and served
  46. 46. The Confident, Competent and Committed (3C) CHP Quality Knowledge Attitude Skill PracticeConfident  Relevant  Positive(self-esteem) education, outlook, trust self. “I can learn and training and do it.” experience. “I can make a Health as positive human right, contribution.” MDGs, KP,  “If others can EVAcoh, coop, do, why can’t I?”Competent SHE.  Humble --“I  Facilitation,  Apply skills(essence)  3 elements am willing to Public in specific of coop health learn more.” speaking, health promotion, Open-minded. Listening, promotion role/TOR,  “It’s a shared Planning, activities such learning principles, S.I.R. as reach-out, process.” content etc. (technical, “I am sincere.”Committed  Continually(consistency) medical, social,  ‘It is my do volunteer legal, etc). obligation to help service ‘rain or others – am not doing this for shine’. something else.”
  47. 47. CHP: Basic Toolkit• Records• BCC materials – maternal and family health (MFH)• Reporting forms• FAQ sheet on MFH• EVAcoh/SHE infosheets
  48. 48. --- end of module 2 ---
  49. 49. MODULE 3:Health-4-MaFa MaFa = Mother and her Family
  50. 50. In this module, we will learn ...1. Our target individuals and groups.2. SHE products and services3. Key health promotion packages and messages Note: Most materials in this module were provided by DOH resource persons and/or downloaded from the internet.
  51. 51. Our clientsa. Women of reproductive age (15-49 years old)b. Infants, children and young peoplec. Men
  52. 52. PROFILE OF CO-OP HEALTH PROMOTERS’ CLIENTS
  53. 53. Region 8 WRA YOUTH MENAge 34 Yrs old 16 Yrs old 41 yrs oldIncome 100% below PL 100% below PL 100% below PLAve. No. of children 2 1 2Unemployment 40% (10% national) 0% 16.89%rateLiteracy rate 100% simple 100% simple 100% simple literacy literacy literacyHEALTH PROFILEGot sick doing self 49.18% 48.72% 41.77%medicationSubmit for lab exam 57.43% 46.26% 65.33% (annual check-up) (enrollment) (annual check-up)Access to health 96% 95.3% 84.7%infoPerceive adequate 33.1% 15.6% 16%govt health servicesSource of info 64.9% (HW) 53.3% (HW) 84.7% (HW) 30% (TV) 40% (TV) 15.3% (TV)
  54. 54. Region 8 WRA YOUTH MENwhere buy meds 61.5% (LDS) 46.6% (BnB) 74.7% (BnB)KASP on MATERNAL & FAMILY HEALTHTB transmit thru 76.7% 48% 71.3%utensilsTB can be cured 95.3% 52.7% 85.3%Ever heard of TB 36.9% 33.1% 16%DOTSKnowledge about 86.6% 47.3% 86.7%hepaKnowledge that 55.7% 36.5% 80.7%hepa is transmittedthru bloodKnows HIV & AIDS 100% 48.6% 100%Correct attitude 49.7% 43.2% 61.3%towards personwith HIV
  55. 55. Region 8-CVPs WRA YOUTH MENAge of 1st sexual 22 yrs. old 18 yrs old 18 years oldrelationshipUsed condom 5.4% 2.7% 40.7%during first sexWith other partner 2.0% 2.7% 16.%Knowledge on FP 77.7% 38.5% 90%Using FP method 68% 81% (married) 49.6%Knowledge on 39.2% 3.3% 48.7%VAWCVAWC reporting 5.4% 2.7% 0%practiceKnowledge on 99% 25% 100%importance ofprenatalFavorable attitude 99.3% 24.3% 100%towards prenatalFavorable attitude 70.9% 0% 0%towardspostpartum
  56. 56. What our SHE offers... <workshop-discussion>1. Pharmacy products2. Clinic services3. CHP outreach services
  57. 57. SHE Health Promotion Packages1. Package 1: promotion of maternal and child health and nutrition (MNCHN)2. Package 2: promotion of adolescent and youth sexual and reproductive health and rights (AYSRHR) and prevention, treatment and care of STI and HIV&AIDS3. Package 3: prevention and treatment of infectious diseases4. Package 4: prevention and management of lifestyle diseases5. Package 5: promotion of gender equality and equity, and prevention of violence against women and children (VAWC)
  58. 58. Package 1promotion of maternal and child health and nutrition (MNCHN)
  59. 59. Home Visit: Scheduling your visitPrenatal Period: Make 4 Home Visits to the Pregnant women!! 1st Trimester 1st HOME VISIT (1-3 months) 2nd Trimester 2nd HOME VISIT (4-6 months) 3rd Trimester 3rd HOME VISIT (7-8 months) 3rd Trimester 4th HOME VISIT (9 months)You can conduct more visits according to thenecessity!!! 61
  60. 60. Home Visit: Scheduling your visitPostnatal Period: up to 42 days Make at least 3 Home Visits to the Postpartum women!! 1st Week 1st HOME VISIT (Preferably 2-3 days after delivery) 2nd HOME VISIT 2 to 3 weeks 3rd HOME VISIT 4 to 6 weeks You can conduct more visits according to the necessity!!! 62
  61. 61. Warning Signs During PregnancyWhich symptoms are the warning signs??Severe Headache & Dizziness, Blurring of Swelling of the legs, hands or 63 Vision face
  62. 62. Warning Signs During PregnancyWhich symptoms are the warning signs?? 64
  63. 63. Warning Signs During PregnancyWhich symptoms are the warning signs?? 65
  64. 64. Warning Signs During Pregnancy1. Swelling of the legs, hands and/or face2. Severe headache, dizziness, blurring of vision3. Vaginal bleeding or vaginal spotting4. Pallor or anemia5. Fever and chills6. Vomiting7. Fast or difficult breathing 66
  65. 65. Warning Signs During Pregnancy cont…8. Severe abdominal pain9. Vaginal discharge and/or genital sores10. Painful urination11. Watery vaginal discharge12. Convulsions or loss of consciousness13. Absence of/ reduced fetal movements(less than 10 kicks in 12 hours in the second half ofpregnancy) 67
  66. 66. 1. Assessing the Postpartum Mother forDanger Signs:If mothers has one or more danger signs, REFERher urgently to the health center:1.Heavy vaginal bleeding (??5 soaked sanitarypads??)2.Fever3.Severe headache or convulsions4.Fast or difficult breathing5.Severe abdominal pain 68
  67. 67. Danger Signs of Newborn (1)Feeding less or not feeding at all • Not able to suck at the breast when the mother tried to put the baby to the breast several times over a few hours: possibility of severe illness • The baby was feeding well after birth but has stopped feeding well now: possibility of infection 69
  68. 68. Danger Signs of Newborn (2) Convulsions• Convulsion indicates severe illness in the baby• The baby’s arms and legs may become stiff• The baby may stop breathing and become blue• Recurring movement of a part of the body like twitching of the mouth or blinking of the eyes 70
  69. 69. Danger Signs of Newborn (3)High or very low temperature • When a baby has a serious infection, the body can become very cold or very hot. The temperature should stay in between 35.5℃ to 37.4℃. • The baby with higher or lower temperature of this range must be referred to the hospital urgently 71
  70. 70. Danger Signs of Newborn (4) Local Infection Most common infection occurs in: 1. Umbilicus: - Pus coming out of the umbilical stump - The skin where the stump is attached to is red 2. Skin: Skin boils filled with pus 3. Eyes: Pus coming out from the eyesAny local infection needs treatment, therefore, you need to refer the baby to the health center 72
  71. 71. Danger Signs of Newborn (5) Yellow soles• Many babies have some jaundice (yellow eyes and skin) in the first week of life, and disappears in a few days. This is a normal condition.• If the baby develops yellow soles, this means that jaundice is severe and can be dangerous ⇒Urgently refer to the health center 73
  72. 72. Danger Signs of Newborn (6) No movement or less movement• Normal baby can move his/her arms or legs or turn the head several times in a minute• If the baby is awake but doesn’t move on his/her own, gently stimulate the baby by tapping or flicking the soles• If the baby only moves when stimulated, or doesn’t move at all with stimulation, this could be a danger sign, needs to be referred to the nearest health facility 74
  73. 73. Danger Signs of Newborn (7) Fast or difficulty in breathing• “Fast breathing”: if the Breathing rate is 60 per minute or more• “Chest indrawing”: the lower chest wall goes in when the child breathes in, and the upper chest and abdomen move out. 75
  74. 74. Reminding of the Mother on Baby CareRoutineRemind the mother of what was discussed duringthe last home visit during the prenatal period.Kangaroo Care, Hand Washing,Delay in bathing after birth, CordCare, Newborn care,Breastfeeding a baby 76
  75. 75. Care during the first few weeks after birth Newborn Screening • A very simple procedural test to see if the baby has harmful or potentially fatal disorders. • It is a simple blood test done to the baby from 48 to 72 hours after birth.CHT-80
  76. 76. Newborn Screening cont…• The disorder can be managed and the child can grow up healthy if diagnosed early!• If case was not detected, it could cause mental retardation or death of the child. 78
  77. 77. Follow-up on the status of immunization and Family Planning• Check the Immunization Record to see if the mother and her baby has been receiving necessary immunization;• Check the Family Planning Record to see if the mother has received the consultation on FP. If not, encourages her to attend the consultation. 79
  78. 78. ImmunizationImmunization protects the babyagainst several infectious diseases.Check the Immunization record tosee if the mother and her babyhas received necessaryimmunizations. CHT- 86
  79. 79. Within 24 6 10 14 9 12-15 16 mos. hrs weeks weeks weeks mos. mos. & above (at birth)BCGDPT/Hep B-HibOPVHBVAMV (9mos)MMROther vaccines
  80. 80. Feeding Recommendations and Exclusive Breastfeeding • A baby should be given only breastmilk for the first 6 months of life. • Breastmilk is the best food for the baby and provides all the food and fluids that the baby needs. Exclusive BreastfeedingCHT- 82
  81. 81. Exclusive Breastfeeding cont…• Breastmilk has antibodies that protect the baby from illnesses.• During the exclusive breastfeeding period, giving other food or fluids, even water, can be harmful for the baby.• The mother should breastfeed on demand, day and night. This will promote milk production so the baby will be healthy and grow well. CHT- 83
  82. 82. Proper Attachment:observing a breastfeed Good Attachment: 1.More areola is seen above than below the baby’s mouth 2.The baby’s mouth is wide open 3.The baby’s lower lip is turned outwards 4.The baby’s chin is touching A the breast B
  83. 83. Proper Positioning:observing a breastfeed Good Positioning: 1.The baby’s head and body are in line (the baby’s neck is not twisted) 2.The baby is held close to the mother’s body; and 3.The baby’s whole body is supported A B
  84. 84. Problems Solutions1. Baby wants to feed all Position the baby properly the time2. Bleeding / sore / cracked Proper position and nipples attachment3. Thrush (white marks on Oral medication or anti- sore nipples) fungal cream
  85. 85. Problems Solutions4. Flat nipple or lumpy, Frequent feeding; express milk; hard and full breasts take warm shower before (breast engorgement) feeding baby5. Tender small lump in Improve drainage of milk, look the breast (blocked for cause & correct duct) Suggest: Frequent feeds, gentle massage towards nipple, warm compress, start feed on unaffected side, vary position
  86. 86. Problems Solutions6. Inflamed red areas on Feed the baby, start with the the breast, along with sore side ; warm and cold flu symptoms like compress to reduce the temperature, aches, swelling ; analgesic or sore breast that is full antibiotic if no improvement (mastitis)7. Baby refuses to feed Feed the baby expressed from the breast breastmilk using a cup; feed the baby when he is almost asleep
  87. 87. • Birth to 6 months Exclusive breastfeeding as long as the child wants, day and night, at least 8 times in 24 hours. Do not give other foods or fluids including water.
  88. 88. • 6 months up to 12 months Breastfeed as often as the child wants. In addition to frequent breastfeeding, give the child who is: *6 months old, 2-3 tablespoons of thick porridge with well mashed foods 2x/day. * 7-8 months old, 2/3 cup of mashed family foods, 3x/day. * 9-11 months, ¾ cup finely chopped or mashed family foods in 3 meals + 1 snack.
  89. 89. • 12 months up to 2 years Breastfeed as often as the child wants. In addition to frequent breastfeeding, give the child a cupful of family foods , chopped or mashed in 3 meals and 2 snacks. Food may include animal food (e.g. meat, fish, egg) and fruits and vegetables (e.g. banana, papaya, orange, carrots, squash, beans and nuts).
  90. 90. • 2 years and older Breastfeeding for 2 years of age or longer helps a child to grow strong and healthy. A growing child needs 3 meals and 2 snacks. Give a variety of foods everyday.
  91. 91. Milk CodeSec. 32. It is the primary responsibility of the health workers to promote, protect and support breastfeeding and appropriate infant and young child feeding. No assistance, support, logistics or training from milk companies shall be permitted.
  92. 92. Package 2promotion of adolescent and youth sexual and reproductive health and rights (AYSRHR) and prevention, treatment and care of STI and HIV&AIDS
  93. 93. Adolescence and Youth Sexual and Reproductive Health and Rights (AYSRHR): Concepts and Realities
  94. 94. Adolescence• is the period in life when an individual is no longer a child, but not yet an adult.• is the period when the individual undergoes enormous physical and psychological changes.
  95. 95. Philippine context• 1 out of 10 Filipina 15-19 years old is already mother (4,702,400 women)• 3 in 10 births (33%) by teenage mothers were unwanted at the time of conception• 46% of abortion attempts occurred among 20-24 y.o and 16% among teenagers• HIV and other STDs 15-24 y.o HIV infection tripled bet. 2007-2008 (from 41-110per year. 29% increase in 2009.(source NDHS, 2008-2009)
  96. 96. Reproductive RightsThese include the rights of couples and individuals to:• Make free and informed decisions about their reproductive lives, including the number, timing and spacing of children• Attain the highest standard of sexual and reproductive health
  97. 97. Sexual RightsThese include the rights of all individuals to:• Make free and informed decisions on all matters relating to their sexuality• Be free of discrimination, coercion, or violence in their sexual lives and decisions• Expect and demand equality, full consent, mutual respect and shared responsibility in sexual relationships
  98. 98. 13 Sexual and Reproductive Health Rights
  99. 99. What shall we do?RESPECT PROTECT FULFILLRefrain from: -third parties do not -health policy or-Discriminatory limit people’s access national health planpractices to information and covering public and-limiting access to services private sectorscontraceptives and -health professionals -public healthmeans of maintaining provide care without infrastructure andsexual and discrimination, having provide sufficientreproductive health free and informed training for service-withhold, censor or consent providersmisrepresent -patients should not beinformation refused adequate-infringing on the right medical treatment into privacy emergency situation -information and counselling
  100. 100. HIV and AIDS 101
  101. 101. DEFINITION
  102. 102. MODES OF TRANSMISSIONA. Unprotected penetrative sex with an HIV infected partner a.1 Male to female, male to male or female to female a.2 Anal, Vaginal or OralB. Infected blood and blood products b.1 Blood transfusion b.2 Organ transplantation b.3 Sharing of used needles and syringes b.4 Occupational hazardsC. Infected mother to child c.1 Delivery c.2 Breastfeeding
  103. 103. 4 REQUIREMENTS FOR TRANSMISSION• Carrier of the virus (Medium) – Semen – Vaginal / Cervical fluid – Milk – Blood• Mode of transmission – Unprotected Penetrative Sex – Mother-to-Child – Blood transfusion / infected blood• Amount of virus – Is it enough?• Entry of virus – Cuts – Sores – Abscess • Should get into the BLOODSTREAM
  104. 104. HIV Progression To AIDS Time when the HIV is introduced into the body and HIV Infection starts to multiply and spread within the body. > Approx. 3-6 months after HIV infection > Individuals are infectious at this stage > “false negative” even when he/she is positive Window Period > No symptoms > Individual will now test positive > 30 – 50% of people suffer from a flu-like illness (fever, Seroconversion swollen lymph nodes, night sweats, recurrent headache, skin rash & cough) > Test positive but no signs & symptomsAsymptomatic Phase (10-15 years or more) > S/he is in high risk of transmission stage Symptoms: • Weight loss • Thrush HIV related illness • Chronic diarrhea • TB • Prolonged fever > “Terminal stage” of HIV infection. > The immune system is severely weakened in PLWA, and cannot cope with infection AIDS > Life expectancy is 1-2 yrs if no treatment. CD4 count less than 200
  105. 105. HIV Progression To AIDS
  106. 106. HIV Testing voluntary confidential, anonymous with pre and post test counseling WINDOW PERIOD  “6 months” from the last exposure with HIV
  107. 107. Process of HIV Testing and Counseling Results & KNOWING Pre-test Blood Post Test YOURCounseling Sample Counseling STATUS
  108. 108. REMINDERS/POINT OF CLARIFICATIONS
  109. 109. PREVENTIONAbstainBe faithfulCorrect and consistent condom useDon’t share needlesEarly detection, early treatmentFollow Universal Blood Precaution
  110. 110. The Connection Between STIs and HIV
  111. 111. Three Main Points• There is a causal link between infection with STIs and increased transmission of HIV• Preventing and treating STIs will reduce the number of new HIV infections• You can make a difference by helping people prevent, identify and treat STIs
  112. 112. What is the STI-HIV Connection?• Similar behaviors put people at risk of both STIs and HIV• A current STI can increase risk of getting HIV by 2-5 times• People with both HIV infection and another STI have increased HIV viral loads and can more easily infect others with HIV• People with HIV can have more serious complications of other STIs
  113. 113. STIs• ulcerative: syphilis, chancroid, genital herpes• inflammatory: gonorrhea, chlamydia, trichomoniasis• US has highest rates of STIs in industrialized countries – especially chlamydia, gonorrhea and genital herpes
  114. 114. Many STIs Have No Symptoms• In women: over 50% with gonorrhea and 70% with Chlamydia had no symptoms• In men: 68-92% with gonorrhea and 92% with Chlamydia reported no symptoms
  115. 115. Epidemiologic Evidence• Researchers have observed a strong association between having STIs and HIV in a number of studies.• The association is termed “epidemiological synergy”• 2-5 fold increased risk for HIV infection among persons who have other STDs.
  116. 116. Why the Increased Risk• Ulcers and inflamed areas provide an easy portal of entry• STIs attract T-helper cells to the infected area• Even asymptomatic STis can cause abnormal cellular changes that allow easier passage of infectious agents.• STIs increase viral load and shedding of HIV
  117. 117. Conclusions• There is a direct link between other STIs and HIV transmission• Early identification and treatment of STIs will reduce HIV transmission• You can make a difference by helping people know these facts and working with those at risk to get screened and treated
  118. 118. Package 3prevention and treatment of infectious diseases
  119. 119. Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another.
  120. 120. Contraction, Transmission, and Stages of Disease (1)• Transmission of Infectious Disease – Interaction of Host, Infectious Agent, and Environment – Reservoirs – Direct vs. Indirect Transmission • Routes of Exposure – Bloodborne, airborne, sexual, fecal-oral, and foodborne • Risk of Infection – Theoretical vs. measurable
  121. 121. Contraction, Transmission, and Stages of Disease (2)• Factors Affecting Disease Transmission – Mode of Entry – Virulence – Number of Organisms Transmitted – Host Resistance – Other Host Factors
  122. 122. Contraction, Transmission, and Stages of Disease (3)• Phases of the Infectious Process – Latent Period – Communicable Period – Incubation Period • Seroconversion and the window phase – Disease Period
  123. 123. Infectious diseases cont’d…• Hepatitis – General Signs & Symptoms • Symptoms are similar regardless of type of infection. • Headache, fever, weakness, joint pain, anorexia, nausea, vomiting, and URQ abdominal pain. • Jaundice, clay-colored stool, and dark urine develop as the disease progresses. – Hepatitis A (Infectious or Viral Hepatitis) (HVA) • Transmitted by fecal-oral route. • Typically is mild; many patients are asymptomatic. • Rarely serious and lasts 2–6 weeks.
  124. 124. Infectious diseases cont’d…• Hepatitis (cont.) – Hepatitis B (Serum Hepatitis) (HBV) • Virus is transmitted through direct contact with infected blood, semen, vaginal fluids, or saliva. • Risk is significantly higher for EMS providers. – 5-35% of all needlesticks result in infection. • Vaccination is available and recommended for all EMS workers. • 60–80% of infected individuals are asymptomatic.
  125. 125. Infectious diseases cont’d…• Tuberculosis – General Info • Most common preventable infectious disease • Drug-resistant TB – Skin Testing ?? – Pathogenesis ?? – Clinical Presentation • Chills, fever, fatigue, chronic cough, weight loss • Night sweats • Hemoptysis
  126. 126. Infectious diseases cont’d…• Pneumonia – History & assessment • Community-acquired pneumonia. • Signs include acute onset of chills, fever, dyspnea, pleuritic chest pain, cough, adventitious breath sounds. • In geriatric patients, the primary sign may be an altered mental state.
  127. 127. Infectious diseases cont’d…• Chickenpox – Varicella Zoster Virus (VCV) – Clinical Presentation • Respiratory symptoms, malaise, and low-grade fever followed by a rash. • Rash may be the first sign of illness and may be limited or widespread; often prolific on the trunk. • Transmission is through airborne droplets and direct contact with lesions. • Can be lethal in adult immunocompromised patients.
  128. 128. Infectious diseases cont’d…• Chickenpox (cont.) – Assessing Immunity • Past history of chickenpox is sufficient. – Immunization ?? – Response and Post-exposure • Observe universal (standard) precautions. • Get postexposure vaccination.
  129. 129. Infectious diseases cont’d…• Meningitis – Inflammation of the Meninges • Caused by a variety of pathogens. – Transmission Factors • Host resistance factors, weather • Contact with oral secretions • Crowding, close contact, smoking
  130. 130. Infectious diseases cont’d…• Meningitis (cont.) – Clinical Presentation • Incubation period of 4–10 days • Fever, chills, headache, nuchal rigidity, arthralgia, lethargy, malaise, altered mental status, vomiting, and seizures – Immunization ?? – Response and Postexposure • Observe universal (standard) precautions. • Perform postexposure prophylaxis within 24 hours.
  131. 131. Airborne Diseases• Influenza and the Common Cold – Viral Infection • Mutation and virulence • Epidemics – Symptoms • Fever, chills, malaise, muscle aches, nasal discharge, mild cough • Secondary infections – Management ?? – Immunization ??
  132. 132. Airborne Diseases• Measles – Viral Infection • Highly communicable, with lifelong immunity after disease. • Transmitted by airborne droplets and direct contact. – Symptoms • Presents similar to severe cold with fever, conjunctivitis, photophobia, cough, and congestion. • Rash. – Management ?? – Immunization ??
  133. 133. Airborne Diseases• Mumps – Viral Infection • Transmitted by airborne droplets and direct contact with saliva of infected patient. • Occurs primarily in 5- to 15-year-old patients. – Symptoms • Painful enlargement of salivary glands • Symptoms of cold with earache, difficulty chewing, and swallowing – Management ?? – Immunization ??
  134. 134. Airborne Diseases• Rubella – Systemic Viral Infection – Symptoms • Sore throat, low-grade fever, and fine pink rash – Management and Immunization• Respiratory Syncytial Virus (RSV) – Viral Infection • Common cause of pneumonias and bronchiolitis • Commonly associated with lower respiratory infections during the winter
  135. 135. Airborne Diseases• RSV (cont.) – Symptoms • Runny nose and congestion, followed by wheezing, tachypnea, and signs of respiratory distress – Management ??• Pertussis (Whooping Cough) – Bacterial Infection – Symptoms • Catarrhal, paroxysmal, and convalescent phases – Management and Immunization ??
  136. 136. Package 4prevention and treatment of lifestyle diseases
  137. 137. “The causes of almost all cancers and diseases are improper diet and lifestyle! The treatment should be geared to lifestyle modification instead of medications.”
  138. 138. VIRUS
  139. 139. I. HOW SERIOUS IS THE PROBLEM?• The Global Picture – CVD and Diabetes are the major causes of premature deaths – CVD- approximately 10M of the total 15M CVD deaths occur each year – 7M deaths each year from Coronary Artery Disease (CAD) and 4.5M from Stroke
  140. 140. The Regional Picture (Region – 8) A) CVD – 1st leading cause of death at 165.73% (2009) B) COPD – 2nd leading cause of death at 66.69% (2009) C) CANCER/NEOPLASM – 3rd leading cause of dealth at 23.81 % (2009) D) DIABETES MILLITUS – 9th leading cause of death at 11.65%
  141. 141. FOUR MAJOR CHRONIC DISEASES1. CVD (Cardio-Vascular Disease)2. DIABETES MELLITUS (Type 1 & 2)3. COPD (Chronic Obstructive Pulomonary Disease)4. CANCER
  142. 142. The Regional Picture (Region – 8) A) CVD – 1st leading cause of death at 165.73% (2009) B) COPD – 2nd leading cause of death at 66.69% (2009) C) CANCER/NEOPLASM – 3rd leading cause of dealth at 23.81 % (2009) D) DIABETES MILLITUS – 9th leading cause of death at 11.65%
  143. 143. CVD (Cardio-Vascular Disease)
  144. 144. Heart disease and stroke kill some 17 million people a year, which is almost one-third of all deaths globally. In the Philippines, facts show: CVD - no. 1 killer in the country Every hour, 9 Filipinos die of CVD1 out of 4 deaths in the country is due to CVD 1 out of 10 Filipinos aged 15 years old and above has hypertension and high blood pressure
  145. 145. CVD (Cardio-Vascular Disease)1. HYPERTENSION2. CORONARY ARTERY DISEASE3. CEREBROVASCULAR DISEASE
  146. 146. II. CAUSES and RISK FACTORSA. Diseases of the Heart and Blood Vessels (CVD) 1. HYPERTENSION - sustained systolic BP of 140mmhg or more and sustained diastolic BP of 90mmhg or more based on measurement done at least 2 visits taken at 1 week apart “Correct diagnosis of hypertension depends on correct BP-taking technique!”
  147. 147. • Hypertension - is defined as a sustained elevation in mean arterial pressure - it is not a single disease state but a disorder with many causes, a variety of symptoms & a range of responses to therapy. - hypertension is also risk factor for the development of other CVD’s like coronary heart disease & stroke.
  148. 148. RISK FACTORS: 1. Older people 35 years old & above 2. Family history of HPN 3. Overweight and Obesity 4. High Salt intake 5. Excess alcohol intake 6. Smoking 7. Diabetics 8. Those on birth control pills 9. Post-menopausal females
  149. 149. SYMPTOMS OF HYPERTENSION : At times, high BP may present when patients have:• 1. Headache• 2. Nape pain• 3. Dizziness• 4. Epistaxis• 5. Blurring of vision
  150. 150. LIFESTYLE MODIFICATION to MANAGEHYPERTENSION :• 1. Weight Reduction. - maintain normal body weight (BMI of 18.5 – 24.9) 2. Adopt a balanced eating plan. - consume a diet risk in fruits, vegetables & low fat dairy products with a reduced content of saturated & total fat.
  151. 151. • 3. Dietary sodium reduction - reduce dietary sodium intake to no more than 100mEq/L(2.4g. Sodium) 4. Physical Activity - engage in regular aerobic physical activity such as brisk walking (at least 30 min. per day, most days of the week)
  152. 152. • 5. Moderation of alcohol consumption - limit consumption to no more than 2 drinks per day (1oz or 30 ml. ethanol, eg. 24oz beer, 10oz wine, or 3 oz. go-proof whisky) in most men & no more than 1 drink per day in women & lighter weight persons.
  153. 153. • 6. Stress management• 7. Regular intake of anti- hypertensive medicines
  154. 154. WHAT WILL HAPPEN IF HYPERTENSION IS NOTCONTROLLED?• The HEART - When the heart pumps blood into a narrow artery, it has to work harder to meet the body’s demand for oxygen, nutrients & other essential. - The heart muscle progressively stretches & thickens, enlarges & subsequently fails.
  155. 155. - When there is total blockage of one of the arteries supplying blood to the heart muscle, a myocardial infarction ensues. This usually presents as severe chest pain & is definitely medical emergency.
  156. 156. • The ARTERIES - Arteries are vessels that carry the blood throughout the body. When the BP is high, the arteries become scarred, hardened & less elastic. - They may not be able to meet the demand of the tissues, & hence the tissues and organs cannot function well.
  157. 157. • The KIDNEYS -High BP cause narrowing of the arteries to the kidneys which in turn can cause kidney failure.The BRAIN - Progressive narrowing of the blood vessels to the brain will decrease blood flow & will cause brain cells to die.
  158. 158. • - Vessels of the brain maybe logged causing a stroke due to thrombosis & hemorrhage or rupture. Like a heart attack, the clogging of brain vessels is an emergency.
  159. 159. Stroke Symptoms:• 1. Weakness• 2. Numbness• 3. Paralysis of a part of the body• 4. Difficulty in the speech• 5. Slurred speech• 6. Dizziness• 7. Nausea• 8. Vomiting
  160. 160. • The EYES - Like other parts of the body, the blood vessels to the eyes may become narrowed & clogged leading to impaired vision & even blindness• These outcomes can be avoided by regular intake of medications & strict blood pressure control
  161. 161. II. CAUSES and RISK FACTORS2. CORONARY ARTERY DISEASE (CAD) heart disease caused by the impaired coronary blood flow or known as “Ischemic Heart Disease”. -Most common is the Atherosclerosis- narrowing of blood vessels because of the accumulation of fats and cholesterol.
  162. 162. CHEST PAINA heart attack occurs when an artery supplying your heart with blood andoxygen becomes blocked. With each passing minute, more tissue is deprivedof oxygen and deteriorates or dies. Restoring blood flow within the first hourwhen most damage occurs is critical to survival of the tissue.
  163. 163. CORONARY ARTERY DISEASE(CAD)• - is heart disease caused by impaired coronary blood flow. It is also known as Ischemic Heart Disease.• - when the coronary arteries become narrowed or clogged, supply of blood & oxygen to the heart muscle is affected.
  164. 164. • - when there is decreased oxygen supplied to the heart, muscle, chest pain (called angina) occurs.• - CAD can cause M.I. (heart attack), arrhythmias, heart failure, sudden death.
  165. 165. CAUSES:• The most common cause is ATHEROSCLEROSIS which is the thickening of the inside walls of arteries or narrowing of blood vessels because of the accumulation of cholesterol & fats.• If the obstruction of blood supply to the heart is severe & prolonged, this may lead to HEART ATTACK. If the obstruction in the blood vessels supplying the brain, this is called STROKE.
  166. 166. RISK FACTORS OF CAD:• Elevated blood lipids & cholesterol level(hyperlipidemia)• Hypertension• Smoking• Diabetes Mellitus• Overweight & Obesity• Physical Inactivity/Sedentary Lifestyle• Stress• Heredity/family History• Male Sex• Increasing Age
  167. 167. LIFESTYLE MODIFICATIONS FOR CAD:• Promote regular physical activity exercises• Encourage proper nutrition particularly by limiting intake of saturated fats & increase LDL, limiting salt intake & increasing intake of dietary fiber by eating more vegetables, fruits, unrefined cereals & wheat bread.
  168. 168. • Maintain body weight & prevent obesity through proper nutrition & physical activity/exercise.• Advice smoking cessation for active smokers & prevent exposure to second-hand smoke.• Early diagnosis, prompt treatment & control of diabetes & hypertension.
  169. 169. II. CAUSES and RISK FACTORS:3. CEREBROVASCULAR DISEASE or STROKE- loss or alteration of bodily function that results from an insufficient supply of blood to some parts of the brain. If the blood flow is obstructed to any part of the brain for several minutes, it loses its energy supply and becomes injured which leads to paralysis, slurring of speech or disability.
  170. 170. CEREBROVASCULAR DISEASE OR STROKE• It is the loss or alteration of bodily function that result from an insufficient supply of blood to some parts of the brain. If the blood flow is obstructed to any part, the brain loses its energy supply & becomes injured. If blood is obstructed for more than several minutes, injury to the brain cells becomes permanent & tissues dies in the affected region resulting in cerebral infarction.
  171. 171. • Stroke is one of the leading causes of disability. It can lead to weakness or paralysis usually of one side of the body. Often, the person has slurring of speech or even inability to talk.
  172. 172. CAUSES :• Almost all strokes are caused by occlusion of cerebral vessels by either thrombi or emboli. 1. Thrombus usually occurs in atherosclerotic blood vessels. This is usually seen in older people & may occur in a person at rest.
  173. 173. • 2. Embolic stroke is caused by a moving blood clot usually from a thrombus in the left heart that becomes lodged in a small artery through which it cannot pass. Its onset is usually sudden.• 3. Hemorrhagic stroke is the most fatal type of stroke due to rupture of intracerebral blood vessels. The most common predisposing factor is hypertension. Other causes of hemorrhage are aneurysm, trauma, erosion of vessel by tumors, & blood disorders. It usually occurs suddenly, usually when the person is active.
  174. 174. RISK FACTORS OF STROKE:• Increasing age• Sex- more women die than men of stroke• Heredity• Hypertension• Cigarette smoking• Diabetes mellitus• Heart disease• Season & climate• Excessive alcohol intake• Certain kinds of drug abuse
  175. 175. LIFESTYLE MODIFICATION FOR STROKE:• Treatment & control of hypertension• Smoking cessation & promoting a smoke-free environment• Limit alcohol consumption• Encourage proper nutrition- low fat, low sodium, high in fiber foods• Avoid intravenous drug abuse & cocaine• Prevent all other risk factors of atherosclerosis• Stress management
  176. 176. CVA Risk Factors are:1. Increasing age 552. Sex- more women than men die of stroke3. Heredity( family history)4. Hypertension5. Cigarette smoking6. Diabetes mellitus- usually have high cholesterol and are overweight
  177. 177. CVA Risk Factors are:7. Heart disease8. High Red Blood Cell (RBC) count- more red blood cells thicken the blood and make clots more likely.9. Season and climate- common in periods of extremely hot or very cold temperatures.10. Socioeconomic factors- people of lower income and educational level have a higher risk of stroke.
  178. 178. CVA Risk Factors are:11. Excessive Alcohol Intake- can raise blood pressure contributing to obesity cancer, cause heart failure and lead to stroke.12. Drug abuse – cocaine use may lead to stroke, heart attack and other CVD complications.
  179. 179. B. DIABETES MELLITUS• Group of metabolic disorder characterized by glucose intolerance with hyperglycemia present - Type I – Insulin Dependent (IDDM) – Type II – Non-insulin Dependent (NIDDM) – FBS 109 mg% (normal) 126 mg% (possible DM)
  180. 180. TYPES OF DIABETES:• 1. Type 1 diabetes is insulin-dependent mellitus(IDDM) - characterized by absolute lack of insulin due to damaged pancreas,prone to develop ketosis, dependent on insulin injections. - genetic, environment, or maybe acquired due to viruses (e.g. mumps, congenital rubella) & chemical toxins (e.g. Nitrosamines)
  181. 181. DIABETES MELLITUS• is one of the leading causes if disability in person over 4 years old. More than half of diabetes persons will die of coronary heart disease. Coronary artery disease tends to occur at an earlier age & with greater security in person with diabetes. It also increases the risk of dying of cardiovascular disease like heart attack or stroke among women.
  182. 182. • Diabetes mellitus is not a single disease. It is a genetically & clinically heterogenous group of metabolic disorders characterized by fucose intolerance, with hyperglycemia present at time of diagnosis.
  183. 183. CAUSES :• It is easier to think of diabetes as a interaction between 2 factors : - GENETIC PREDISPOSITION (diabetogenic genes) + ENVIRONMENT/LIFESTYLE (obesity, nutrition, lack of exercise)• Lifestyle includes obesity, nutrition & lack of physical activity or exercise.• Specific causes depend on the type of diabetes.
  184. 184. • 2. Type II diabetes is non-insulin dependent diabetes mellitus(NIDDM) - characterized by fasting hyperglycemia despite availability of insulin. - possible causes include impaired insulin secretion, peripheral insulin esistance & increased hepatic glucose production. - usually occurs in older overweight persons (about 80%).
  185. 185. Signs and Symptoms of Diabetes Mellitus:• Abnormal thirst• Frequent urination• Extreme hunger• Drowsiness and fatigue• Visual disturbances• Remarkable weight loss• Itching and infection of the skin and genitalia
  186. 186. RISK FACTORS OF TYPE 2 DM:• Family history of diabetes• Overweight (BMI 23kg/m2) & obesity (BMI>30kg/m2)• Sedentary lifestyle• Hypertension• High density lipoprotein<35mg/dl (0.90mmol/L)& or triglyceride level> 250mg/dl(2.82mmol/L)• History of gestational diabetes mellitus (GDM) or delivery of a baby weighing 9lbs.(4.0kgs.)• Previously identified to have impaired glucose tolerance (IGT)
  187. 187. COMPLICATION OF DIABETES MELLITUS:• Acute complications include diabetic ketoacidosis & hypoglycemia especially in type I diabetes.• Chronic complications cause most of the disability associated with the disease. These include renal disease (nephropathy), blindness (retinopathy), coronary artery disease & stroke, neuropathies & foot ulcers.
  188. 188. LIFESTYLE MODIFICATIONS FOR DIABETESMELLITUS:• Be meticulous about blood sugar control.• Be meticulous about blood pressure control.• Maintain body weight & prevent obesity.• Encourage proper nutrition – eat more DIETARY FIBER, reduce salt & fat intake, avoid simple sugars like cakes & pastries; avoid junk foods.
  189. 189. • Promote regular physical activity & exercise to prevent obesity, hypercholesterolemia & enhance insulin action in the body.• Advice smoking cessation for active smokers & prevent exposure to second-hand smoke.
  190. 190. COPD C hronic O bstructive P ulmonary An airway flow disease D isease A very common problem224 Tobacco and COPD
  191. 191. C. Chronic Obstructive Pulmonary Disease (COPD)• Characterized by cough, sputum production and dyspnea upon exertion
  192. 192. CHRONIC OBSTRUCTIONS PULMONARYDISEASE• It is a disease characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive & associated with an abnormal inflammatory response of the lungs to noxious particles or gases.• The lungs undergo permanent structural change, which leads to varying degrees of hypoxemia & hyper apnea. This explains the breathlessness & frequent cough associated with COPD.
  193. 193. CAUSES & RISK FACTORS:• COPD is usually due to chronic bronchitis & emphysema, both of which are due to cigarette smoking.• Cigarette smoking is the primary cause of COPD.
  194. 194. COPD• Chronic Bronchitis• Emphysema• These two are the most common diagnoses given to patients228 Tobacco and COPD
  195. 195. COMPLICATIONS:• Respiratory failure• Cardiovascular disease – pulmonary hypertension, which develops late in the course COPD), is the major cardiovascular complication of COPD & is associated with the development of corpulmonale & a poor prognosis.
  196. 196. The wheeze• Inspiration • widens the airway Expiration  narrows the airway  WHEEZING IS WORSE DURING EXPIRATION AND MAY BE THE FIRST SIGN OF AIRWAY NARROWING231 Tobacco and COPD
  197. 197. 90%• 90% of COPD patients are current or former smokers Tobacco and COPD 232
  198. 198. Pathology of COPD• Small and large airway narrowing caused by – Epithelial thickening – Increased mucus cells – Hyperplasia – Fibrosis – Mucus plugs 233 Tobacco and COPD
  199. 199. Secondary Effects• Renal dysfunctions• Weight loss• Muscular wasting• Osteoporosis all complicating factors in COPD Tobacco and COPD 234
  200. 200. D. Cancer- not all tumors are cancerous- Benign tumors grow slowly and do not spread while malignant tumors grow more rapidly, metastasize and cause death.
  201. 201. Causes and Risk factors of Cancer1. Heredity/ family history2. Carcinogens- maybe a chemical and environmental agent, radiation and viruses Many cancers are associated with lifestyle risk factors like: • Smoking • Dietary factors • Alcohol consumption
  202. 202. Other Causes of Cancer• Radiation - can cause cancer including ultraviolet rays from sunlight, x-rays, radioactive chemicals, etc.• Viruses - found in cervical cancer, liver CA (hepa B virus), lymphoma and leukemia.
  203. 203. Example of Chemicals and Environmental Agents• Polycylic hydrocarbons found in cigarette smoke; industrial agents; found in food as smoked foods ( tinapa)• Aflatoxin – found in peanuts and peanut butter• Benzopyrene – found in charcoal broiled or smoked meat or fish (barbecue)“Avoid eating burned food and eat smoked food in moderation.”• Nitrosamines – used as preservatives in food like tocino, longganisa, bacon and hotdog
  204. 204. Nine Warning Signs of CancerC - change in bowel or bladder habitsA - a sore throat that does not healU - unusual bleeding or dischargeT - thickening or lump in breast or elsewhereI - indigestion or difficulty in swallowingO - obvious change in wart and moleN - nagging cough or hoarsenessU - unexplained anemiaS - sudden unexplained weight loss Acronym “CAUTION US” for Cancer
  205. 205. Screening Procedures1. Breast Cancer Breast self-exam monthly- a week after onset of menstruation2. Cervical Cancer Pap smear over 18 years old in between menses ( 2 weeks after)At risk are: - Sexually active - Multiple partners - Commercial sex workers
  206. 206. Screening Procedures3. Colon-rectal cancer - digital rectal exam4. Lung cancer - X-ray and sputum cytology
  207. 207. What is Healthy Lifestyle?• A way of life which promotes and protects one’s health and well-being• Practicing good health habits such as eating healthy diet, regular physical activity, staying smoke free, abstinence from alcohol or drinking in moderation• An integrated approach to non-communicable disease prevention and control and composition of programs like: CVD, Cancer, Diabetes, Asthma, COPD including nutrition.
  208. 208. PROMOTING PROPER NUTRITION• Eat 2-3 servings of vegetable each day, one serving of which is green or yellow leafy vegetables – Raw vegetable - 1 cup – Cooked vegetable - ½ cup• Eat at least 2 servings of fruit per day“The Filipino Diet Pyramid Food Guide for Today’s Lifestyle”
  209. 209. Do you know that beingoverweight or underweightincreases the risk of health problems?
  210. 210. Hypertension Heart DiseasesOVERWEIGHT Stroke Diabetes Cancer
  211. 211. Heart Problems Chronic FatigueUNDERWEIGHT Anemia Depression Lowered resistance to infection
  212. 212. A. OVERWEIGHT / OBESITY - Body fat can best be assessed using BMI. WEIGHT (kg) BMI = HEIGHT (m)2 BMI Result Condition • Less than 18.5 kg/m2 • Underweight • 18.6 – 22.9 kg/m2 • Healthy Weight • Greater than 23.0 kg/m2 • Overweight • 23.0 - 24.9 kg/m2 • At risk • 25.0 - 29.9 kg/m2 • Obese I • Greater than 30.0 kg/m2 • Obese II“Central OBESITY is a risk factor to HEART DISEASE and STROKE”
  213. 213. OVERWEIGHT / OBESITY WC = WAIST CIRCUMFERENCE Ideal WC for - • MEN = Less than 90 cm (35 inches) • WOMEN = Less than 80 cm (31.5 inches)“Waist Circumference greater than the above-mentioned value is not normal and the person is atrisk even if BMI result is normal.”
  214. 214. C. Cholesterol in BloodPhilippine Food According to Cholesterol Content: I. VERY HIGH CHOLESTEROL: Meat : Carabao’s Brain; Cow’s Brain; Cara Lungs Eggs : Duck; Chicken; Balut; Salted Duck’s Egg.II. MODERATE CHOLESTEROL: Meat : Cow’s Spleen/Lungs/Kidney; Pig Spleen and Lungs Poultry : Chicken LiverIII. LOW AMOUNT OF CHOLESTEROL: Meat & Poultry: Cow’s Liver & Small Intestines / Chicken Heart / Pig’s Liver and Tongue Fish/Shellfish : Large Crab ; Small Shrimps
  215. 215. C. Cholesterol in BloodPhilippine Food According to Cholesterol Content:IV. LOWEST CHOLESTEROL (99 mgs) Meat : Cow’s / Carabao’s Tongue & Uterine Pork Liempo Lean Beef and Pork Fish & Shellfish : Alimasag Lapu-lapu Salmon Kuhol Tulya Talaba Tangigue Tahong Bangus Chicken Meat & Egg White
  216. 216. C. Cholesterol in Blood Food High in Sodium Content (400 mg/ serving): • Soy Sauce • Corned Beef • Shrimp Paste • Cheese • Fish Sauces (Patis) • Carbonated Drinks • Fish Paste (Bagoong isda) • Pickles • Bacon • Tausi • Salted Peanuts/Crackers/Chips “Persons at risk of high blood cholesterol level and heart disease should limit intake of fatty meat cholesterol-rich food and saturated fats.” - Eat egg yolk 2-3 times a week - Chill meat or poultry broth until fat become solid then spoon-off the fat “sebo” before using the broth.
  217. 217. C. Cholesterol in Blood Types of Fats/Cholesterol: 1. Saturated fats raise blood cholesterol level ex: fat in meat, skin of chicken and ducks, butter, lard cream and milk products 2. Polyunsaturated fats lower total cholesterol level and LDL or bad cholesterol raise HDL ex: corn oil, soybean oil, sunflower oil 3. Monounsaturated fat lower LDL HDL remain unchanged ex: canola oil, olive oil
  218. 218. •Avoid oil or lard that is solid inroom temperature (tumitigas)•Use iodized salt but avoidexcessive intake of salty foods- topromote physical and mentaldevelopment and prevent iodinedeficiency disorder
  219. 219. Finally:•Manage weight effectively•Build healthy nutrition•Choose food wisely or an Acronym: •A = Aim for ideal body weight •B = Build healthy nutrition practices •C = Choose food wisely
  220. 220. 2. PROMOTING SMOKE-FREE ENVIRONMENTLung Cancer• Most significant cause of death from cancer in the world• Major cause is tobacco, smoking particularly cigarette• Smokers body = 4000 +chemicals present in cigarette smoke and 43 are carcinogens
  221. 221. Cigarette produces 2 kinds of smoke: Mainstream or active smoker Sidestream or passive smokerHow does smoking harm us?•Responsible for 90% of all lung cancer•75% of chronic bronchitis and emphysema•25% of ischemic heart disease
  222. 222. KEY AREAS FOR PREVENTION ARE: 1. Promote proper nutrition 2. Encourages more physical activity and exercise 3. Promote a Smoke-free Environment and Smoking Cessation 4. Discourages excessive alcohol 5. Manage stress effectively 6. Regular health check-up for early diagnosis and prompt treatmentFactors that influence the increasing trend of lifestyle-related diseases worldwide: 1. Increasing life expectancy 2. Increasing urbanization 3. Increasing industrialization or globalization
  223. 223. PHYSICAL ACTIVITY AND EXERCISEPHYSICAL ACTIVITY - Is something you do at home, like washing the dishes, sweeping the floor and cleaning the house. It is what you do outside the house like gardening. 60% – 85% of the adult population lead sedentary life.EXERCISE - Is a planned, structured and repetitive movement done to improve or maintain one or more components of physical fitness.
  224. 224. HEALTH BENEFITS OF REGULAR PHYSICAL ACTIVITY:• Reduce the risk of dying from coronary heart disease (CAD)• Reduce the risk of having a 2nd heart attack in people whohave experienced heart attack.• Lowers bad cholesterol or LDL and increases goodcholesterol or HDL.• Lowers the risk of developing high blood pressure.•Lowers the risk of developing Type II Diabetes Melitus.
  225. 225. HEALTH BENEFITS OF REGULAR PHYSICAL ACTIVITY:• Reduces the risk of developing colon cancer.• Help achieve and maintain a healthy body weight.• Reduces feelings of depression and feeling of stress• Help maintain healthy bones and muscles and joints.• Helps older adults become stronger and better able to movewithout becoming fatigued.
  226. 226. • We need to exercise to be physically fit• We need to exercise to improve our lungs• We need to exercise to build our muscles.• Exercise helps control diabetes – helps burncalories• Walking is a complete exercise. This is injury-free,sustaining and effective
  227. 227. • Frequency of exercise - 3 – 4 times a week• Intensity of exercise - For the older persons aged 50 years and above, the heart rate ratio is 40-50% of maximal heart rate.• Exercise time - For a start, 10 -15 minutes of exercise is good and gradually increase to 30 minutes.• For older persons - Walking, swimming, stretching, dancing, gardening, hiking are all excellent activities. Physical activity is a means to control joint swelling and joint pains in arthritis.
  228. 228. 3. PROMOTING PHYSICAL ACTIVITY AND EXERCISE Consider the “FIT” Principle : F- Frequency of exercise = 3 to 4 x a week, spread only the week I- Intensity to exercise, the more intense the exercise, the faster the heart rate. T- Exercise a minimum of 30 minutes each time. Start with 10 – 15 minutes then increase gradually to 30 minutes.To lose fat for weight do the aerobic exercise. Aerobic Exercises - may be walking, jogging, running, swimming and biking. Anaerobic Exercises - may be weightlifting, push-ups or pull-ups.
  229. 229. 3. PROMOTING PHYSICAL ACTIVITY AND EXERCISE Why warm – up? Prepare the body for exercise Circulation of the blood needs to be redirected Protect the articular space and prevent injury Cooling Down – is just as important as warm-ups. Our body needs to slow down at its resting level. 5 – 10 minutes cooling down is the minimum.
  230. 230. PREVENT ILLNESS... DO INTESTINAL CLEANSING Take virgin coconut oiland/or papaya everyday!
  231. 231. WANNA LIVE LONGER1. EXERCISE for 30 minutes, most days of the week.- this can gain 2.4 yrs. of life.2. QUIT smoking - men who smoke a pack a day. Lose an average of 13 years of life, while women lose 14 years.
  232. 232. • 3. EAT FRUITS & VEGETABLES.- eat fruits & veggies can lengthen your life by 2-4 years.• 4. REMEMBER THE FIBER.- for every 10 gms. Of fiber you can consume per day, your risk of heart attack goes down by 14% & risk of death from heart disease drops by 27%.
  233. 233. 5. EAT NUTS - eating one-quarter cup of nuts 5x a week can add 2.5 years to your life.6. ONLY the “GOOD” FATS please - get 20% of total daily calories from healthful fats, limit saturated fat, to 10% or less.7. LOSE WEIGHT. - maintaining IBW for height & age can lengthen your life by 11 years.
  234. 234. Mabuhay!
  235. 235. Package 5Promotion of gender equity and equality, and prevention of violence against women and children (VAWC)
  236. 236. key health messagesSex and Gender:• Sex refers to natural, physical attributes of a person• Gender refers to psycho-social identityHealth:• Sex and gender affects access to health services  power relations (degree of control)  outcome (welfare/health status?)• Our tasks: conscienticize, influence power relations to empower women
  237. 237. VAWC:• Forms/Types of abuse: rape (sexual), “sampal” (physical), verbal (emotional), absence of income (economic/financial)• If u feel hurt then u are abused• VAWC leads to: emotional imbalance, physical impairment, sickness (“makunan”, STI),
  238. 238. Pointers...• Abuser should stop the violence not because of FEAR but because of LOVE• Know the provisions of RA 9262• Isumbong: DSWD, PNP, BLGU (may power ang Punong Barangay to issue “protection order”  good for 15 days)• Nothing can be settled at the barangay because issue is complicated  BLGU and PNP should protect• Ensure safety inside the house• Contact the barangay VAWC desk officer aside from the Punong Barangay• Provide individual conseling first then as a couple• Create and operationalize a co-op a gender and woman empowerment committee (not VAWC committee – negative)• Inform and advocate: poster (if you experience these… then report to…)• Disaggregate survey data and analysis by sex.
  239. 239. -- end of module 3 --
  240. 240. MODULE 4Let’s Make It Happen!
  241. 241. In this module, we will ...1. Learn appropriate tools and processes in determining and knowing our target clients;2. Learn guidelines and tips in setting targets and in preparing and action plan; and3. Prepare a re-entry action plan for the CHP team.
  242. 242. Planning Tools: 1) Targeting Form PERFORMANCE TOTAL JANUARY-MARCH INDICATORS SHE TARGET TARGET1 Number of clients REACHED with behavior change messages CLIENT MANAGEMENT TOOLS  See sub-categories2 Number of clients SERVED with medical services/products  See sub-categoriesNOTE: Reached = those who received at Served = those who received consultation least 2 kinds of health promotion or diagnostic services; or pharmacy activities such as seminars and products worth at least PHP 50 per referrals purchase
  243. 243. Client Category/Sub-Category Total Target 2012 Target1 Women of Repro Age (15-49)1.1  Walang asawa na may-anak1.2  Live-in1.3 Legally-married1.4  Below 14 y-o but with child/ren2 Youth2.1  Male2.2  Female3 Others3.1  14 y-o and below including newborn3.1.1 -- male3.1.2 -- female3.2  lalake, 14-49 y-o3.3  All people 50 y-o and above3.3.1 -- male3.3.2 -- female
  244. 244. You got to be S.M.A.R.T.S = SpecificM = MeasurableA = AttainableR = RelevantT = Time-bound
  245. 245. Reference: Target Per CVP based on approved SHE business plan Reached CVP Served WRA Youth Others TotalBCCI 5,000 1,000 700 6,700 6,700AFCCO 4,700 1,000 1,328 7,028 22,680HFBMPC 2,250 300 2,250 4,800 850SPPMPC 6,600 1,065 3,750 11,415 4,566LAMP 3,000 2,400 4,800 10,200 1,618NSDWCC 4,000 400 800 5,200 9,000PATECI 1,400 - 953 2,353 3,996BMPC 2,200 907 668 3,775 9,362Other CVPs ???
  246. 246. Planning Tools: 2) Client Profile Form <Use DOH-CHT Form>
  247. 247. Planning Tools: 3) CHP Report Form 1Name of Co-op Health Promoter:Area/s of Coverage:Month: 1. ACCOMPLISHMENT VS. TARGETS PERFORMANCE SMART AREAS TARGETS ACCOMPLISHMENT 1.1 PLANNED WRA MEN CHILDREN TOTAL WRA MEN CHILDREN TOTAL RESULTS M F M F a Number of clients served b Number of clients reached 1.2 PLANNED ACTIVITIES OUTPUTS OF ACTIVITIES a Outreach - Brgy. 800 300 - - 1,100 Reached 900 individuals with 700 WRA & 200 Men Assembly (thru health education seminars covering all the 5 coop health promotion packages) b
  248. 248. 2. CHALLENGES AND GOOD PRACTICESA. CHALLENGES ITEM BRIEF DESCRIPTION OF ACTIONS RESULTS RECOMMENDATIONS CHALLENGES TAKEN YOU ENCOUNTERED1 Attendance Low turn-out of mothers Set mothers class To be conducted Written communication due to miscommunication thru BLGU with the mother-leader23B. GOOD PRACTICES ITEM BRIEF DESCRIPTION OF GOOD RESULTS RECOMMENDATIONS PRACTICES YOU WANT TO SHARE1 Hilot involvement Hilots in the area are now Zero Home-based delivery Percentage provision per member of the CHP and actively endorsement as motivation promote “Facility Based Delivery”.23
  249. 249. Attachment 1: SUMMARY OF CLIENTS REACHED KIND/S OF DATE/S CATEGORY ITEM FULL NAME ADDRESS AGE SEX SERVICE reached PROVIDEDA. WRA 1 2 3A. MEN 1 2 3A. CHILDREN 1 2 3
  250. 250. Attachment 2: SUMMARY OF CLIENTS SERVED KIND/S OF CATEGORY ITEM FULL NAME ADDRESS AGE SEX DATE/S served SERVICE PROVIDEDA. WRA 1 2 3A. MEN 1 2 3A. CHILDREN 1 2 3
  251. 251. CHP Team Action Plan (2012)Item Activity Output Date/s Lead Person1 Get formal appointment, Formal appointment terms of reference (TOR) with attached TOR and budget from and approved budget BOD/GM2 Map-out target WRA Directory & profile of coop members target WRAs3 Conduct SHE health ??? WRAs reached education classes per coop cluster (covering EVAcoh’s 5 Health Promotion Packages)4 Monitoring of WRA ??? WRAs served family/clients and submission of reports5 Year-end evaluation List of gains and lessons
  252. 252. Guide:1. Group by Coop-SHE.2. Set CHP targets: refer to targets set in the SHE bizplan and decide the target to be accomplished during the period (i.e., January-December 2012).3. Prepare the action plan: identify key activities to be implemented. Use template.4. Report back to the plenary.
  253. 253. -- end of module 4 --

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