ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

FAMILY ASSESSMENT GUIDE

Head of the Family: Edgar A. Demayo

_______________________________________________________________

I. Demographic Data:
Barangay: Mercedes Family No. (Health Center): N/A
House No: N/A

II. Family Data:

Length of Residency: 10 years Family Size: 4
Religion: Roman Catholic Dialect: Tagalog, Chavacano
Ethnicity: Zamboangaueno Type of Family Structure: Nuclear

A. INITIAL DATA BASE OF FAMILY

1. Family Structure, Characteristics & Dynamics

Family Members Relationship A S C Place of Educational Occupation Income/ Health
to the Head g e / Residence Attainment Month Remarks
of family e x S
Edgar A. Demayo Head 50 M M Mercedes Post N/A 24,000 Hyperten
Graduate sion
Sarah Jane C. Wife 46 F M Mercedes Post 30,000 Hyperten
Demayo Graduate sion
Elisha Juliana C. Mother 14 F M Mercedes Undergrad N/A N/A N/A
Demayo
Edson John Brother 21 M S Mercedes Undergrad N/A N/A
C.Demayo
 1. Family Dynamics and Relationships

The Demayo family is Nuclear family which consists of a child or children living with two parents
who are married to each other, especially when all live under the same roof. Both the father and the
mother is doing the decision makings they help each other when there is problems going through our
family.

2. Socio-economic and Cultural Characteristics

Both Husband and Wife sustains the needs of their children they are both earning to give the needs
and wants of their children. The family’s religion is Roman Catholic. The family is fond of doing
gardening during weekends taking good care of their pets, the family have 3 cats and 4 dogs. The
family love them and treat the pets as part of the family.

3. Home and Environment

The family lives in Zone 3 Balinsungay Mercedes. The family has an adequate living
space.
The house is a concrete type

4. Health Status of Each Family Member

Family Member Medical History Present Illness Risk Factors
Edgar A. Demayo None Hypertension
Sarah Jane C. Demayo None Hypertension

Edson John C. None

Demayo
Elisha Juliana C. None
Demayo
5. Values & Practices on Health Promotion/ Maintenance and Disease Prevention

The head of the family, the mother and the wife are avoiding to eat foods that can trigger
their illnesses. The Wife is health conscious and she only eats only during breakfast and
lunch, except dinner to maintain her weight. Both wife and husband is taking their
maintenance for their hypertension.
ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

FIRST LEVEL ASSESSMENT:

A. Health Threat: Inherent Personality Characteristics as Health Threat

Subjective Cues: Verbalized: “Mabilis lang po ako magalit”
Objective Cues: Clenching of Jaws and Grinding Teeth, Shaking and Trembling

B. Heath Deficit: Hypertension as Health Deficit

Subjective Cues: Verbalized: They are both hypertensive and taking their maintenance
exercising everyday while we are still in ECQ because this is their only time to exercise
because there is no work.

Objective Cues: Medications: Losartan 50mg; Blood pressure: 140/90 (wife) 160/100

(husband)

C. Health Deficit: Stress Points/Foreseeable Crisis in School as Health Deficit

Subjective Cues: Verbalized:” Late nakakatulog dahil sa paperworks at chores.”

Objective Cues: Facial expression that is sleepy.

 RANKING OF HEALTH PROBLEMS:
Inherent Personality Characteristics as Health Threat
Criteria COMPUTATION ACTUAL JUSTIFICATION
SCORE
1. Nature of the Problem is a health
Problem 2/3 x 1 0.7 threat that requires an
intervention.
2. Modifiability The resources and
of the intervention to solve
2/2 x 2 2 problem are easily
Problem
available to family.
3. Preventive The possibility of
Potential acquiring diseases is
2/3 x 1 0.6 not that high.
Preventive potential is
moderate.
4. Salience The family recognizes
1/2 x 1 0.5 the existence of the
problem.
Total Score 3.8

Hypertension as Health Deficit

Criteria COMPUTATION ACTUAL JUSTIFICATION
SCORE
1. Nature of the Problem is a health
Problem deficit that needs
3/3 x 1 1 immediate
intervention.
2. Modifiability The resources and
of the intervention to solve
2/2 x 2 2 problem are available
Problem
to family.
3. Preventive The possibility of
Potential acquiring diseases is
3/3 x 1 1 high. Preventive
potential is high.
4. Salience The family recognizes
2/2 x 1 1 the existence of the
problem.
Total Score 5
 Criteria COMPUTATION ACTUAL JUSTIFICATION
SCORE
1. Nature of the Problem for
Problem foreseeable crisis, not
1/3 x 1 0.3 requires immediate
intervention.
2. Modifiability The resources and
of the intervention to solve
2/2 x 2 2
Problem problem are available
to family.
3. Preventive The possibility of
Potential acquiring diseases is
2/3 x 1 0.7 moderate. Preventive
potential is moderate.
4. Salience The family recognizes
1/2 x 1 0.5 the existence of the
problem.
Total Score 3.5

SECOND LEVEL ASSESSMENT:

Problem #1: Hypertension as Health Deficit

- Inability to make decisions with respect to taking appropriate health action

due to conflicting opinions among family members regarding action to take.

Problem #2: Inherent Personality Characteristics as Health Threat

- Inability to recognize the presence of a problem due to attitude/philosophy
in life.

Problem #3: Stress Points/Foreseeable Crisis in School as Health Deficit

- Inability to recognize the presence of a problem due to attitude/philosophy

of life
 ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

GENERAL OBJECTIVES:

AFTER 40 MINS OF VARIED LECTURE-TEACHING, THE X FAMILY WILL BE ABLE TO ACQUIRE BASIC KNOWLEDGE, DEVELOP SKILLS AND
POSITIVE ATTITUDE IN THE CONCEPT OF HYPERTENSION.

SPECIFIC CONTENT TIME METHODOLOGY RESOURCES EVALUATION

OBJECTIVES ALLOTMENT
Specifically, the Question and
students will be able to: Answer:
Human
resources:
1. Define hypertension Time and effort What is
Hypertension, also referred to 3 mins Group discussion
of the nurse and hypertension?
as high blood pressure, HTN or HPN, is a
family
medical condition in which the blood
members
pressure is chronically elevated.
Hypertension is defined as a sustained Material
elevation in the mean arterial pressure. It resources:
is often an asymptomatic disorder
Powerpoint
characterized by persistent elevation of
pres.
blood pressure associated with the
thickening and loss of elasticity in the
 arterial walls. Visual Aids

2. Enumerate the Hypertension can be classified Question and

classifications of either primary or secondary. Primary answer:
hypertension hypertension indicates that no specific 3 mins Group discussion
medical cause can be found to explain a What are the 2
patient's condition. It is also called classifications of
essential hypertension or idiopathic hypertension?
hypertension. About 90 % of all
hypertensive have primary hypertension.
Secondary hypertension indicates that the
high blood pressure is a result of (i.e.,
secondary to) another condition, such as
kidney disease or tumours.
3. Identify the Normal is classified with a blood
classification of BP pressure of <120 mmHg systolic and <80 5 mins Group discussion Question and
and categories of mmHg diastolic. Pre-hypertension is answer:
hypertension for classified with a blood pressure of 102-
adults 18 and older 139 mmHg systolic and 80-89 mmHg What is the normal
diastolic. Stage 1 hypertension is blood pressure?
classified with a blood pressure of 140-
159 mmHg systolic and 90-99mmHg
diastolic.
4. Contributing factors Question and
of factors 10 mins Group discussion answer:
The risk of hypertension is 5 times
higher in the obese as compared to those What are the
of normal weight and up to two-thirds of factors that lead to
cases can be attributed to excess weight. Hypertension.
More than 85% of cases occur in those
with a BMI>25.

 Sodium sensitivity

Sodium is an environmental
factor that has received the greatest
attention. Approximately one third of the
essential hypertensive population is
responsive to sodium intake. This is due
to the fact that increasing amounts of salt
in a person's bloodstream causes cells to
release water (due to osmotic pressure) to
equilibrate concentration gradient of salt
between the cells and the bloodstream;
increasing the pressure on the blood
vessel walls.

 Role of renin

Renin is an enzyme secreted

by the juxtaglomerular apparatus of the
kidney and linked with aldosterone in a
negative feedback loop. The range of
renin activity observed in hypertensive
subjects tends to be broader than in
normotensive individuals. In
consequence, some
hypertensive patients have been defined
as having low-renin and others as having
essential hypertension. Low-renin
hypertension is more common in African
Americans than white Americans, and
may explain why African Americans
tend to respond better to diuretic therapy
than drugs that interfere with the renin-
angiotensin system. High Renin levels
predispose to Hypertension: Increased
Renin → Increased Angiotensin II →
Increased Vasoconstriction, Thirst/ADH
and Aldosterone → Increased Sodium
Resorption in the Kidneys (DCT and CD)
→ Increased Blood Pressure. Some
authorities claim that potassium might
both prevent and treat hypertension.
  Insulin resistance

Insulin is a polypeptide hormone

secreted by cells in the islets of
langerhans, which are contained
throughout the pancreas. Its main
purpose is to regulate the levels of
glucose in the body antagonistically with
glucagon through negative feedback
loops. Insulin also exhibits vasodilatory
properties. In normotensive individuals,
insulin may stimulate sympathetic
activity without elevating mean arterial
pressure. However, in more extreme
conditions such as that of the metabolic
syndrome, the increased sympathetic
neural activity may over-ride the
vasodilatory effects of insulin. Insulin
resistance and/or hyperinsulinemia have
been suggested as being responsible for
the increased arterial pressure in some
patients with hypertension. This feature
is now widely recognized as part of
syndrome X, or the metabolic syndrome.

 Genetics

Hypertension is one of the most

common complex disorders, with genetic
heritability averaging 30. Data
supporting this view emerge from animal
studies as well as in population studies in
humans. Most of these studies support
the concept that the inheritance is
probably multifactorial or that a number
of different genetic defects each have an
elevated blood pressure as one of their
phenotypic expressions.

 Age

Over time, the number of collagen

fibers in artery and arteriole walls
increases, making blood vessels stiffer.
With the reduced elasticity comes a
smaller cross-sectional area in systole,
and so a raised mean arterial blood
pressure.

 Liquorice

Consumption of liquorice (which

can be of potent strength in liquorice
candy) can lead to a surge in blood
pressure. People with hypertension or
history of cardio-vascular disease should
avoid liquorice raising their blood
pressure to risky levels. Frequently, if
liquorice is the cause of the high blood
pressure, a low blood level of potassium
will also be present.
 Question and
answer:
5. Identify the signs Group discussion
and symptoms of What is the
hypertension 3 mins
common feeling
that you feel when
your blood
Hypertension is usually found pressure will go
incidentally by healthcare professionals up?
measuring blood pressure during a
routine checkup. In isolation, it usually
produces no symptoms although some
people report headaches, fatigue,
dizziness, blurred vision, facial flushing,
transient insomnia or difficulty sleeping
due to feeling hot or flushed, and tinnitus
during beginning onset or before
hypertension diagnosis.

Hypertension is often confused

with mental tension, stress and anxiety.
While chronic anxiety and/or irritability
is associated with poor outcomes in
people with hypertension, it alone does
not cause it. Accelerated hypertension is
 associated with somnolence, confusion,
visual disturbances, and nausea and
vomiting (hypertensive encephalopathy).

6. Enumerate the ways

on how hypertension 3 mins Group discussion Question and
can be diagnosed answer:
What is the
average diastolic
Diagnosis in adults as made and the average
when an average of two or more diastolic systolic for adults?
readings on at least two subsequent visits
is between 80-90 mmHg or when the
average on multiple systolic BP on two
or more subsequent visits is between
120-139 mmHg. Tests are undertaken to
identify possible causes of secondary
hypertension, and seek evidence for end-
organ damage to the heart itself or the
eyes (retina) and kidneys. Diabetes and
raised cholesterol levels being additional
risk factors for the development of
cardiovascular disease are also tested for
as they will also require management.

Blood tests commonly performed

include:
  Creatinine (renal function) - to
identify both underlying renal
disease as a cause of hypertension
and conversely hypertension
causing onset of kidney damage.
Also a baseline for later
monitoring the possible side-
effects of certain antihypertensive
drugs. Question and
 Electrolytes (sodium, potassium) answer:
 Glucose - to identify diabetes
Why do we need to
7. List the non- mellitus know these
pharmacological and  Cholesterol
non- 5 mins management for
pharmacological hypertension?
management for Discuss atleast 3
hypertension given management
for hyprtension.
Lifestyle modification
(nonpharmacologic treatment)

 Weight reduction and regular aerobic

exercise (e.g., jogging) are
recommended as the first steps in
treating mild to moderate
hypertension. Regular mild exercise
improves blood flow and helps to
reduce resting heart rate and blood
pressure. These steps are highly
effective in reducing blood pressure,
 although drug therapy is still
necessary for many patients with
moderate or severe hypertension to
bring their blood pressure down to a
safe level.
 Reducing dietary sugar intake
 Reducing sodium (salt) in the diet is
proven very effective: it decreases
blood pressure in about 60 percent of
people (see above). Many people
choose to use a salt substitute to
reduce their salt intake.
 Additional dietary changes beneficial
to reducing blood pressure includes
the DASH diet (dietaryapproaches
to stop hypertension), which is rich in
fruits and vegetables and low fat or
fat-free dairy foods. This diet is
shown effective based on research
sponsored by the US National
Institutes of Health.[citation needed] In
addition, an increase in daily calcium
intake has the benefit of increasing
dietary potassium, which
theoretically can offset the effect of
sodium and act on the kidney to
decrease blood pressure. This has
also been shown to be highly
effective in reducing blood pressure.
 Discontinuing tobacco use and
alcohol consumption has been shown
to lower blood pressure. The exact
mechanisms are not fully understood,
but blood pressure (especially
systolic) always transiently increases
following alcohol and/or nicotine
consumption. Besides, abstention
from cigarette smoking is important
for people with hypertension because
it reduces the risk of many dangerous
outcomes of hypertension, such as
stroke and heart attack. Note that
coffee drinking (caffeine ingestion)
also increases blood pressure
transiently, but does not produce
chronic hypertension.
 Reducing stress, for example with
relaxation therapy, such as meditation
and other mindbody relaxation
techniques, by reducing
environmental stress such as high
sound levels and over-illumination
can be an additional method of
ameliorating hypertension. Jacobson's
Progressive Muscle Relaxation and
biofeedback are also used,
particularly, device-guided paced
breathing, although meta-analysis
 suggests it is not effective unless
combined with other relaxation
techniques.

Medications

Unless hypertension is severe,

lifestyle changes such as those discussed
in the preceding section are strongly
recommended before initiation of drug
therapy. Adoption of the DASH diet is
one example of lifestyle change
repeatedly shown to effectively lower
mildly-elevated blood pressure. If
hypertension is high enough to justify
immediate use of medications, lifestyle
changes are initiated concomitantly.

There are many classes of

medications for treating hypertension,
together called antihypertensives, which
— by varying means — act by lowering
blood pressure. Evidence suggests that
reduction of the blood pressure by 5-6
mmHg can decrease the risk of stroke by
40%, of coronary heart disease by 15-
20%, and reduces the likelihood of
dementia, heart failure, and mortality
from vascular disease.

The aim of treatment should be

blood pressure control to <140/90 mmHg
for most patients, and lower in certain
contexts such as diabetes or kidney
disease (some medical professionals
recommend keeping levels below 120/80
mmHg). Each added drug may reduce the
systolic blood pressure by 5-10 mmHg,
so often multiple drugs are necessary to
achieve blood pressure control.

Commonly used drugs include:

 ACE inhibitors such as creatine

captopril, enalapril, fosinopril
(Monopril), lisinopril (Zestril),
quinapril, ramipril (Altace)
 Angiotensin II receptor antagonists:
eg, telmisartan (Micardis, Pritor),
irbesartan (Avapro), losartan
(Cozaar), valsartan (Diovan),
candesartan (Amias)
 Alpha blockers such as prazosin, or
terazosin. Doxazosin has been shown
to increase risk of heart failure, and to
be less effective than a simple
diuretic, so is not recommended.
 Beta blockers such as atenolol,
labetalol, metoprolol (Lopressor,
Toprol-XL), propranolol.
 Calcium channel blockers such as
nifedipine (Adalat) amlodipine
(Norvasc), diltiazem, verapamil
 Direct renin inhibitors such as
 aliskiren (Tekturna)
 Diuretics: eg, bendroflumethiazide,
chlortalidone, hydrochlorothiazide
(also called HCTZ)
 Combination products (which usually
contain HCTZ and one other drug)
8. Discuss
hypertension as
a risk factor for
COVID-19 8 mins Group discussion

Risk of hypertension to COVID-19

A weaker immune system is one reason
people with high blood pressure and other
health problems are at higher risk for
coronavirus. Long-term health conditions
and aging weaken your immune system so
it's less able to fight off the virus. Nearly
two-thirds of people over 60 have high
blood pressure.
While pneumonia is the most common
complication of the virus, it can also
damage the cardiovascular system. That’s
why people with high blood pressure, heart
disease, and heart failure are at risk
High blood pressure damages arteries and
reduces the flow of blood to your heart.
That means your heart has to work harder
to pump enough blood. Over time, this
extra work can weaken your heart to the
point where it can't pump as much oxygen-
rich blood to your body.
Coronavirus can also damage the heart
directly, which can be especially risky if
your heart is already weakened by the
effects of high blood pressure. The virus
may cause inflammation of the heart
muscle called myocarditis, which makes it
harder for the heart to pump.
Reference list:

 Black, et.al. MEDICAL –SURGICAL NURSING. 8TH edition. Elsevier Pte Ltd. Singapore,
2008
 WebMD LLC. (2020). Coronavirus and High Blood Pressure: What’s the Link? Retrieved
May 26, 2020, from WebMD: https:// www.webmd.com/coronavirus-high-blood-pressure
 Spriggs, B. (2019). Everything you need to know about hypertension. Retrieved May 26,
2020, from MedicalNewsToday: https://www.medicalnewstoday.com/articles
ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

FAMILY NURSING CARE PLAN

 Nursing DX/Clinical Client Goals/Desired Nursing I Evaluation
Problem Outcomes/Objectives Interventions/Actions/Order
Goals Interventions
s
Risk for self or Long-Term Goal: Long-Term Interventions:      Long-Term: 1.) The client stated that by
other- directed knowing the way his body
Client will identify impulse 1.) Assist clients to identify Evaluation of this goal is
violence r/t feels when he gets in
behaviors and demonstrate precipitants of dysfunctional set for [date]. The client
impulsivity and aggressive moods, he can to
appropriate self-control mood, differentiating what has demonstrated
impaired judgment stop and think about what his
behaviors to refrain from can and cannot be changed. progress toward this goal
and persuasive next move is going to be
harming self and others by Help them identify available by identifying that he
disregard for the rights instead of acting out on
[date]. resources and personal now knows when he is
of others AEB risk- impulse. He also said that he
strengths. Teach new becoming angry and what
taking behaviors,       knows that instead of
problem-solving and coping usually results when he
irritability, anger and punching or pushing a peer,
      skills. (Foley, 2010). does not control his
aggressiveness, he can go to the staff to talk
impulses. He has also
conflict with authority, Short-Term Goal: Rationale: Knowledge of about the situation.
demonstrated less
history of previous precipitants helps clients
Client will displace anger to aggressive behaviors 2.) The client discussed a
violence, and develop strategies to prevent
meaningful activities, towards his peers during time when he did not follow
impulsive, explosive mood changes. Using
refrain from verbal conflicts. the rules during gym time
behavior personal strengths and
outbursts, and display no and consequentially he lost
abilities enhances feels of      
  aggressive activity [date] gym privileges for the rest of
control.
Short-term: the week and did not receive
2.) Develop a behavioral his points for the day. He
Evaluation of this goal stated that he knows he
management plan that is
was set for [date]. The deserves the punishment, and
implemented consistently
client has accomplished from now on he will be
among all healthcare
this goal by using patient and follow the rules.
providers. Communication
meaningful physical
of rules, expectations, and
activities whenever he 3.) The client had just found
consequences should be
gets angry, refraining out about a death in his
addressed as well as
from verbal outbursts by family, and shortly following
limitations on intrusive,
explaining his feelings had an altercation with a peer
interruptive behaviors.
first, and not getting into where he was shoved. He
Provide consistent aggressive activity. demonstrated self-control
consequences for both behaviors by putting his
desired and undesired hands up, taking a few steps
behaviors and praise the backward, and explaining to
desired behaviors (Foley, the peer why he was upset
2010). and that he did not want to
fight. They both apologized
Rationale: Consistency
and moved on  
about rules and expectations
reduce power struggles and      
promote feelings of security
1.) The client verbally
for clients. Positive feedback
expressed stimuli that
for desired behaviors helps
triggered his violence: not
reinforce them. 
being able to get his way,
3.) Have client keep an being wrong, having
anger diary and discuss everyone tell him what to do.
alternative responses
2.) The client expressed that
together. Teach cognitive
he wants to be able to control
behavioral techniques for
his temper and that he knows
self- evaluation from the
all of the clients in the
client (Ackley, & Ladwig,
facility are under stress. He
2008).
stated that some people clash
Rationale: Clients with so it is best to avoid them or
anger management try to decrease their triggers
difficulties may not be aware as well as his own to promote
of changes and cues that a better environment.
they are becoming angry or
3.) The client has gone to his
of a time delay in the
room to do pushups and sit-
stimulus to their angry
ups whenever his
response. By using cognitive
temperament has escalated.
behavior techniques and
reviewing the diary with
staff, the client can identify
though processes leading u
to anger and the space
between the stimulus and
response.
     
     
Short-Term Interventions:
1.) Identify stimuli that
initiate violence and the
means of dealing with the
stimuli, such as walking
away. (Ackley, & Ladwig,
2008).
Rationale: Assisting the
client to identify situations
and people that upset him
provides information needed
for problem solving. The
client can then identify
alternative responses:
leaving the stimulus,
initiating a distracting
activity, or responding
assertively rather than
aggressively.
     
2.) Emphasize that the client
is responsible for his choices
and behavior. Introduce
descriptions of possible
effects of a client’s
aggressive/violent behavior
on others (Ackley, &
Ladwig, 2008).
Rationale: In many cases
clients operate from a
worldview that perceives
others as instruments of the
clients’ gratification. Clients
must gain that they are
dealing with other human
beings who experience pain.
Clients’ behaviors influence
how others respond to them.
     
3.) Redirect possible violent
behaviors into physical
activities such as doing
pushups and sit-ups (Ackley,
& Ladwig, 2008).
Rationale: Activities that
distract while draining
excess energy help to build a
repertoire of alternative
behaviors for stress
reduction.
Reference

Sep 1, 2016 | Posted by admin in NURSING | Comments Off on 18: Anger, Aggression, and Violence

https://nursekey.com/18-anger-aggression-and-violence/

https://nurseslabs.com/ineffective-coping/
ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

STUDY ILLNESS CONDITION

Abruptio Placentae
Organ/System Normal Pathophysiology Diagnostic Tests Evaluation
Involved Function/Physio and Findings
logy
Uterus Uterus, also Placental If the pregnant Actual Problem:
Placenta
called womb, an abruption occurs mother suffers
Abruption
inverted pear- when the from abdominal
shaped maternal vessels pain and bleeding
Probable/Anticip
muscular organ o tear away from the doctor will do atory Problem:
Mother – blood
f the the placenta and physical exam,
transfusion
female reproduc bleeding occurs fetal monitoring, Fetus –
Premature birth
tive system, between the run blood tests

located between uterine lining and and ultrasound. Foreseeable

Crisis:
the bladder and the maternal side The doctor may
Miscarriage and
the rectum. It of the placenta. suspect placental death for both
mother and fetus.
As the blood abruption, but
functions to
accumulates, it they can only
nourish and
pushes the truly diagnose it
house a
uterine wall and after given birth. 
fertilized egg unti
placenta apart.
l the fetus, or
The placenta is
offspring, is
the fetus’ source Reference:
ready to be
of oxygen and Wilson, DR.
delivered. The
nutrients as well (2018)
uterus performs
as the way the
multiple
fetus excretes
functions and
waste products.
plays a major Diffusion to and
role in fertility from the maternal
and childbearing. circulatory
This organ is able system is
to change in essential to
shape as muscles maintaining these
tighten and relax life-sustaining
to make it functions of the
possible to carry placenta. When
a fetus. The accumulating
uterus has four blood causes
major regions: separation of the
the fundus is the placenta from the
broad curved maternal vascular
upper area in network, these
which vital functions of
the fallopian the placenta are
tubes connect to interrupted. If the
the uterus; the fetus does not
body, the main receive enough
part of the uterus, oxygen and
starts directly nutrients, it dies.
below the level
of the fallopian
tubes and
continues Reference:
downward until Schmidt,
the uterine walls P.; Skelly,
and cavity begin C.; Raines, D.
to narrow; the (2019)
isthmus is the
lower, narrow
neck region; and
the lowest
section,
the cervix,
extends
downward from
the isthmus until
it opens into
the vagina.

Physiology
The functions of
uterus include
nurturing the
fertilized ovum
that develops into
the fetus and
holding it till the
baby is mature
enough for birth.
The fertilized
ovum gets
implanted into
the endometrium
and derives
nourishment
from blood
vessels which
develop
exclusively for
this purpose. The
fertilized ovum
becomes an
 embryo, develops
into a fetus and
develops until
childbirth.

Reference:
Mandal, A.

(2019) 

References:

Mandal, A. (2019) What does the uterus do? Retrieved May 26, 2020, from NewsMedical:
https://www.news-medical.net/health/What-Does-the-Uterus-Do.aspx

Schmidt, P.; Skelly, C.; Raines, D. (2019) Placenta Abruption (Abruptio Placentae). Retrieved May
26, 2020, from NCBI: https://www.ncbi.nlm.nih.gov/books/NBK482335/

Wilson, DR. (2018) What is placental abruption? Retrieved May 26, 2020, from Healthline
Parenthood: https://www.healthline.com/health/pregnancy/complications-placental-abruption
ROTATION 6

Name: Demayo, Edson John C. Clinical Instructor: Mrs. Awelda Mundoc RN,MN

Year & Section: BSN – 2A Rotation Area: San Jose Gusu Health Center

Rotation Dates: May 7,8,9,14,15,16, 2020

DOH PROGRAMS

1. ADOLESCENT HEALTH AND DEVELOPMENT PROGRAM

In April 2000, DOH issued the Administrative Order 34- A s 2000, the Adolescent and Youth Health
(AYH) Policy, creating the Adolescent Youth Health Sub-program under the Children’s Health
Cluster of Family Health Office. In 2006, the department created the Technical Committee for
Adolescent and Youth Health Program, composed of both government and non-government
organizations dedicated to uplifting the welfare of adolescents and tasked to revitalize the program.
Due to an increasing health risky behaviour among our Filipino adolescents,

DOH embarked on revising the policy and to focus on the emerging issues of the adolescents which
are the 10 – 19 years old.

In March 21, 2013, DOH with the support of the United Nations Population Fund (UNFPA)
Philippines, revised the policy and served the Administrative Order 0013 - 2013 National Health
Policy and Strategic Framework on Adolescent Health and Development (AHDP). The Strategic
Framework 2013 is designed in accordance with this goal.

In 2015, DOH AHDP Program revived the National External Technical Working Group (TWG) on
AHDP. This is composed of different stakeholders from the government, non-government, academe,
and youth – led organizations. In 2016, DOH recognized the need for harmonization of programs
within the department that caters 10 – 19 years old. The AHDP Program convened the first DOH –
Internal Technical Working Group. This aims to ensure that all programs are working together for the
betterment of the adolescents in the country. It is also an avenue to discuss indicators, policies,
strategies, and service delivery at the national and local implementation levels. The External and
Internal TWGs on AHDP are multi -sectoral, collaborative approaches to fulfil the goal, vision, and
mission of the program. In 2017, both TWGs revised the strategic framework, and developed a
logical framework, and monitoring and evaluation framework of the program.

Vision

The AHDP envisions a country with well informed, empowered, responsible and healthy adolescents
who are leaders in the society

Mission

Its mission is to ensure that all adolescents have access to comprehensive health care and services in
an adolescent-friendly environment.

Objectives

Improve the health status of adolescents and enable them to fully enjoy their rights to health.

Program Components

1. Nutrition
2. National Safe Motherhood
3. Family Planning
4. Oral Health
5. National Immunization Program
6. Dangerous Drugs Abuse Prevention and Treatment
7. Harmful Use of Alcohol
8. Tobacco Control
9. Mental Health
10. Violence & Injury Prevention
11. Women and Children Protection
12. HIV/STI

Partner Institutions

Local & International Development Partners:

 Department of Education
  National Youth Commission
 Commission on Higher Education
 Commission on Population
 Council for the Welfare of Children
 Department of Social Welfare and Development
 Department of Interior and Local Government
 Linangan ng Kababaihan (Likhaan)
 The Family Planning Organization of the Philippines
 Technical Education and Skills Development Authority
 WomanHealth Philippines
 Save the Children
 ACT! 2015 Alliance
 Youth Peer Education Network
 Society of Adolescent Medicine in the Philippines Inc.
 Micronutrient Initiatives
 Child Protection Network
 National Nutrition Council
 Philippine National AIDS Council
 Philippine Society of Adolescent Medicine Specialist
 United Nations for Children’s Fund
 United Nations Population Fund
 United Nations Programme for HIV and AIDS
 United States Agency for International Development
 World Health Organization

Policies and Laws

 Republic Act 10354 (The Responsible and Reproductive Health Act of 2012)
 Administrative Order No. 2013-0013 (National Policy and Strategic Framework on
Adolescent Health and Development)
 Administrative Order No. 2017-0012 (Guidelines on the Adoption of Baseline
Primary Health Care Guarantees for All Filipinos)
  Proclamation 99 s.1992 (Linggo ng Kabataan)

Strategies, action Points and Timeline

 Health promotion and behavior change for adolescents

 Adolescent participation in governance and policy decisions
 Developing/transforming health care centers to become adolescent-friendly facilities
 Expanding health insurance to young people
 Enhancing skills of service providers, families and adolescents
 Strengthening partnerships among adolescent groups, government agencies, private
sectors, Civil Society organizations, families and communities
 Resource mobilization
 Regular assessment and evaluation

Program Accomplishments/ Status

Health Education and Promotion

o Advocacy and awareness raising activities such as Adolescent Health TV segment

and Healthy Young Ones

Provision of Health Services

o Establishment of Adolescent-Friendly Health Facilities Nationwide includes:

a. Core package of adolescent health services (AO 2017-0012) available at the
different levels of the health care system and in settings outside the health
care system.
b. Institutionalize linkage between school, community, civil society
organizations and health facilities in a service delivery network (SDN).
c. Trained health and non-health personnel nationwide with the following:
a. Competency Training on Adolescent Health
b. Adolescent Job Aid (AJA) Training
c. Adolescent Health Education and Practical Training (ADEPT)
d. Healthy Young Ones (HYO) Training
 e. Adolescent Health and Development Program Manual of Operations
(MOP) Training

Calendar of Activities

The celebration of Linggo ng Kabataan every second week of December

Statistics

Violence: Sixteen percent (16.6%) of women age 15-19 have experienced physical violence at least
once in their life and 4.4% are survivors of sexual violence. Seventeen percent (17%) of Young Adult
Fertility and Sexuality Survey in 2013 (YAFSS) adolescent respondents have experienced violence in
the past year, and 23 % have been aggressors of violence between the aged 15 – 24 years old. Almost
half (47.7%) of 13-15 year old schoolchildren in the 2013 Global Scholl Health Survey (GSHS) have
experienced bullying and 4.8% of YAFSS adolescents have been harassed using technology.

Alcohol, Tobacco, and Illegal Substances: In the 2013 National Nutrition Survey (NNS), 6.8% of
adolescents are current smokers and 5.7% are former smokers. Fifteen percent (15.6%) of YAFSS
(2013) respondents are current smokers and 2.6% have ever used drugs. In YAFSS, 8.1% of
adolescents 15-19 years old have ever passed out drunk. The 2015 Global Youth Tobacco Survey
(GYTS), together with Global School Based Health Survey (GSHS) and YAFS describe other risk
behaviors. In 2015, GSHS found that 18.2% of schoolchildren 13-15 years old have experienced
being really drunk at least one drinking alcohol once one or more days during the past 30 days.
According GSHS, 11.0% have smoked cigarettes in the past month. In 2015, GYTS analyzed that a
total of 16.0% of the respondents currently use any tobacco product (smoked tobacco and/or
smokeless tobacco) and 28.1% of students are ever tobacco users.

Malnutrition: It is a double burden with 12.4% of adolescents wasted and 8.3% overweight or obese.
The latter is somewhat expected given that 42.2% consume soft drinks one or more times per day
while only 13.9% were physically active for a total of at least 60 minutes daily on five or more days
during the past week. On the other hand, one in three (37.2%) pregnant adolescents are nutritionally
at risk (based on weightfor- height classification, P<95).

Sexual and Reproductive Health: While General Fertility (GF) has significantly decreased since
1970, Age Specific Fertility Rates (ASFR) of adolescents has changed little. The 2017 National
Demographic and Health Survey (NDHS) places adolescent ASFR at 47 livebirths per 1,000 women
15-19 years old, up from 57 in the 2013 NDHS. According to YAFSS 4, data shows that in the
Philippines, an increasing proportion of adolescents and young people have early sexual encounters.
In 2013, 1 in 3 young people report having premarital sex. The prevalence of early sexual encounters
has increased over the last 20 years. Males are more likely to report having premarital sex than
females. In 2013, 36% of males reported having early sexual encounters compared to 29% of females.
The highest levels of early sexual encounters are reported in NCR (41%) & Central Luzon (31%)
regions. Also, many young people marry young, and it is important that they have good information
before they are married so that they can make healthy, informed decisions.

HIV and AIDS: In April 2017, there were 629 new HIV antibody sero-positive individuals reported
to the HIV/ AIDS & ART Registry of the Philippines (HARP) [Table 1]. More than half were from
the 25-34 year age group while 30% were youth aged 15-24 years. 33 adolescents aged 10-19 years
were reported. All were infected through sexual contact (8 male-female sex, 19 male-male sex, 6 sex
with both males & females). From January 1984 to April 2017, 1,606 (4%) of the reported cases were
19 years old and below. Seven percent (111 out of 1,606) were children (less than 10 y/o) and among
them, 108 were infected through mother-to-child transmission, 1 through blood transfusion and 2 had
no specified mode of transmission. Ninety three percent (1,495 out 1,606) were adolescents. Among
these, 1,359 (91%) were male. Most (93%) of the adolescents were infected through sexual contact
185 male-female sex, 843 male-male sex, 367 sex with both males & females), 85 (6%) were infected
through sharing of infected needles, 8 (<1%) through mother-to-child transmission, and 7 had no
specified mode of transmission.

Reference: https://www.doh.gov.ph/Adolescent-Health-and-Development-Program

2. BLOOD DONATION PROGRAM

 Republic Act No. 7719, also known as the National Blood Services Act of 1994, promotes voluntary
blood donation to provide sufficient supply of safe blood and to regulate blood banks. This act aims
to inculcate public awareness that blood donation is a humanitarian act.
                 The National Voluntary Blood Services Program (NVBSP) of the Department of Health is
targeting the youth as volunteers in its blood donation program this year. In accordance with RA No.
7719, it aims to create public consciousness on the importance of blood donation in saving the lives
of millions of Filipinos.

                 Based from the data from the National Voluntary Blood Services Program, a total of
654,763 blood units were collected in 2009. Fifty-eight percent of which was from voluntary blood
donation and the remaining from replacement donation. This year, particular provinces have already
achieved 100% voluntary blood donation. The DOH is hoping that many individuals will become
regular voluntary unpaid donors to guarantee sufficient supply of safe blood and to meet national
blood necessities.

Mission:

  Blood Safety
  Blood Adequacy  
  Rational Blood Use
  Efficiency of Blood Services

Goals:

The National Voluntary Blood Services Program (NVBSP) aims to achieve the following:

1. Development of a fully voluntary blood donation system;

2. Strengthening of a nationally coordinated network of BSF to increase efficiency by centralized

testing and processing of blood;

3. Implementation of a quality management system including of Good Manufacturing Practice GMP

and Management Information System (MIS);

4. Attainment of maximum utilization of blood through rational use of blood products and component
therapy; and

5. Development of a sound, viable sustainable management and funding for the nationally
coordinated blood network.
Reference: https://www.doh.gov.ph/blood-donation-program

3. EMERGING AND RE-EMERGING INFECTIOUS DISEASE PROGRAM

Description

In the recent past, the Philippines has seen many outbreaks of emerging infectious diseases and it
continues to be susceptible to the threat of re-emerging infections such as leptospirosis, dengue,
meningococcemia, tuberculosis among. The current situation emphasizes the risks and highlights the
need to improve preparedness at local, national and international levels for against future pandemics.
New pathogens will continue to emerge and spread across regions and will challenge public health as
never before signifying grim repercussions and health burden. These may cause countless morbidities
and mortalities, disrupting trade and negatively affect the economy.

There are several social determinants contributing to the emergence of novel infectious diseases and
resurgence of controlled or eradicated infectious diseases in our country. These contributing factors
are namely: (1) Demographic factors like the population distribution and density, (2) international
travel/ tourism and increased OFWs, (3) Socio-economic factors and (4) Environmental factors. The
latter includes our country’s vulnerability to disasters, increased livestock production, man- made
ecological changes or industries and lastly the urbanization which encroach and destroy the animal
habitats.

Emerging and Re-emerging Infectious Diseases are unpredictable and create a gap between planning
and concrete action. To address this gap, there is a need to come up with proactive systems that would
ensure preparedness and response in anticipation to negative consequences that may result in
pandemic proportions of diseases. Proactive and multi- disciplinary preparedness must be in place to
reduce the impact of the public the health threats. 
Vision

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

Mission

Provide and strengthen an integrated, responsive, and collaborative health system on emerging and re-
emerging infectious diseases towards a healthy and bio-secure country.

Goal

Prevention and control of emerging and re-emerging infectious disease from becoming public health
problems, as indicated by EREID case fatality rate of less than one percent

Program Strategies

The EREID Strategies are:

 Policy Development
 Resource Management and Mobilization
 Coordinated Networks of Facilities
 Building Health Human Resource Capacity
 Establishment of Logistics Management System
 Managing Information to Enhance Disease Surveillance
 Improving Risk Communication and Advocacy

Target Population/ Client

All ages; Citizen of the Philippines

Area of Coverage

Philippines and it’s international borders

Partner Institutions
DOH Central and Regional Bureau’s/Offices, Other Government and Non-Government Offices,
Medical Societies, Academe, Developmental Partners (World Health Organization, FAO-OIE, CDC,
GPP-Canada)

Policies and Laws

 Executive Order No. 168  -    Creating the Inter-Agency Task Force for the Management
of Emerging Infectious Diseases in the Philippines
 Administrative Order No. 10 s. 2011 - Creating the Philippine Inter-Agency Committee
on Zoonosis, Defining Its Powers, Functions, Responsibilities, Other Related Matters and
Providing Funds Thereof

Other Related Issuances/ Guidelines

 Administrative Order no. 2012-0022 - National Policy for the Implementation of on

International Health Regulation and Asia Pacific Strategy for Emerging Diseases in the
Philippines
 Department Memorandum No. 2017- 2558 - Creation of Functional Groups for the
National EREID Program
 Department Personnel Order No. 2005-1585 - Creation of a Management Committee
on Prevention and Control of Emerging and Re-emerging Infectious Diseases (DOHMC-
PCREID)
 Department Memorandum No. 2017 - 0348 - Interim Technical Guidelines, Standards
and other Instructions in the Implementation of Enhanced Human Avian Flu Surveillance,
Management, and Infection Control in the Health Care Setting
 Department Memorandum No. 2016 - 0169 - Interim Guidelines on the Clinical
Management of Zika Virus Infection
 Department Memorandum No. 2014 - 0257 - Preparedness and Response Plan for the
Prevention and Control of Ebola Virus Disease
 Department Memorandum No. 2014 - 0075 - Interim Guidelines on the Preparedness
and Response to MERS-CoV
 Department Memorandum No. 2009 - 0144 - Technical Guidelines, Standards and
other Instructions for Reference in the Pandemic Response to Influenza A H1N1
  Department Memorandum No. 2009-0250 - Interim Guidelines on the Prevention of
Leptospirosis through the use of Prophylaxis in Areas affected by Floods
 Department Memorandum No. 2005-0021 - Case Guidelines on the Management and
Control of Meningococcal Disease

Strategies, Actions Points

To achieve this goal within the medium term, with a benchmark of less than one percent EREID case
fatality rate, the EREID Program Strategic Investment Plan highlights the seven Strategic Priorities,
each with the following goals:

1. Policy Development: Establish updated, relevant, and implementable policies on

EREID providing the overall direction in implementing the different Program
components for all the network of health providers and facilities.
2. Resource Management and Mobilization: Effectively manage and mobilize available
resources from the DOH and partners both local and international needed in EREID
detection, preparedness, and response.
3. Coordinated Networks of Facilities: Organize adequate and efficient systems of
coordination among network of facilities both public and private needed in EREID
detection, preparedness, and response within the context of integrated health service
delivery system at national and sub-national levels.
4. Building Health Human Resource Capacity: Health care professionals skilled,
competent and motivated in detection, prevention and management of EREID cases,
with provision of supervised psychosocial support and risk communication at the
national and sub-national levels.
5. Establishment of Logistics Management System: Manage the systems of procurement
and distribution of logistics for EREID detection, preparedness and response under each
mode of disease transmission.
6. Managing Information to Enhance Disease Surveillance: Improve case detection and
surveillance of EREID to prevent and or minimize its entry and spread and to mitigate
the possible impact of widespread community and national transmission.
7. Improving Risk Communication and Advocacy: Institute a risk communication and
advocacy system that is factual, timely and context relevant implemented at the national
and sub-national levels.
Program Accomplishments/ Status

Policy Development and Review:

 Zika Guidelines finalized and approved ; Avian Influenza Guidelines updated

 Formation of the EREID Technical Working Group ; Experts Panel and EREID
Management Group
 Development of the Situational Analysis of EREID in the Philippines
 Development of the EREID Manual of Operations for Preparedness and Response
 Development of the EREID 5- Year Strategic/ Investment Plan
 Active Participation in the finalization of the IRR of PhilCZ (AO No. 10)
 Community Simulation Exercise –CALABARZON (Oct 2017)
 Initial drafts of the Regional Preparedness and Response Plans (18) ; Initial drafts of the
provincial Preparedness and Response plans (5) -CALABARZON

Resource Management and Mobilization:

 Program Implementation Review (PIR) (February 2017)

 Strategic Plan / Risk Communication Workshop (May 2017)
 Health Promotion / M&E Tool Workshop (Sept 2017)
 Participation in the Marawi Intervention
 Co-handling / assistance to BAI on the Avian Influenza (H5N6) outbreak
 Funding/ Sub- allotments to all regional offices ; RITM and 5 SNLs
 Strengthened collaboration with DOH bureaus, government agencies, medical societies,
academe, civil organizations and societies

Network of Facilities and Stakeholders:

 CBCP, Schools, AFP and LGU ; 7 TWG meetings conducted

 Medical societies as active (PIDSP, PISMD and PAFP)
 Academe collaboration started with UP Manila and NIH
 Philhealth, FAO and OIE, UP Manila, PGH as partners
 Regional EREID Forums : Region V, Region VI, Region IV A
 Field Visit : Region VI (RO, Hospital, RHU and LGU)
Logistic Management System:

 Procurement of PPE (Personal Protective Equipment); Doxycycline; Oseltamivir;

 Pre-positioning EREID supplies to all regional offices (18) ; RITM and Sub National
Laboratories (SNLs)

Risk Communication and Advocacy:

 Risk Communication Guidelines (per mode of transmission) –May 2017

 IEC, media placements, FB, advisories on Zika, Leptospirosis, Avian Influenza and JE
 Health Promotion Plan – Oct 2017

Calendar of Activities

WAYS FORWARD – 2018

 Consolidation of all Regional preparedness plans and assistance to advocate to their

Regional Directors and LCEs
 Strengthening of the Rapid Response Team (RRT) – Regional, Provincial and LGU
levels
 Strengthened collaboration with HEMB, HPCS, EB, RITM and other partner DOH
bureaus and private institutions
 Institutionalize the ONE HEALTH Paradigm (animal, human and environmental health)
in the EREID operational framework and activities
 Integration of strategies addressing the emerging infectious diseases and the public health
emergencies as in APSED III 2017 proposal
 IHR Joint External Evaluation Tool (JEE)
 Development of EREID National Policy and Program Monitoring Tool
 MOP dissemination thru Training Modules / Capacity Enhancement (18 ROs)
 One Health Strategy Workshops
 Interim Clinical Guidelines/ Policies - Review and Updating
 Field Support Visits / Annual Partners’ / Stakeholders’ Forum

Statistics
Zika: Case Fatality Rate:  Zero (0)  (2017)

AH5N6: No Human cases (2017)

Reference: https://www.doh.gov.ph/emerging-and-re-emerging-infectious-disease-program

4. FOOD AND WATERBORNE DISEASES PREVENTION AND CONTROL PROGRAM

DESCRIPTION

FWBDs refer to the limited group of illnesses characterized by diarrhea, nausea, vomiting with or
without fever, abdominal pain, headache and/or body malaise. These are spread or acquired through
the ingestion of food or water contaminated by disease-causing microorganisms (bacterial or its
toxins, parasitic, viral).

VISION

Zero Mortality from FWBDs

MISSION

To reduce morbidity and mortality due to FWBDs

OBJECTIVES

 To guarantee universal access to quality FWBD-PCP intervention and services at all

stages of the life
 To guarantee financial risk protection of clients availing diagnosis, management and
treatment for FWBDs
  To guarantee a responsive service delivery network for the prevention and control of
FWBDs

PROGRAM COMPONENTS

A. Policy, Plans and Organizational Support. This component ensures that supportive policies,
directional and annual plans are developed and updated to govern the design and
implementation of the FWBD-PCP. It shall ensure that organizational support to the FWBD-
PCP is in place at various levels of operations. This includes establishment of partnership
between DOH and LGUs and with other partners in the other sectors.
B. Diagnosis, Management and Treatment. This component ascertains the proper diagnosis as
well as prompt management and treatment of patients suffering from FWBDs. Focus will be
given to the development of clinical practice guidelines (CPGs) on FWBD diagnosis,
management and treatment. Diagnosis will encompass strengthening the laboratory services
and the use of rapid diagnostic test (RDTs). In the management and treatment, support for the
establishment and sustained operations of ORT corners in the hospitals and even in outpatient
health facilities will be provided. Training of health providers will be undertaken on the CPGs
and overall FWBD-PCP management. 
C. Quality Assurance System. This component ensures the quality of diagnostic services of
FWBD cases. This requires regular test, validation and follow-up of laboratory capacities and
competencies of medical technologists as well as provision of the necessary laboratory
supplies and equipment.
D. Logistic Management. This component guarantees that essential drugs/medicines, supplies
and equipment are in place and available at the point of service. While the LGUs are mainly
responsible for placing-in these commodities and other logistics at their level, the DOH shall
design a system for forecasting the needs nationwide and design a procurement, allocation and
distribution system to ensure these reach the facilities with proper tracking and monitoring of
their utilization.
E. Capability Building. This component secures the quality of services by training the service
providers on the standards and protocols on the diagnosis, management and treatment of
FWBDs. It shall also develop the managerial and supervisory capability of FWBD-PCP
managers/coordinators at various levels of administration to ensure the efficient and effective
implementation of the Program.
 F. Health Promotion and Advocacy. This component ensures the prevention of FWBDs which
hinges on the promotion of proper practices on water, sanitation and personal hygiene. It takes
off from the development of an overall Health Promotion and Communication Plan aimed at
effecting behavior change among community members and garnering support from key
stakeholders through advocacy. It also encompasses collaboration with the Environmental
Health and Sanitation Unit on the installation of safe water and sanitation facilities.
G. Monitoring and Evaluation, Research, Surveillance and Response.  Under this component,
necessary system and tools will be developed to ensure that quality and timely data are
generated as basis for decision-making, prioritization of resources and appropriate and
immediate response to any outbreak. A FWBD Surveillance System that will provide a
comprehensive epidemiologic information, on current situation on FWBD, in an area will be
strengthened. Regular monitoring of the status of FWBD-PCP implementation will be carried
out including special researches or studies as needed.
H. Outbreak Response/Disaster Management. This component ensures that any outbreak due
to FWBD in any area is properly monitored and immediately responded to especially during
disaster or emergency situations where the affected population became most prone to these
infections as in evacuation centers or flooded areas.

TARGET POPULATION/ CLIENT

FWBD by Sex

Based on EB’s data in 2016, there were slightly more males generally experiencing FWBDs (cholera,
typhoid, Hepa A, rotavirus and paralytic shellfish poisoning) than females. However, for acute bloody
diarrhea, there were more females than males reported experiencing the disease in the same year.     

FWBDs by Age Group

Majority of the reported acute bloody diarrhea in 2016 were among the 1-4 year old children.
Rotavirus as characterized occurs mainly among the same age group and those below 1 year old. As
for Hepa A, mostly affected are the 15 to 39 year olds and also notable among the younger age group
(5-14 years old). As for typhoid, cholera and paralytic shellfish poisoning, highest number of cases
reported was among the 5-14 years old.

FWBDs by Geographical Areas

The Visayas Region particularly Regions 7 and 8 came out as hosts of the highest incidence of
FWBDs in the country. Incidence of acute bloody diarrhea is highest in Region 7 and also the host of
the highest number of reported Hepa A and Typhoid cases in 2016.  Region 8 on the other hand had
the highest incidence of cholera and paralytic shellfish poisoning. Region 1 came out highest in the
incidence of rotavirus in the same year.

AREA OF COVERAGE

FWBDs are usually manifested as diarrhea. Based on the 2015 Global Health Observatory (GHO)
data, diarrhea accounts for 9% of the total deaths among children below 5 years old. In the
Philippines, a total of 11,876 cases of acute bloody diarrhea (ABD) were reported from sentinel sites
nationwide in the same year. In addition, 830 Hepatitis A cases and 74 cases of paralytic shellfish
poisoning were also reported. The Philippine Health Statistics data showed that diarrhea placed 5th as
a leading cause of morbidity among general population in 2010 from being the top or second leading
cause in the 1990s. Morbidity rate due to diarrhea has gone down from 1,520/100,000 population in
1990 to 347.3/100,000 population in 2010. Despite this decline however, several notable outbreaks
continue to occur. It is believed that since the occurrence of FWBDs is essentially related to economic
and socio-cultural factors.

PARTNER INSTITUTIONS

The management and implementation of the FWBD-PCP are shared responsibility among the
following offices:

A. Department of Health – Central Office

1. Infectious Disease Office (IDO) - Disease Prevention and Control Bureau (DPCPB)

The overall management and coordination of the FWBD-PCP is lodged in the IDO-DPCB.  It takes
the lead in setting the overall direction and focus of the Program.

 Formulate and disseminate national policies, standards and guidelines governing the
management and implementation of the FWBD-PCP
 Develop strategic plans  and cascade this to the regional offices for adoption
 Ensure the provision/delivery of quality diagnosis, management and treatment
services of FWBDs
  Design and undertake training program on various components of the program
 Manage the logistics requirements of the Program
 Secure financing for the FWBD-PCP
 Establish partnership with other national government agencies and other partners in
the private sector
 Undertake monitoring and evaluation of the status and performance of the FWBD-
PCP
 Coordinate with HPCS and other entities in promoting WASH practices and key
messages on prevention and control of FWBDs
 Monitor together with EB any outbreak due to FWBD and coordinate with HEMB
for the immediate response

2. Environmental Health and Sanitation

 Provide technical assistance to the regions and LGUs to comply with the provisions
and requirements of the Sanitation Code in the Philippines;
 Formulate policies, guidelines and standards in promoting increased access to safe
water and sanitation services
 Design strategic approaches to achieve zero open defecation areas nationwide
 Develop and promote guidelines on healthy wash, sanitation and hygiene practices
among food handlers, and other concerned institutions
 Coordinate with the Department of Environment and Natural Resources (DENR) for
interventions that will support the prevention and control of FWBDs

3. Epidemiology Bureau (EB)

 Establish, operate and sustain FWBD surveillance nationwide

 Support LGUs in case investigation of reported FWBD cases and in providing
immediate and proper response
 Inform/communicate with the DOH-IDO and other offices concerned of any
impending or notable FWBD outbreaks
 Generate timely FWBD surveillance reports and disseminate to concerned DOH
offices
  Coordinate with RITM in taking the lead to develop a work and financial plan
and/or proposal funding for the surveillance.
 Provide assistance to RESUs and LESUs if needed in the investigation of cases of
food and waterborne illness.
 Notify the WHO through the National IRR (International Health Regulations) Focal
Point when the assessment indicates a food or waterborne disease event is notifiable
pursuant to paragraph 1 of Article 6 and Annex 2 and to inform WHO as required
pursuant to Article 7 and paragraph 2 of Article 9 of IHR (Annex 3.8A).

4. Health Emergency Management Bureau (HEMB)

 Provide technical assistance in developing plans in times of emergencies and

disasters.
 Mobilize WASH resources through Regional DRRM-H Manager to ensure adequate
and safe water through water quality surveillance, disinfection / treatment in
coordination with DPCB-EOH.
 Augment logistic support to FWBD during emergencies and disaster situations.

5. Health Promotion and Communication Services (HPCS)

 Formulate and design a communication plan to address the poor health seeking
behavior of the community and their unhealthy food and water practices including
personal hygiene
 Develop key IEC messages for various groups of audiences relative to the
prevention and control of FWBDs
 Design appropriate media channels and materials to communicate the key FWBD
prevention and control messages
 Track improvement in the awareness, attitudes and practices of the targeted
population on FWBD prevention and control

6. Research Institute for Tropical Medicine (RITM) and National Reference Laboratories
(Parasitology, Bacterial Enterics and Viral Enterics)

 Perform laboratory testing for samples referred for the FWBD surveillance and
outbreak investigation
  Provides technical support for specimen collection, transport and storage for the
referring hospitals
 Provides laboratory technical support, training and quality assurance to the
subnational, regional and other laboratories
 Provides linelist of laboratory results to EB and RESU, and individual laboratory
results to the RESU, in the form of transmittals (for distribution to the DRUs)
 Refer a subset of samples to the designated Regional Reference Laboratory (RRL)
for quality assurance purpose
 Performs further studies to determine other etiologies of FWBD
 Maintain continuous coordination/communication with stakeholders to promote
information exchange
 Train laboratory personnel in the diagnosis of FWB pathogens
 Provide external quality assurance program for laboratory diagnosis for FWB
pathogens
 Evaluate test kits and reagents in coordination with FDA
 Develop and offer confirmatory assays for other FWB pathogens
 Conduct research relevant to FWB program
 Provide recommendation to LRD office as to the need for activation of Outbreak
Codes to mount multidepartment, division-level response as appropriate
 Conduct laboratory surveillance for the FWB pathogens

7. Food and Drug Administration (FDA)

 Perform microbiologic tests on food samples submitted to the laboratory

 Provide EB with a monthly report of etiologic agents of food and waterborne
diseases on food samples tested
 Monitor the safety of pre-packaged food in the market and issue Public Advisory /
Warning to prevent consumption of contaminated food
 Undertake surveillance of microbiologic agents of food and waterborne diseases
which are transmissible to humans Alert the DOH offices in cases of unusual
increases in the number of reported organisms known to cause food and waterborne
disease in humans. (To be deleted) (Transfer to DA)

B. DOH – Regional Offices

1. Infectious Disease Prevention and Control Cluster
 Disseminate national policies, standards and guidelines governing the management
and implementation of the FWBD-PCP
 Develop local plans and cascade to LGUs
 Undertake training related to FWBD-PCP to local government unit
 Provide logistic support on FWBD-PCP to LGU
 Monitor and evaluate the implementation of the program to LGU
 Coordinate with the regional environmental and Occupational Health on the
implementation of the FWBD-PCP
 Assist RESU in monitoring incidence of FWBDs
 Coordinate with other partners in the region for the management of the FWBD-PCP
2. Regional Epidemiology and Surveillance Unit (RESU)
 Encode data on patients with laboratory confirmed Salmonella and other food and
waterborne infections
 Analyze surveillance data and activate EICT outbreak investigation when deemed
necessary
 Provide technical assistance during trainings on laboratory-based surveillance to be
conducted among hospital staff or sentinel sites
 Fill up laboratory request forms and submit appropriately-labeled stool specimens
from patients and samples of suspected food/water vehicles to the appropriate DOH
or DA laboratory for microbiologic tests
 Encode and collate epidemiologic data from LGUs (Provincial/City Epidemiology
Surveillance Unit, P/CESU), and hospital sentinel sites on the occurrence of
Salmonella and other food and waterborne disease and submit to EB
 Submit monthly report to EB on notifiable diseases. (StratPlan – PIDSR Report)
 Notify EB through the National IRR (International Health Regulations) Focal Point
when the assessment indicates a food or waterborne disease event is notifiable
pursuant to paragraph 1 of Article 6 and Annex 2 and to inform WHO as required
pursuant to Article 7 and paragraph 2 of Article 9 of IHR (Annex 3.8A)
3. Environmental and Occupational Health Unit
 Provide technical assistance to LGUs to increase HHs with access to safe water and
with sanitary toilet, and achievement of zero defecation area
 Implement the preventive measures of FWBD
  Assist in the investigation of FWBD Outbreaks
 Support campaign of prevention and control of FWBD
4. Provincial DOH Office
 Advocate for LCEs’ support to FWBD-PCP
 Lobby to LGUs for funds/budget for FWBD-PCP through inclusion in the  annual
budget
 Ensure adaption of DOH policy by LGU through ordinances
 Monitor implementation of FWBD
 Provide logistic / fund to EOH for FWBD prevention campaign.

C. Other Government Agencies

1. Department of Interior and Local Government (DILG)

 Support the DOH and DA in the collection and documentation of food-borne illness
data, monitoring and research
 Participate in training programs, standards development and other food safety
activities to be undertaken by the DA, DOH and other concerned national agencies
2. Department of Education
 Integrate messages on proper water, food and sanitary practices including personal
hygiene in the school curriculum
 Support and expand the implementation of WINS in public schools
 Integrate hand-washing practices during school feeding programs
3. Department of Agriculture
 Develop and transfer technologies that will improve and sustain the development of
the livestock industry which ensure food security and competitiveness of the local
produce in the global market
 Plan, coordinate and implement research and development programs on swine, beef
cattle, poultry, small ruminants and equine on areas of genetics and breeding system,
animal nutrition and feed resources utilization, herd management, animal health and
disease control, containment and eradication of diseases, post-production, value-
added meat products and by-products technology and animal waste management
 Submit report of all investigations involving foodborne disease
  Alert the Department of Health agencies in cases of unusual increase in the number
of reported organisms known to cause foodborne disease in humans (DA, BAI)
4. Department of Social Welfare and Development
 Proper water, food and sanitary practices including personal hygiene of DSWD
residential centers, canteen, caterers
 Support and expand implementation of hand-washing practices during feeding
programs
 Ensure that DSWD residential centers, canteen, caterers, and DSWD-food for work
and feeding programs use and serve fortified foods with Sangkap Pinoy Seal, if
available
 Use and serve fortified foods such as rice, wheat, flour, oil and refined sugar in
DSWD relief operations and encourage LGUs and NGOs to follow the same
 Authorize food manufacturers to use the DOH seal of acceptance as guide for
consumers in selecting nutritious foods (DSWD)
5. Department of Environment and Natural Resources
 Control the construction and maintenance of waterworks, sewerage, and sanitation
systems and other public utilities
 Prohibiting dumping of waste products detrimental to the plants and animals or
inhabitants therein
 Prohibiting of leaving an exposed or unsanitary conditions refuse or debris or
depositing in ground or in bodies of water
 Raise awareness on the importance of maintaining reliable and effective treatment of
wastewater
 Endeavor to achieve social justice by ensuring the integrity of our ecosystems on
which local communities depend for food and livelihood
 Strive to recycle wastewater to benefit communities and not to allow untreated
wastewater that will harm people (DENR)

D. Local Government Units (LGUs)

The LGUs are primarily responsible in the delivery of quality FWBD diagnosis, management and
treatment and conduct of preventive and control interventions at the local level. Specifically, the
LGUs are expected to:
 o Enforce the implementation of the “Code of Sanitation of the Philippines” (PD No.
856, December 23, 1975): (i) sanitation particularly in public markets,
slaughterhouses, micro and small food processing establishments and public eating
places, (ii) codes of practice for production, post-harvest handling, processing and
hygiene, (iii) safe use of food additives, processing aids and sanitation chemicals
and (iv) proper labeling of prepackaged foods
o Ensure access of households to safe drinking water, safe water and sanitation
facilities
o Inspect food establishments on adherence to standards sanitation practices
o Provide training to food handlers and regulate
o Ensure proper waste disposal
o Establish, operate and sustain local epidemiology and surveillance units with the
following tasks:
oRegister cases of laboratory confirmed Salmonella and other food and
waterborne infections identified from the local government unit (LGU) in
the surveillance.
oFill up laboratory request forms and submits appropriately labeled specimens
from patients and samples of suspected food/water vehicles to the
appropriate DOH or DA laboratory for microbiological tests
oProvide technical support for training on laboratory-based surveillance to
hospital staff of sentinel sites
oEncode and collate epidemiologic data on the occurrence of Salmonella and
other food and waterborne infections to the EB
oSubmit monthly reports of food and waterborne diseases to RESU
oNotify RESU when the assessment indicates a food and waterborne disease
event is notifiable pursuant to paragraph 1 of Article 6 and Annex 2 of IHR
and to inform WHO as required pursuant to Article 7 and paragraph 2 of
Article 9 of IHR (Annex 3.8A)

E. Hospitals

 Attend to cases of diarrhea (no signs, some signs, severe signs of dehydration)
 Request for basic laboratory workups  in case of complications
  Carry out further investigation as deemed necessary
 Refer cases appropriately to specialties/sub-specialties when needed
 Observe proper hydration and monitoring of hemodynamic status Encourage oral
rehydrating solution as soon as patient can tolerate
 Give appropriate anti-microbial if indicated
 Provide health education including handwashing, sanitation, hygiene will be provided
 Give IEC materials to patient/s prior to discharge

F. Laboratories

1. Subnational Laboratories

 Perform laboratory testing of samples from FWBD cases referred by the disease reporting
units, as well as from cluster/outbreak investigations. (we should refer this to our
'algorithm')
 Participate in monitoring and evaluation visits by the DOH FWBD Monitoring team
 Participate in the laboratory quality assurance program
 Provide laboratory results to the National Reference Laboratories and RESU
 Coordinate with the National Reference Laboratories for technical concerns (specimen
collection, transport, storage, testing and troubleshooting)

2. Regional Laboratories

 Perform direct fecal smear, modified acid fast staining, formalin ether concentration
technique, kato-katz and RDT for detection of FWB parasites

3. Tertiary Hospitals

 Perform direct fecal smear, modified acid fast staining, formalin ether concentration
technique, kato-katz and RDT for detection of FWB parasites

4. Level 3 Laboratories
  Perform direct fecal smear, modified acid fast staining, formalin ether concentration
technique, kato-katz and RDT for detection of FWB parasites

5. Level 2 Laboratories

 Perform direct fecal smear, kato-katz and modified acid fast staining for detection of
FWB parasites

6. Level 1 Laboratories

 Perform direct fecal smear and kato-katz for detection of FWB parasites

7. Rural Health Units

 Perform direct fecal smear and kato-katz for detection of FWB parasites

POLICIES AND LAWS

Mandate
Title Year Issued
Sanitation Code of the Philippines 1975 PD No. 856  
Intensifying the Program on Food Handlers and Water Quality
1996 DOH DC No. 110
Surveillance to Curb Outbreaks of water and sanitation related diseases
Creation of the Food and Water-Borne Disease Prevention and Control
1997 DOH AO No. 29-A
Program
Issuance of the Philippines National Standards for Drinking Water 2007 AO No. 0012
Food Safety Act to strengthen the food safety regulatory system in the
country to protect consumer health and facilitate market access of local 2012. RA 10611
foods and food product
Title AO/DM/DC No.
Banning Neomycin in Anti-Diarrheal Preparations AO 24-A s. 1982
Policies and Guidelines for the National Control of Diarrheal Diseases
DC No 179 s. 1993
Program
Designation of Ad Hoc Committee for the formulation of plans, policies
1997.DOH DO No. 99-H
and standards for the FWBD-PCP
 Title AO/DM/DC No.
Revised of List of Notifiable or Reportable Diseases which included
cholera, typhoid, and paratyphoid fever, paralytic shellfish poisoning,
2001. DOH DC No. 176  
acute watery diarrhea, acute bloody diarrhea, food poisoning and
chemical poisoning
Alert for Possible Diarrhea Outbreak Particularly Cholera during Rainy
DC No. 191 s. 2004
Season
Guidelines for Foodborne Disease Surveillance of the DOH Philippines
AO No. 2005-0012
with Salmonella as pilot pathogen
Operational Guidelines for Parasitologic Screening of Food Handlers 2006 AO No. 2006-001
Reproduction of Health Advisory on Diarrhea DM No. 2006-0159
Zinc Supplementation and Reformulated Oral Rehydration Salt in the
2007 AO 2007-0045
Management of Diarrhea among Children
Diagnosis and Treatment Guidelines for Capillariasis Infections 2009 AO 2009-0021
Issuance of Diagnosis and Treatment Guidelines for Paragonimiasis 2010 AO No 2010-0037
Guidelines on verification and certification of Barangay for Zero Open
2015 DM No 2015-0021
Defecation Status
Designation of the RITM as the NRL for Rotavirus and other Enteric
2015 AO No 2015-0050
Viruses
Perform monitoring activities for the Implementation of Harmonized
2016-0230
Schedule and Combined Mass Drug Administration
Conduct monitoring of Food and Waterborne Diseases Outbreak in
2016-1397
Zamboanga City
Dialogue with the Regional Directors of Region 5 & 11 on the
2016-2362
Integration of TB & Paragonimiasis Management
Annual Consultative Meeting for Disease Surveillance Officers and
2016-2704
Coordinators
Provide technical assistance in the Launching and Signing of
2017-0377
Memorandum of Agreement of Regional Food Safety Committee
Orientation on the Guidelines of Integrating the Diagnosis of
2017-3205
Paragonimiasis wiith the NTP-TB Microscopy Services
Creation of Technical Task Force, Expert Panel and Steering
Committee for the Development of Clinical Practice Guidelines (CPGs) 2017-3642
on selected food and waterborne diseases
Consultation on Program and Policy Development for NTD-WASH
2017-3674
Integration
 

STRATEGIES, ACTION POINTS, AND TIMELINE

Strategy 1.  Regulate and monitor food and water sanitation practices at the local level through enforcement of national
and local legislations, application of appropriate technical standards and participation of non-government agencies.
 There is a robust set of laws and policies that support food and water sanitation
practices in the country; the extent of compliance and adherence however to these
laws and policies cannot be fully ascertained given the absence of data relative to
such practices:
o 2012. RA 10611 on Food Safety Act to strengthen the food
safety regulatory system in the country to protect consumer health and
Implementation
facilitate market access of local foods and food product
Status
o 2000 RA Act 9003. 200 providing for an ecological solid
waste management program, creating the necessary institutional
mechanisms and incentives declaring certain acts prohibited and
providing penalties, appropriating funds therefor and for other
purpose
o 1975 PD No. 856  Code of Sanitation of the Philippines
 

Strategy 2.  Sustain inter-agency collaboration to fast-track sanitation  infrastructure development in poor urban areas
and in rural areas with low access to safe water and sanitation facilities.
Implementation  Interagency Committee on Environmental Health with sub-task forces on
Status Water, Solid Waste, Toxic Chemicals and Occupational Health
 
 Strategy 3.  Promote personal hygiene, food and water sanitation practices and the principles of environmental health.
 90% of HHs have access to safe water (2015)
Implementation
 86.7% of HHs with sanitary toilets (2015)
Status
 No data available to  establish extent of personal hygiene practices
 

Strategy 4.  Promote the use of ORS in the management of diarrhea to prevent dehydration, especially among infants
and children.
 ORS continues to be the primary intervention of children with diarrhea as
Implementation shown by the 2015 FHSIS Reports that 100% of diarrhea cases were given ORS.
Status  However, facilities visited are already without ORT Corners
 Likewise, some health facilities have inadequate supply of zinc
 

Strategy 5.  Promote breastfeeding and other good feeding practices for infants and children.
 WHO discourages use of bottles with nipples for feeding during early infancy
as it is usually associated with malnutrition and increased risk of infection,
Implementation especially diarrheal disease, through unhygienic procedures in the preparation of
Status the liquid or the feeding bottle and use of unsafe water. The 2013 NDHS showed
that bottle-feeding is relatively still common in the Philippines with 27% of infants
under age two months being fed using a bottle with a nipple.
 

Strategy 6. Continue training of health personnel in the early diagnosis and treatment of food-borne and waterborne
diseases.
 No training has been conducted on the early diagnosis and treatment of
Implementation FWBDs; the clinic practice guidelines are still currently being finalized which will
Status be packaged into a  Training Module for both hospital and public health facility
staff
 

Strategy 7.  Continue nationwide information campaign for the prevention and control of food-borne and waterborne
diseases.
 No nationwide information campaign has been designed and mounted on the
Implementation prevention and control of FWBDs in the past 6 years
Status
 
 

PROGRAM ACCOMPLISHMENTS/ STATUS

Annual Report
Performance Against 2016 Target Color Labels
2016 Performance already Met  the Target  
2016 Performance within 1-10% off the target  
2016 Performance > 10% off the target  
 Accomplishment                               Performance
Indicator Baseline 2016 Target
2015/2016 Status
Objective 1. Morbidity and mortality rates due to FWBDs are reduced
288.7 per 100,000 2015 FHSIS
(2010 FHSIS) No. of Cases

  Acute Bloody Diarrhea:   35,255

1.1 Morbidity rate due
230.0 per 100,000 Acute Watery Diarrhea: 130,246
to  diarrhea per 100,000    
pop
population
   
  Morbidity Rate
  Acute Bloody Diarrhea:    35.62
  Acute Watery Diarrhea:  127.98
6.1/100,000 Mortality Rate:
1.2 Mortality rate due (2005 PSA) 2014 PSA  
to diarrhea per 100,000 No death
population    
  No. of deaths: 18 (2016 EB)  
Objective 2.  FWBD outbreaks is reduced or eliminated
Cholera: 800 cases No. of Cases: 86
(2008, DOH Surveillance
Rate: 0.08/100,000
2.1 Number of cholera Data)
Zero outbreak
cases as confirmed by   2015 FHSIS
per/year
DOH    
  No. of Confirmed Cases: 18
 
  2016, EB
2.2 Number of typhoid, Typhoid: 2,500 cases No. of Cases: 11,369
paratyphoid as (2008, DOH Surveillance
Zero outbreak Rate: 11.17/100,000                       2015 FHSIS
confirmed by DOH Data)
per/year
    No. of Confirmed Cases: 269
    2016 EB
Objectives Indicator Baseline 2016 Target
Morbidity and Morbidity rate from 288.7 (2010), FHSIS
mortality rates due to
diarrhea per 100,000
food-borne and water-   230
population
borne
diseases are reduced    
  Mortality rate of 6.1 (2005, PSA)
  diarrhea per 100,000   No death
  Population  
2008, DOH
FWBD outbreaks is Number of typhoid, Zero outbreak per    
Surveillance Data
reduced or eliminated paratyphoid and Cholera: 800 cases Year    
cholera cases as confirmed
  Typhoid: 2,500 cases      
by the DOH
 

 
Target Date/s to be
Training /Workshop Learning Outcomes/ Objectives
conducted  
 To initiate Clinical Practice Guidelines
(CPG) for selected Food and Waterborne
1. Clinical Practice Guidelines on Selected Food and
Diseases that shall serve as the country’s July 1, 2017  
Waterborne Diseases
response in addressing diarrhea as public
health issue

To review the activities and indicators in

1. FWBD 2017-2022 Strategic Plan and Action Plan Workshop support to the strategies planned for July 19-21, 2017  
implementation
To detect early TB and/or Paragonimiasis
2. Orientation on the Guidelines of Integrating Diagnosis of in known endemic sites for prompt
August 1-4, 2017  
Paragonimiasis and NTP Microscopy Services in Davao treatment and appropriate management of
respective diseases
To augment the information for diagnosis,
3. Clinical Practice Guidelines on Selected Food and
treatment, and management on diarrhea in August 5, 2017  
Waterborne Diseases Expert Panel Presentation
the field

To strengthen the health service delivery

to rapidly detect suspected cholera cases,
4. Cholera RDT Training for Diarrhea Outbreak Response in
provide early screening for case August 9-10, 2017  
Marawi
management and prompt response to
outbreak of the disease

To augment the information for diagnosis,

5.  Clinical Practice Guidelines on Selected Food and
treatment, and management on diarrhea in September 23, 2017  
Waterborne Diseases Expert Panel Presentation
the field
To provide National , Regional Updates
5. FWBD Program PIR October 17-20, 2017  
and come up with 2018 activities

STATISTICS

A. Morbidity and Mortality Rates By Specific Food and Water-Borne Diseases

Diarrhea

Morbidity Rate due to diarrhea has gone down almost by two thirds from its 2010 level of 288.7/100,000 population to only
166.8/100,000 population in 2015 (both acute bloody diarrhea and acute watery diarrhea). In 2013, both the number of acute bloody
diarrhea and acute watery diarrhea cases reached their lowest but these again began to build up from 2014 to 2015. These fluctuating
values reflect that the control and prevention of diarrhea has been difficult to sustain in the past 6 years.b
Mortality. The desired zero death due to diarrhea was not realized. Surveillance data in 2015 showed 18 deaths due to diarrhea, which
even increased to 44 in 2016.

Cholera and Typhoid

Morbidity. Though the number of confirmed typhoid and cholera cases decreased over the past 6 years, substantial
number of cases continue to be reported. Cholera cases slightly increased from 2013 to 2016 while typhoid cases
decreased from 2013 to 2014. However, this rose again in 2015.

Mortality. There have been no deaths reported due to cholera from 2015 to 2016. No death was also reported due to
typhoid in 2015. Two deaths were reported though from the National Capital Region (NCR) in 2016

Other Food and Water-Borne Diseases

Morbidity. Surveillance data from 2015 to 2016 showed the occurrence of Hepa A, Rotavirus and Paralytic Shellfish
Poisoning cases and deaths. The number of Hepa A cases went down from 2015 to 2016. Cases of rotavirus and paralytic
shellfish poisoning increased over the same period. These increases could be a result though of increasing sentinel sites
reporting during this period.

Mortality. There were a number of deaths reported due to Hepa A, rotavirus and paralytic shellfish poisoning (PSP) from
2015 to 2016. The number of PSP deaths doubled from 3 in 2015 to 6 in 2016 and so with deaths due to Hepa A from 1 in
2015 to 2 in 2016. Only 5 deaths were reported due to rotavirus over the same period.
FWBDs by Sex Based on EB’s data in 2016, there were slightly more males generally experiencing FWBDs (cholera,
typhoid, Hepa A, rotavirus and paralytic shellfish poisoning) than females. However, for acute bloody diarrhea, there were
more females than males reported experiencing the disease in the same year.

FWBDs by Age Group Majority of the reported acute bloody diarrhea in 2016 were among the 1-4 year old children.
Rotavirus as characterized occurs mainly among the same age group and those below 1 year old. As for Hepa A, mostly
affected are the 15 to 39 year olds and also notable among the younger age group (5-14 years old). As fortyphoid, cholera
and paralytic shellfish poisoning, highest number of cases reported was among the 5-14 years old.

WBDs by Geographical Areas The Visayas Region particularly Regions 7 and 8 came out as hosts of the highest
incidence of FWBDs in the country. Incidence of acute bloody diarrhea is highest in Region 7 and also the host of the
highest number of reported Hepa A and Typhoid cases in 2016.  Region 8 on the other hand had the highest incidence of
cholera and paralytic shellfish poisoning. Region 1 came out highest in the incidence of rotavirus in the same year.

B. Outbreaks Due to FWBDs

The objective of the FWBD-PCP to eliminate FWBD outbreaks was not realized given the several reported FWBD-related
events experienced in the various parts of the country from 2012 to 2016. A total of 115 food and waterborne Illness health
events were verified by the Event-Based Surveillance and Response (ESR) Unit from 2012 – 2016. In these events, a total
of 17, 246 cases and 143 deaths were reported during the period.

Summary of Food and Water-Borne Illness Health Events, 2012 - 2016

2012 2013 2014 2015 2016

FWBD Case
Events Cases Deaths Events Cases Deaths Events Cases Deaths Events Cases Deaths Events Deaths
s
ABD 0 0 0 0 0 0 0 0 0 1 20 0 1 29 0
Shigella 2 194 1 4 2368 4 2 662 3 0 0 0 1 30 2
Salmonella 2 1036 4 4 317 5 2 41 0 3 29 2 1 4 0
Amoebiasis 6 385 5 4 83 0 10 389 3 12 284 5 20 2268 12
Rotavirus 0 0 0 2 300 0 1 710 1 0 0 0 2 1290 14
Hepa A 3 98 0 0 0 0 9 505 1 12 255 3 4 119 0
Paralytic
Shellfish 2 14 2 3 29 2 2 32 2 10 57 2 4 55 4
Poisoning
Capillariasis0 0 0 0 0 0 4 4 0 0 0 0 3 3 1
Paragonimiasis
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Others 0 0 0 2 12 0 1 1447 10 2 221 0 2 3956 22
Total 15 1727 12 19 3109 16 31 3790 20 40 866 12 38 7754 55
Most (6, 40%) were Most (10, 32%) were Majority (20, 53%)
Amoebiasis health Amoebiasis health Most (12, 30%) were were Amoebiasis
Most (5, 26%) were
Amoebiasis and
Highest FWBD events Diarrhea and Typhoid events health events
Hepatitis A health
Fever health events
events
     
Region 12 had the
Region 6 had the most Region 1 had the most Region 1 had the most
most (32, 17%)
Most Affected (17, 26%) number of (23, 26%) number of (19, 19%) number of
number of Food-borne  
Regions Food-borne Illness Food-borne Illness Food-borne Illness
Illness health events
health events reported health events reported health events reported
reported
5. HIV/STI PREVENTION PROGRAM

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 following are the
strategies and interventions:

1. Availability of free voluntary HIV Counseling and Testing Service;

2. 100% Condom Use Program (CUP) especially for entertainment establishments;

3.  Peer education and outreach;

4.  Multi-sectoral coordination through Philippine National AIDS Council (PNAC);

5.  Empowerment of communities;

6. Community assemblies and for a to reduce stigma;

7.  Augmentation of resources of social Hygiene Clinics; and

8. Procured male condoms distributed as education materials during outreach.

Program Accomplishments:

As of the first quarter of 2011, the program has attained particular targets for the three major final
outputs: health policy and program development; capability building of local government units
(LGUs) and other stakeholders; and leveraging services for priority health programs.
For the health policy and program development, the Manual of Procedures/ Standards/ Guidelines is
already finalized and disseminated. The ARV Resistance surveillance among People Living with HIV
(PLHIV) on Treatment is being implemented through the Research Institute for Tropical Medicine
(RITM). Moreover, both the Strategic Plan 2012-2016 for Prevention of Mother to Child
Transmission and the Strategic Plan 2012-2016 for Most at Risk Young People and HIV Prevention
and Treatment are being drafted.

With regard to capability building, the Training Curriculum for HIV Counseling and Testing is
already revised. Twenty five priority LGUs provided support in strengthening Local AIDS councils.
as of March 2011, there were already 17 Treatment Hubs nationwide.

Lastly, for the leveraging services, baseline laboratory testing is being provided while male condoms
are being distributed through social Hygiene Clinics. A total of 1,250 PLHIV were provided with
treatment and 4,000 STI were treated.

Partner Organizations/Agencies:

The following organizations/agencies take part in achieving the goal of the National HIV/STI
Prevention Program:

 Department of Interior and Local Government (DILG)

 Philippine National AIDS Council (PNAC)
 Research Institute for Tropical Medicine (RITM)
 STI/AIDS Cooperative Central Laboratory (SCCL)
 World Health Organization (WHO)
 United States Agency for International Development (USAID)
 Pinoy Plus Association
 AIDS Society of the Philippines (ASP)
 Positive Action Foundation Philippines, Inc. (PAFPI)
 Action for Health Initiatives (ACHIEVES)
 Affiliation Against AIDS in Mindanao (ALAGAD-Mindanao)
 AIDS Watch Council (AWAC)
 Family Planning Organization of the Philippines (FPOP)
 Free Rehabilitation, Economic, Education, and Legal Assistance Volunteers
Association, Inc. (FREELAVA)
 Philippine NGO council on Population, Health, and Welfare, Inc. (PNGOC)
 Leyte Family Development Organization (LEFADO)
 Remedios AIDS Foundation (RAF)
 Social Development Research Institute (SDRI)
 TLF share Collectives, Inc.
 Trade Union Congress of the Philippines (TUCP) Katipunang Manggagawang
Pilipino
 Health Action Information Network (HAIN)
 Hope Volunteers Foundation, Inc.
 KANLUNGAN Center Foundation, Inc. (KCFI)
 Kabataang Gabay sa Positibong Pamumuhay, Inc. (KGPP)