STRATEGIES:

1) Strengthen local government ownership,

coordination, and partnership
2) Stop leprosy and its complications
3) Stop discrimination and promote inclusion

MALARIA
 Malaria is a mosquito-borne febrile illness caused by
the Plasmodium protozoa
 Symptoms of the disease are associated with the
rupture and release of merozoites during the blood
stage of the infection
 Classically paroxysms of chills, fevers, and
diaphoresis occur, every second day “tertian fever”
from P. vivax, P. falciparum, and P. ovale, and every
third day “quartan fever” from P. malariae.
FILARIASIS SCHISTOSOMIASIS
 Causative Agents:
o Blood flukes:
 Schistosoma haematobium, S.
japonicum, S. mansoni
 Schistosomiasis is a trematode infection of humans
caused by a blood fluke with preference for the:
o Portal and mesenteric venous system (S.
japonicum, S. mansoni)
o or urinary bladder venous plexus (S.
haematobium).
 Symptoms:
o Most infections are asymptomatic, with
severity of illness based on worm burden.
o “Swimmers itch” or schistosoma dermatitis
occurs when the Cercariae penetrate the
skin and case urticarial, pruritus, and a
macular rash.
o Previously sensitized individuals may have
more pronounced symptoms.
o Acute schistosomiasis may cause Katayama
fever, specifically from S. japonicum & S.
mansoni.
o Several weeks after exposure, patients may
develop fever, chills, malaise, abdominal
pain, diarrhea, hematochezia, chest pain,
cough, and hepatosplenomegaly.
o Chronic infections can cause granulomatous
changes in the liver (S. japonicum, S.
mansoni) and hematuria (S. haematobium).
S. haematobium can cause bladder
calcification and uretral reflux, leading to
kidney damage.
  Mode of transmission:
o sexual contact
o blood transfusion
o sharing in the “works” among drug users
 Signs & Symptoms:
o Primary:
 Chancre can appear within 10 days
to 3 months after exposure
o Secondary:
 Condylomata, alopecia, sore
throat, mucous patches of the
mouth
o Tertiary:
 Gumma formation, cardiovascular
and nervous system involvement
STDs
 Laboratory / Diagnostic Tests:
What is STD? o Darkfield illumination test
 Specific infections spread primarily during sexual o VDRL test
contact o Fluorescent treponemal antibody test
 Once called venereal disease from the word venus  Treatment:
relating to the act of sexual pleasure o Penicillin
 Common among teenagers and young adults (15-24) o Tetracycline
o Erythromycin
GONORRHEA  Nursing care:
o Symptomatic
 Clap, Drip, Tulo
 Prevention:
 Causative agent:
o Practice monogamy
o Neisseria gonorrhea
o Sex education
 Incubation period:
o 2-7 days
 Symptoms: HIV
o thick, yellowish, purulent, urethral  HIV is a retrovirus that infects humans.
discharge  The clinically asymptomatic phase can last 3 to 12
o Frequency in urination among females years
o Burning urination (dysuria) among males  It eventually leads to symptoms of disease such as
 Diagnosis: opportunistic infections (OIs) and other
o Culture of specimen in cervix – Female noninfectious diseases that constitute the syndrome
o Gram stain – male known as AIDS.
 Treatment:  AIDS is defined by CDC as any person with HIV
o Penicillin, ceftriaxone, doxycycline, infection and a CD4 lymphocyte count below 200
azithromycin cells/mcL (or a CD4 count below 14%) or having an
 Nursing Care: AIDS-indicator condition.
o Symptomatic  Most common type of pneumonia-complication
 Prevention: related to HIV is Penumocystis carinii pneumonia
o Crede’s prophylaxis
o Avoid contact with secretions CLINICAL STAGES:
1. Window phase – initial exposure
o Practice monogamous sexual contact
2. Primary HIV infection
- flu-like symptoms
SYPHILIS - ideally, screen
 Causative agent: 3. Asymptomatic phase – 1  20 years
o Treponema pallidum 4. ARC (AIDS-related complex)
 Incubation period: 5. AIDS
o 10 – 90 days
HIV-ASSOCIATED MALIGNANCY: 2. 100% Condom Use Program (CUP) especially for
 Kaposi’s sarcoma entertainment establishments;
- Affects vascular endothelium 3. Peer education and outreach
- More common among homo/bisexual men 4. Multi-sectoral coordination through Philippine
- Characterized by purplish-red lesions, not National AIDS Council (PNAC);
- Painful or pruritic; flat or indurated 5. Empowerment of communities
6. Community assemblies and for a to reduce stigma
AIDS-RELATED COMPLICATIONS: 7. Augmentation of resources of social hygiene clinics;
 Histoplasmosis and
 Kaposi’s sarcoma 8. Procured male condoms distributed as education
 Lymphoma materials during outreach.
 Mycobacterium avian complex
 Salmonella
 Wasting syndrome
 Herpes simplex
 Cervical cancer
 Tuberculosis

HOW DO YOU DETECT & MONITOR HIV INFECTION?

 Enzyme Link Immunosorbent Assay (ELISA)
o initial screening test
 Western Blot
o usually taken for confirmation of the (+)
results from ELISA
 Polymerase Chain Reaction (PCR) technology
 CD4 cell counts T4 cell (CD4) count
o 800 – 1000 is the normal count; below 500
indicates immunodeficiency.

PREVENTION:
 Screening
 Education
 Counseling
 Training

HIV / STI PREVENTION PROGRAM

 ABCDE (Abstinence, Be mutually
faithful/Monogamous, Condom Use, Don’t reuse
needles & Don’t do drugs, Education)

OBJECTIVE:
 Reduce the transmission of HIV and STI among the
most at risk population and general population and
mitigate its impact at the individual, family, and
community level

PROGRAM ACTIVITIES:
With regard to the prevention and fight against stigma and
discrimination, the ff are the strategies and interventions:

1. Availability of free voluntary HIV counseling and

testing service
 ENVIRONMENTAL SANITATION
NURSING RESPONSIBILITIES & ACTIVITIES IN ENVI.
SANITATION:
1. Health education
2. Actively participate in the training component of the
service
3. Assist in the deworming activities
4. Coordinators of programs/activities with other
government & non-government agencies
5. Health advocate or facilitator
6. Actively participate in environmental sanitation
campaigns and projects
7. Role model in terms of cleanliness in the home and
surroundings
8. Participate in research/studies to be conducted in
their respected areas of assignment
9. Helps in the implementation and interpretation of
PD 856
10. Assist in disaster management.
ENVIRONMENTAL HEALTH
 branch of public health that deals with the study of
preventing illnesses by managing the environment &
changing people’s behavior to reduce exposure to
biological & non-biological agents of disease and
injury, deals with disease agents, people &
environment.
ENVIRONEMENTAL SANITATION PROGRAM
VISION: Environmental Health related diseases are prevented
and no longer a public health problem in the Philippines
MISSION: To guarantee Environmental Sanitation services in
every community.
Program components:
 Drinking water supply
 Sanitation (excreta, sewage and septage
management)
 Zero open defacation program (ZODP)
 Food sanitation
 Air pollution (indoor and ambient)
 Chemical Safety
 WASH (Water, Sanitation & Hygiene) in emergency
situation
 Climate change for health and health impact
assessment (HIA)
ENVIRONMENTAL SANITATION
 The control of all factors in man’s physical
environment, which may exercise a deleterious
effect on his well -being & survival
COMPONENTS
1. Water Sanitation
2. Air pollution
3. Noise
4. Radiological Protection
5. Food Sanitation
6. Refuse & Garbage disposal
7. Excreta disposal
8. Insect, vermin & rodent control
9. Housing
10. Institutional Sanitation
11. Steam Pollution
LEGISLATIONS ON ENVIRONMENTAL SANITATION
 P.D. 825 - Anti-littering Act
- provides for penalty for improper disposal
of garbage
 P.D. 856 - Sanitation Code
- provides for the control of all factors in
man’s environment that affect health
 R.A. 8749 - Clean Air Act
- mandates use of unleaded gasoline; bans
incinerators; requires vehicular emission
test for registration of vehicles
 R.A. 9003 - Ecological Waste Management Act
- mandates segregation of wastes
 R.A. 9275 - Clean Water Act
- preservation and revival of fresh, brackish
and marine waters.
----------------------------------------------------------------------------------
WATER ANALYSIS
Methods of water analysis to determine potability:
1. Physical
- examination of water for its appearance,
odor and taste; can be done by anybody.
2. Chemical
- test for chemical attributes of water, such
as pH and presence of Cl-, Fe, lead,
mercury.
3. Bacteriological
- test for the presence of indicator organisms
such as coliforms; when water is coliform +,
it is contaminated by human excreta.
UNAPPROVED TYPE OF WATER FACILITIES
 Water coming from doubtful sources
 Unimproved springs, well that needs priming
APPROVED TYPES OF WATER FACILITIES: A. Initial examination
LEVEL DESCRIPTION - physical, chemical, bacteriological
examinations of water & possible
1 ● A protected well (could be shallow or radioactive contamination
(Point deep) or spring
B. Periodic examination
Source) ● No distribution system
- interval shall not be longer than 6 months;
general systematic chemical examination
● Adaptable for rural areas (1525 shall be conducted every 12 months or
households)
often
● Within 25m from the farthest user ***Water examination shall be performed only in private or
government laboratories duly accredited by the Department
● Has the greater risk for
contamination because you drink
from the point source too HOUSEHOLD TREATMENT OF WATER
II ● Composed of a source
 Boiling
(Communal reservoir  Filtration
Faucet of A plied distribution network Communal  Chemical disinfection – with the use of chlorine
●
Stand-post) faucets
located not more than 25m from the TREATMENT OF PUBLIC WATER SUPPLY
● farthest house 1. Sedimentation
● 100 households 2. Flocculation/coagulation
Most common
3. Aeration
●
4. Filtration
● Tanks sa subdivisions 5. Disinfection with chlorine
6. Fluoridation
III ● Suited for urban areas
(Waterworks ● Each household has a tap
system or
individual Water Undergoes treatment at the EXCRETA DISPOSAL
household ●
water facility like chlorine CRITERIA FOR ACCEPTABLE EXCRETA DISPOSAL FACILITIES
connection)
 Sanitary
 Simple, cheap & easy to construct with local
● Maynilad, NAWASA, NWSS
materials
● With source, transmission pipes, and  Easy to maintain
distributed among the different  With adequate protection against the elements &
households
provides desirable privacy
 Acceptable to users
Water Quality Monitoring Surveillance
APPROVED TYPE OF TOILET FACILITIES
 Set by the National Drinking Water Standards
 LEVEL I
o treatment of water to render it safe for
- Non-water carriage toilet - ex. Pit latrine
drinking
- Toilet facilities require a small amount of
o disinfection of contaminated water sources
water to wash the waste into the receiving
& their distribution system space. x. Pit privy, Antipolo toilet
 LEVEL II
TESTING FOR WATER POTABILITY: - Onsite toilet of the water carriage type with
 Coliform Test water-sealed (flushed type) with septic tank
o test for the presence of Coliforms; when  LEVEL III
water is Coliform +, it is contaminated by o Water carriage type connected to sewerage
human excreta system to treatment plant

TYPES OF WATER EXAMINATIONS REQUIRED FOR DRINKING LEVEL 1: Non-carriage type of toilet facility
WATER
  Requiring a small amount of water to wash excreta
into the receiving space/pit (ex. Pour-flush toilet)
 Non-water carriage toilet facility requiring no water
to wash excreta into the receiving space/pit (ex.
Ventilated improved pit latrine, sanitary pit privy,
Antipolo type.
 Types:
 Sanitary pit privy
- Type of toilet facility without using
any amount of water, with a pit of
at least 1-2 meters depth, a hole of
one square meter, provided with a
floor covering, a riser, seat with
cover which are all fly and rodent
proof and a building for privacy.
 Ventilated improve pit
- Refers to an on-site toilet facility
wherein the pit receives excreta
directly from the user and therefore
does not require water for flushing;
it comprises a lined pit, vent pipe
with a fly screen, cover slab and a
superstructure which allows entry
of fresh air into the pit.
LEVEL 2: water carriage type of toilet facility
 on site toilet water carriage type having a pour-flush
or flush type toilet facility and a septic vault/tank as
a disposal facility.
 Flush
- type of toilet facility with a water-
sealed toilet bowl or water closet &
a mechanical device used to wash
excreta into the receiving public
sewer or any private sewage
disposal plants/units by the use of
flushing water with traps to
provide “water seal”.
 Pour-flush
- Type of toilet facility with a water-
sealed toilet bowl that is flushed by
manually pouring water to wash
excreta into the receiving space/pit.
LEVEL 3: Sewerage system
 Facilities that collect human waste and sullage from
residences & establishments usually pipe and
convey in structures (sewers, pump stations) for
eventual treatment and safe disposal.
 Piped sewerage includes a collection system (street
laterals), a conveyance system (trunk sewers &
pump stations) & a treatment plant/disposal system.
 Water carriage toilet connected to a septic tank or to
sewerage system to treatment plant.
LEVEL OF TOILET USE
1. Communal
- a toilet facility shared by two or more
households
2. Public
- a toilet facility located at public places like
markets, bus stations, etc. Intended for
public use
3. School
- a toilet facility located in a school
essentially for the use of students
4. Household
- a toilet facility being used by an individual
household
UNAPPROVED/UNSANITARY TYPES
 Open pit privy
- A pit of at least the same dimension as the
sanitary pit privy, provided with pit flooring,
with or without riser and seat and without
cover to protect from flies and rodents
 Overhung
- A structure provided with flooring and with
an opening built above the body of water or
above the ground without a pit under it,
used for defecation or the disposal of
human waste. It can be a part of the house
or a separate structure outside the house
OTHER TYPES OF EXCRETA DISPOSAL FACILITIES:
 Trench latrine / temporary toilet
 Chemical toilet
 Cathole
SOLID WASTE MANAGEMENT
SOLID WASTE MANAGEMENT: NEED FOR SORTING/WASTE
SEGREGATION
 Refuse
o all solid and semi-solid wastes except
human excreta
 Garbage
o biodegradable wastes
 Rubbish/trash
o non-biodegradable
METHODS OF SOLID WASTE MANAGEMENT
 Recycling- other names:
o Total recycling
o Waste recovery method
o Zero waste management
o Volume reduction method
 Sanitary landfill – burying
  Incineration – burning not cause any harm to the consumer when it is
 Open Dumping prepared and eaten according to its intended use
 DOH
Hospital Waste Management Color Coding  Food and Drug Administration (FDA)
 RA 9711: Food and Drug Administration Act
COLOR DESCRIPTION
o Safeguarding the safety and quality of
Black ● Non-hazardous and non-bio wastes processed foods, drugs and diagnostic
● Dry waste products (packaging, reagents, medical devices, cosmetics and
newspapers, wrappers) household substances
Green ● Non-hazardous biodegradable waste
REPUBLIC ACT NO. 10611 – Food Safety Act of 2013
● Usually leftover food
“An act to strengthen the food safety regulatory system in
Yellow ● Hazardous wastes,
the country to protect consumer health and facilitate market
pathological/anatomical wastes, access of local foods and food products, and for other
pharmaceutical, cytotoxic chemicals purposes” otherwise known as the “food safety act of 2013
● Dressing, swabs, used in the treatment
and diagnosis of diseases FOOD SANITATION PROGRAM
Orange ● Radioactive 1. Inspection of all food sources, containers & transport
vehicles
CATEGORIES OF HOSPITAL WASTES 2. Compliance to sanitary permit
 General waste 3. Health certificate for food handlers, cooks, helpers
 Infectious Waste 4. Banning of food unfit for consumption
 Pathological waste 5. Training of food handlers & operators
 Sharps 6. Ambulatory food vendors health certificate
 Pharmaceutical waste 7. Household food sanitation
 Genotoxic waste
 Chemical waste CLASSIFICATION OF FOOD ESTABLISHMENTS
 Waste with high content of heavy metals The Public Health Code (PHC) Section 19-13-B42
 Pressurized containers  Class 1
 The description of food preparation
 Radioactive waste
permitted includes the commercially pre-
packaged food
PEST CONTROL METHODS
 Ex:
 Mosquito Control Project
o Commercially packed cold
 C= Chemically treated mosquito net
 L= Larva-eating fish sandwiches
 E= Environmental Sanitation o Hot and cold beverages (coffee,
 A= Anti- mosquito soap: soap with basil or tea, soft drinks)
citronella  Class 2
 N= Neem and other aromatic plants  These are establishments which serves cold
or ready-to-eat foods.
AEDES MOSQUITO CONTROL METHODS  ex:
 The most vulnerable stage in the life cycle of the o Cafes, sandwich shops, ice cream &
mosquito is the larva (wriggler) yogurt shops
 Triple A  Class 3
o Asin  Serves hot preparation foods
o Alcohol  ex:
o Aciete (oil) o hot meat sandwiches, pizza, soups,
and seafoods

FOOD SANITATION PROGRAM

 Class 4
 National Environmental Health Action Plan (NEHAP)
defined food safety as the assurance that food will
  Hot preparation of potentially hazardous
foods served more than accumulative 4
hours after heat treatment.
 ex:
o most restaurants, hospitals,
caterers, institutional or industrial
food service,

4 RIGHTS OF FOOD SAFETY

1. Right source
2. Right preparation
3. Right cooking
4. Right storage

DOH IMPLEMENTING RULES AND REGULATIONS

 Sanitary Permit: Establishment
 Health Certificate: Employees/ Workers
 Food Preparation Area and Storage Rooms should
never be used as sleeping area or directly connected
to a toilet
 Utensils Bactericidal Treatments
o Immersion for at least 30 seconds in clean
hot water (77C)
o Immersion for at least 1 minute in
lukewarm water containing 55-100 ppm of
chlorine solution
o Exposure to steam for at least 15 minutes
to 77C or for 5 minutes to at least 200C