Public Health

 

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COURSE OUTCOMES:   At the end of the course, you will be able to: Understand Public Health and related concepts Explain relationship of public health and pharmacy practice Appreciate the roles of pharmacists in a

PUBLIC HEALTH

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FOCUS

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This course primarily focuses on factors

Course Overview affecting health, indicators of general

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collaborative health setting in addressing public health issues Understand existing policies, laws, interventions, and programs that address public health issues Demonstrate understanding on the determinants of health, public health issues and government and nongovernment programs Demonstrate understanding on the roles of pharmacists in improving public health Demonstrate understanding on the definition, types, importance, roles of pharmacists and process of administration of Immunization

health in the community, past and current This subject focuses on  on  factors (drug and non-drug related, local affectingissues health, indicators of general and international) pertinent tohealth Public in the community, past current issues Health and laws andand policies, interventions (drug and non-drugthat related, and and programs address local these issues, and determination roles of Pharmacists international) pertinent toofPublic Health and in Public Health, and application of and these laws and policies, interventions programs that address these issues. With this, you will now what are the roles of a pharmacist in the community, especially in saving and prolonging lives.

concepts.

COURSE CONTENT:      S     M     I     L     E     R     P      S     M     R     E     T     D     I     M

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Unit I. Public Health Concepts Unit II. Factors that Affect Health Unit III. Etiology of Diseases

Unit IV. Disease prevention and control UNIT V: Health Promotion in Industry UNIT VI:  Governmental and Non-Governmental Health Programs and Services

Diseases in the Philippines UNIT   VII: Infectious Prepared by:

  Kathleen P. Buncab, RPh   Faculty, College of Pharmacy   Lorma Colleges PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

IMPORTANT: This IMPORTANT: This module is only a COMPILATION from various sources and only a SUPPLEMENTAL NOTE. Please refer to the   suggested readings for more comprehensive discussion.

PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

 

 

UNIT I. PUBLIC HEALTH CONCEPTS OBJECTIVES:

     

 At the end of the topic, you will be able to 1. Be familiar and understand the definition PUBLIC HEALTH 2. To know the history of Public health 3. To know the essential functions of public health and its different approaches towards health. 4. To differentiate the different levels of prevention

   

5. To know the determinants of health 6. To be familiar with the contributors in the evolution of public health and their contributions

LECTURE NOTES

HISTORY OF PUBLIC HEALTH   In pre-hi pre-historic storic people, people, they usually assume that that people who are sick are caused by by a cursed or punished by spirits which they call call as gods/goddesses. gods/goddesses. Their Their so-called so-called doctor during those times are known as as “sha “shaman” man” or “medicine man”. These pre-historic doctors use medicinal herbs, amulets, charms, or spell that would drive away the “evil spirits”. They also conduct ceremonies to please the supernatural spirits and giving advice to the public on how to maintain life. Some of the practices that are being performed by the shamans are somewhat disturbing but occurred in real life. Examples are Geophagy  or  or the ingestion of clay  .

 Another is the so-called Trepanning where the human skull is being drilled to produce a whole. For them, drilling the skull will release the spirit that is dwelling within the patient.

 

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According to the history, Shamans have different skills in healing. They use medicinal herbs, amulets, charms or spells (ward of evil spirits). They also conduct ceremonies (appease gods, revert the curse that cause illness) and giving advice to individuals on how to maintain an illness-free life

Luckily, these practices have been eradicated. As the time went on, they have discovered that diseases are caused by microorganisms such as bacteria, fungi, viruses, and the like. With these they are able to formulate drugs and other interventions for them to be able to deal with various kinds of diseases.   Here is a link for you to t o watch about the timeline of the evolution of public health: https://www.youtube.com/watch?v=sQgVGuxiH5w  

WHAT IS PUBLIC HEALTH? Let us ask the following contributors of public health

Public Health is the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the: a. sanitation of the environment, b. the control of community infections,

Charles Edward Armory Winslow 1923

c. the education of the individual in principles of personal hygiene, d. the organization of medical and nursing services for the early diagnosis and preventive treatment of  disease, e. and the development of the social machinery which will ensure to every individual in the community a standard of living

Public Health is one of the efforts organized by society to protect, promote, and restore the peoples’ health. It is the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions. The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population. It is thus a social institution, a discipline, and a practice .

 Jhon M. Last 2001

PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

 

the science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Deals with: a. Surveillance of emergence of diseases b. Identification of diseases among community regarding ways that will prevent them from acquiring the diseases c. Investigating factors that contribute to the existence of diseases d. Educating the community regarding ways that will prevent from acquiring diseases 5. Creation of strategies that will ensure sustained well – being among the community 6. Provision of health services to address community members who are already having the disease or recuperating from complications of the disease 7. Institutionalize lessons learned through policies and structures that will prevent occurrence of similar or other diseases 8. Monitoring the health status of the community and providing means that will

From the definitions stated by the contributors, we can conclude that Public Health’s aim is to prolong the life of people and prevent the emergence of diseases. Now that we understand the definition of public health, let me discuss to you a brief history of Public health

Since we said that the aim of Public health is to prolong the life of people and to prevent the emergence of disease, you might be wondering how it is being fulfilled. For you to better understand, here are the functions of public health for them to be able to achieve its goal.

ESSENTIAL FUNCTIONS OF PUBLIC HEALTH

1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.

For essential functions of public health to be fulfilled, here are the approach or steps to be conducted.

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PUBLIC HEALTH APPROACH

STEPS: 1. Define the health problem. - Requires the collection, analysis, and interpretation of data to define the problem and outline: • What • Where • When • Who • How 2. Identify risk factors associated with the problem. 3. Develop and test community-level interventions to control or prevent the cause or the problem. -Requires a determination of: • Preventable or not preventable • Controllable or not controllable • Priority 4. Implement interventions to improve the health of the population.  -The potential for prevention or control frequently requires: • A plan • A champion • A strategy/method • A method • The will • Funding 5. Monitor those interventions to assess their effectiveness. - After implementation the cycle begins again, but this time to evaluate the program results. Did the strategy work as intended? Were the results as expected? If yes, can you expand or replicate the program? If no, do you abandon or revise and try again?  

 

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Since public health’s focus is health, let us define health. According to the World Health Organization, Health is defined as, a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. It is the absence of any disease or impairment. They also said that health is a state that allows the individual to adequately cope with all demands of daily life. It is also a state of balance, an equilibrium that an individual has established within himself and between himself and his social and physical environment.

Basing on its definition, do you consider a deaf without any other disease healthy?

Please watch: https://www.youtube.com/watch?v=XQkYIpCmTDw

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HEALTHCARE CONCEPTS defined as multitude of the services rendered to the individuals, families, community by the agent of the health services, for the purpose of promoting, maintenance, monitoring and restoration of health.

Health care Health system Components of health care

KEY CONCEPTS Includes general care and medical care, must be appropriate, Comprehensive, Adequate, Available, Accessible, Affordable It constitutes the delivery of health services, Involves Policy, Management, Planning, Resources, Action Concepts, Health and Disease, Ideas, Coverage, equity, effectiveness, objects, Hospitals, THQ, RHC, BHU, Dispensaries, Persons, Consumer and providers

LEVELS OF HEALTHCARE betwe en the individuals and the health system 1.PRIMARY HEALTHCARE- First level of contact between  - In the PI, provided by the barangay or village midwife or the PH Nurse or GP (General practitioner) as Primary Care Physicians - Usually available in RHU (Rural Health unit) or BHC (Barangay Health Center) or family clinics - Preventive care, promotion of optimal health and well – being strategies & interventions - MCH services (immunization, FP, pre/post-natal care) - Largely community based

2. Secondary care - consist of specialized care, more complicated and sophisticated diagnosis and treatment   than is provided by the Primary health care level. Normally involves hospitalization - Secondary care involves curative services and is given by the district hospitals - More focused in its form of service ser vice and type of patients - More complex in nature than the ones provided in 1o care 3. Tertiary care- This care involves super specialist care - Provided at the central or regional level - Far more advanced considering the medical cases c ases are far more complex - More difficult, procedures are more complicated c omplicated and advanced ** The process of transferring a patient from one level of care to another is called the Referral process. The patient may assess him or herself on which level of care shall he or she seek wherein she can choose to look for an alternative treatment such as herbal remedies up to seeking care from a health care professional. Promptness of deciding to seek care may affect prognosis. Such delay of seeking care are termed as follows: a. 1st delay Delay in seeking care Detrimental to the patient b. 2nd delay Delay to transfer a Px from 1O to 2O health facility c. 3rd delay Inability to provide urgent and appropriate care  

DETERMINANTS OF HEALTH There are different factors that may affect health. These factors may include the place we live, our genes, nature of work, income, family, relationships, and the like. These factors are known as Determinants of health and they are classified into different categories such as: Policymaking, Social factors, Health services, individual behavior, Biology, and genetics. Policymaking- some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the prohibition of dispensing 

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antibiotics without prescription to prevent the emerging of antibiotic resistance. Social factors-  social determinants of health reflect to the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical

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determinants of health, they impact a wide range of health, functioning and quality-of-life outcomes. For example, discriminations, exposure to crime, social interactions, interact ions, and the like. (Najorda, 2019) Health services- the limited and lack access of health services may affect the health of individual. Examples are the expensive hospital bill, the unavailability of needed devices (such as MRI), delayed intervention of healthcare practitioners due to lack of manpower and many other more. Biology and genetics Age can be a factor of health. An old adult may have poor health than the younger ones due to the degeneration dege neration of their body functions caused by aging. Heredity, aside from age may also affect health. For example, cancer can be passed on from a parent to their offspring.

FUTURE OF PUBLIC HEALTH *Dr. Jeffrey Koplan oversees the future of public health and he stated that “over the course of the past century, public health has grown both in depth and breadth - Today, it addresses a wide range of issues: a. All infectious diseases b. All chronic diseases c. Violence d. Injury prevention e. Birth defects f. Bioterrorism

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In addition to the Doctors, Nurses, Engineers and Nutritionists who hold Public Health degrees, the field also embraces a wide range of professionals in the behavioral and social sciences – a. Demographers b. Communications specialists c. Specialists in evaluation science d. Specialists in decision science

RESEARCH ACTIVITY: Search for the following and note their contributions on the evolution of public health. 1. Egyptians 9. Anton Van Leeuwenhoek 2. Greeks 10. Schola Medicana 3. Hippocrates 11. Carl Linnaeus 4. Galen 12. Edward Jenner 5. Al-Razi 13. Edwin Chadwick 6. Girolamo Fracastoro 14. Dr. John Snow 7. Andreas Vesalius 15. Louis Pasteur 8. William Harvey 16. Declaration of Alma Ata

ASSESSMENT TEST: LINKS IN GOOGLE FORM:

REFERENCES: Nillos, B. E. (2015). Introduction (2015). Introduction to Public Health first edition. Educational edition. Educational Publishing House Najorda, G.S (2019). Community and Public Health. Health. EDRIC Publishing House

PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

UNIT II. FACTORS THAT AFFECT HEALTH  (COMMUNITY HEALTH, EPIDEMIOLOGY AND HUMAN BEHAVIOR) OBJECTIVES:

   

 At the end of the topic, you will be able to 1. To know the different factors that may affect or cause disease   2. To know the different measures and methods to control the spread spread of disease   3. To be familiar with the laws that promulgates rules and methods to counteract vectors of of diseases   4. To know the concept of Epidemiology

LECTURE NOTES

DEFINITION OF TERMS  

COMMUNITY HEALTH- according to WHO, it is defined as environmental, social, and economic resources to

 

sustain emotional and physical well-being among people in ways that advance their aspirations and satisfy their needs in their unique environment. - It mainly focuses on improving the health of a group or community

EPIDEMIOLOGY-  it is the study of the distribution and determinants of diseases and injuries in human populations (Mausner and Kramer, 1985) - the study of the distribution and determinants of health-related states or events in specified Populations, and the application of this study to the control of health problems. HUMAN BEHAVIOR- responses of individuals or groups of humans to internal and external stimuli. It refers to the array of every physical action and observable emotion associated with individuals, as well the human race.  LOCAL FACTORS THAT MAY AFFECT HEALTH OF COMMUNITIES

quality of air and as water well aspollution the surroundings of acertain community maysuch affect 1. PHYSICAL ENVIRONMENT – the their health. The water air and may cause diseases as cholera   lung cancer and the like.

2. SOCIAL ENVIRONMENT – level of social and emotional support people received from friends and or family PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

3. POVERTY – significant factor worldwide, shortens and reduces enjoyment e njoyment of life and the access to health.

4. BEHAVIOR AND LIFESTYLE – daily exercise, balanced diet, sedentary life, unhealthy diet, vices such as smoking and other lifestyle.

5. FAMILY GENETICS AND INDIVIDUAL BIOLOGY  – if you come from a healthy family you have a better chance of staying well.

The Said factors reminds us that Public Health or community Health is not just a matter or absence of a disease. This includes our emotional, social, and mental health as well.

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ENVIRONMENTAL SANITATION Sanitation is a very important tool in order to sustain good health. health. According to centers for disease control and prevention (CDC) Basic sanitation is described as having access to facilities for the t he safe disposal of human waste (feces and urine), as well as having the ability to maintain hygienic conditions, through services such as garbage collection, industrial/hazardous waste management, and wastewater treatment and disposal. Thus, sanitation provides protection between excreta and humans to prevent the transmission of diseases.

Fig. F-diagram   In the Philippines, sanitation is governed by Presidential Decree No. 856 also known the Code on Sanitation of the Philippines issued by the past President Ferdinand Marcos in 1975. This decree contains the regulation on water supply, food establishments, markets, school sanitation and health services, public bathing places, camps and picnic ground, massage clinics and hostels and apartments, public laundry, industrial hygiene, and dance halls. It also contains regulation on sewage control and disposal, vermin control, refuse and excreta disposal including disposal of dead persons.

WATER SANITATION   One of the most source of infection if not controlled is the body of water. For drinking water, there is a standard set by the Code of sanitation of the Philippines to make sure that the drinking water is safe and free from contamination. The examination performed are as follows: a. Initial examination. – The physical, chemical and bacteriological examinations of water from newly constructed systems or sources are required before they are operated and opened for public use. Examination of water for possible radio-active contamination should also be done initially.

b. Periodic examination  – Water from existing sources is subject to bacteriological examination as often as possible but the interval shall not be longer than six months, while general systematic chemical examination shall be conducted every 12 months or oftener. Examination of water sources shall be conducted yearly for possible radioactive contamination.

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(WHO, 1997)

 

From the same decree on Section 13, to protect drinking water from contamination, the following measures shall be observed: a. Washing clothes or bathing within a radius of 25 meters from any well or other source of drinking water is prohibited. b. No artesian, deep or shallow well shall be constructed c onstructed within 25 meters from any source of pollution. c. No radioactive sources or materials shall be stored within a radius of 25 meters from any well or source of drinking water unless the radioactive source is adequately and safely enclosed e nclosed by proper shielding. d. No person charged with the management of a public water supply system shall permit any physical connection between its distribution system and that of any other water supply, unless the latter is regularly examined as to its quality by those in charge of the public supply to which the connection is made and found to be safe and potable. e. The installation of booster pump to boost water direct from the water distribution line of a water supply system, where low-water pressure prevails is prohibited.

WATER ANALYSIS In order to be sure that the water that is being supplied to the public is clean and secured, certain procedures for analysis must be obtained. This analysis includes, Physical, Chemical, radiological, and bacteriological analysis.  PHYSICAL ANALYSIS- this test may be performed using the organoleptic measures which includes color, turbidity and odor and taste of water. Water must be clear and free from bad odor. CHEMICAL ANALYSIS- pH level, hardness level of water, toxic chemicals and the level of oxygen are the 

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properties that are analyzed before distributing to the t he public BACTERIOLOGICAL TEST- some of the infectious disease may be due to fecal contamination particularly Escherichia coli. The tests used to analyze its safety is through multiple-tube method, membrane filtration method, on-site testing method and presence-absence test.

WASTE DISPOSAL

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  Aside from water, waste disposal has also a big contribution in health. Improper disposal of waste may lead to several diseases such as diarrhea and many other more. There are several types of waste such as solid waste and human waste. For this manual, we will only tackle this two.

 Solid waste management  - According RA 9003, it is described as discipline associated with the control of generation, storage, collection, transfer and transport, processing, and disposal of solid waste. This type of waste can be segregated from biodegradable, non-biodegradable, hazardous and recyclable.

- this law also categorizes and describes different types of wastes and they are as follows: follows: from planting or harvesting of crops, trimming, or pruning of 1. Agricultural waste- refer to waste generated from plants and wastes or run-off materials from farms or fields 2. Bulky wastes- refer to waste materials which cannot be appropriately placed in separate containers because of either its bulky size, shape, or other physical attributes. These include large worn-out or broken household, commercial, and industrial items such as furniture, lamps, bookcases, filing cabinets, and other similar items. 3. Consumer electronics- refer to special waste that includes worn-out, broken, and other discarded items such as radios, stereos, and TV sets. 4. Hazardous waste- refer to solid waste management or combination of solid waste which because of its quantity, concentration or physical, chemical, or infectious characteristics may:  a . cause, or significantly contribute to an increase in mortality or an increase in serious irreversible, or incapacitating reversible, illness; or b. poses a substantial present or potential hazard to human health or the environment when improperly treated, stored, transported, or disposed of, or otherwise managed.   5. Municipal waste- refer to wastes produced from activities within local government units which include a combination of domestic, commercial, institutional, and industrial wastes and street litters. 6. Yard waste  - refer to wood, small or chipped branches, leaves, grass clippings, garden debris, vegetable residue that is recognized as part of a plant or vegetable and other materials identified by the Commission.

** RA 9003 also mandated that sanitary landfills must have the following: educe or (a) Liners - a system of clay layers and/or geosynthetic membranes used to contain leachate and rreduce prevent contaminant flow to groundwater. (b) Leachate collection and treatment system - installation of pipes at the low areas of the liner to collect leachate for storage and eventual treatment and discharge. (c) Gas control and recovery system - a series of vertical wells or horizontal trenches containing permeable materials and perforated piping placed in the landfill to collect gas for treatment or productive use as an energy source. (d) Groundwater monitoring well system  - wells placed at an appropriate location and depth for taking water that are representative of ground water quality. (e) Cover - two (2) forms of cover consisting of soil and geosynthetic materials to protect the waste from longterm contact with the environment: (i) a daily cover placed over the waste at the close of each day's operations (ii) a final cover, or cap, which is the material placed over the completed landfill to control infiltration of water, gas emission to the atmosphere, and erosion. (f) Closure procedure with the objectives of establishing e stablishing low maintenance cover systems and final cover that minimizes the infiltration of precipitation into the waste. Installation of the final cover must be completed within six (6) months of the last receipt of waste. (g) Post-closure care procedure - During this period, the landfill owner shall be responsible for providing for the general upkeep of the landfill, maintaining all of the landfill's environmental protection features, operating monitoring migration orequipment, emission. remediating groundwater should it become contaminated and controlling landfill gas

HUMAN WASTE PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

- excreta can be managed by putting up of sanitary toilets. A toilet can be built with septic tank which eliminates waste by using the natural filtering process of the soil. PD 856 has regulations construction of septic tank which are as follows: a. It shall be generally rectangular in shape. When a number of compartments are used, the first compartment shall have the capacity from one-half to two-thirds of the total volume of the tank. b. It shall be built of concrete, whether pre-cast or poured in place. Brick, concrete blocks, or adobe may be used. c. It shall not be constructed under any building and within 25 meters from any source of water supply. FOOD AND MILK SANITATION Spoiled and contaminated food are one of the major causes of diarrhea and meningitis, cancer and even death. With this reason, there is a need to protect the food from contamination through heating or cooling of food and protecting it from flies and other other insects that can contribute to its contamination. With this reason, PD 865 established a law that all establishments that prepares or manufactures food must secure a permit from local health office. This is to ensure that the food handlers and manufacturers follows the standard guidelines in preparing food and milk products. Here are the following requirements promulgated by PD 856: a. Meats, meat products and fish shall be procured from sources under sanitary or veterinary supervision. b. All meat and fish shall be properly cooked before serving. c. No meat products, fish, vegetables and other food sources shall be procured from sources or areas known to have been affected by radioactivity as for example, areas contaminated with a very large amount of radioactive fallout. d. Milk and fluid milk products shall be obtained from sources approved by the local health authority. Milk obtained from other sources must be sterilized, pasteurized or otherwise heated. e. Milk shall be stored in a refrigerator. Canned or package milk, other than dry milk powders, shall be refrigerated after the container has been opened. f. All perishable and potentially hazardous foods shall be stored at 45°F (7°C) or below.

 

g. Cooked food intended to be served hot shall be kept at a te temperature mperature not lower than 140°F (60°C). h. Raw fruits and vegetables shall be thoroughly washed before they are used. The World Health Organization explains basic principles that the whole community should know in preparing

food.

MILK SANITATION Milk sanitation is very important since milk is a very good vehicle of diseases which may be carried out by different sources such as the utensils that is used to prepare the milk, the handlers, water and as well as the environment. Contaminated milk may cause diseases such as streptococcal infection, typhoid, cholera, and diarrhea. Here are the things that must be checked to ensure the safety of milk: a. Source of milk (Animals) must be healthy, free from any kind of disease and must be clean b. the setting of where the milk was obtained shall be sanitized to avoid contamination c. All utensils or materials used from collecting down to packaging of milk must be sterilized. d. Milk handlers shall have their PPE and must observe proper hygiene. e. Milk handlers must be healthy and free from communicable diseases

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METHOD OF PASTEURIZATION: PASTEURIZATION: Pasteurization was introduced by Louis Pasteur. This process is done to prevent the growth of harmful bacteria that is harmful to health. Procedure: 1. Milk is heated in a 63°C for not less then 30 minutes (or 72°C for not less than 16 sec.) while agitated. After 30 minutes, milk will be cooled down and stored in a suitable container and shall be placed inside the refrigerator

CONTROL OF AIR POLLUTION   Pollution is the introduction of contaminants into the natural environment that cause adverse change (Nillos, 2015). These contaminants are known as pollutants and they can be in the form of chemical substances coming from factories, car, pollutants like noise, heat light, and scattered trash on places like soil and water.

According to Republic act 8749, Air pollution is defined as any alteration of the physical, chemical and biological properties of the atmospheric air, or any discharge thereto of any liquid, gaseous or solid substances that will or is likely to create or to render the air resources of the country harmful, detrimental, or injurious to public health, safety or welfare or which will adversely affect their utilization for domestic, commercial, industrial, agricultural, recreational, or other legitimate purposes. This law also defines Air pollutants as any matter found in the atmosphere other than t han oxygen, nitrogen, water vapor, carbon dioxide, and the inert gases in their natural or normal concentrations, that is detrimental to health or the environment, which includes but not limited to smoke, dust, soot, cinders, fly ash, solid particles of any kind, gases, fumes, chemical mists, steam and radio-active substances.

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To control and lessen the exacerbation of air pollution, the Republic Act of 8749 or also known as Philippine Clean Air Act of 1999 formulated guidelines, and here are some of tthe he guidelines: Pollution from Smoking- Smoking inside a public building or an enclosed public place including public vehicles and other means of transport or in any enclosed area outside of one's private residence, private place of work or any duly designated smoking area is hereby prohibited under this Act. This provision shall be implemented by the LGUs. Pollution from Other Mobile Sources: - The Department, in coordination with appropriate agencies, shall formulate and establish the necessary standards for all mobile sources other than those referred to in Section 21 of this Act. The imposition of the appropriate fines and penalties from these sources for any violation of emission standards shall be under the jurisdiction of the DOTC. Ozone-Depleting Substances. - Consistent with the terms and conditions of the Montreal Protocol on Substances that Deplete the Ozone Layer and other international agreements and protocols to which 

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the Philippine is a signatory, the Department shall phase out ozone-depleting substances. Greenhouse Gases. - The Philippine Atmospheric, Geophysical and Astronomical Service Administration (PAGASA) shall regularly monitor meteorological factors affecting environmental conditions including ozone depletion and greenhouse gases and coordinate with the Department in order to effectively guide air pollution monitoring and standard-setting activities. Persistent Organic Pollutants. - The Department shall, within a period of two (2) years after the enactment of this Act, establish an inventory list of all sources of Persistent Organic Pollutants (POPs) in the country. The Department shall develop short-term and long-term national government programs on the reduction and elimination of POPs such as dioxins and furans. Such programs shall be formulated INSECT AND RODENT CONTROL 

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within a year after the establishment of the inventory list. Flies, mosquitoes, cockroaches, bedbugs, fleas, lice, ticks, ants, and other insects that are of public health significance are termed by the VERMIN CONTROL OF THE CODE OF SANITATION OF THE PHILIPPINES as Insects. They also define Rodents as small mammals such as rat, mice characterized by constantly growing incisor teeth used for gnawing or nibbling. Insects and rodents are one of the sources of disease such as Leptospirosis, dengue, malaria and many other more. ** Here are the measures and methods for the abatement of the following For insects: 

For Rodents:

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EPIDEMIOLOGY

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It is a data driven and relies on a systematic unbiased approach to the collection, analysis, and interpretation of data (Najorda,2019). It is used to assess the number of cases of emerging disease in a particular group or community in a particular area and time. It is also concerned with the frequency and pattern of health events in a population (Najorda,2019).

Frequency- refers to the number of health event and the number of populations. The result will now determine the occurrence of disease in a certain population. Pattern- refers to the occurrence of health-related events by time, place and person. Epidemiologist- focuses on identifying the exposure or source that caused the illness, the exposure or source that caused the disease, the number of people infected, spread, interventions and prevention of additional cases and recurrence of disease. FUNCTIONS OF EPIDEMIOLOGY 

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Public health surveillance- systematic collection, analysis, interpretation and dissemination of health data to guide the public health decision making and actions (Najorda,2019). This is done through the determination of morbidity and mortality reports which will further help the epidemiologist analyze the cause and may end up formulating an intervention for the treatment of the community in the disease.   Field investigation- will help in identifying the unreported or unrecognized cases of disease to prevent the spread of infection to the community. For example, the contact tracing of the emerging disease COVID-19.

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Analytic studies- combination of surveillance and field investigation to come up with a hypothesis about the cause of disease. This will also help them (epidemiologist) in the determination of how it is being transmitted. Evaluation-  process of determining, as systematically and objectively as possible, the relevance, effectiveness, efficiency, and impact of activities with respect to established goals (Najorda,2019). Linkages-  collaborated with other health allied professionals to come up with the treatment or proper intervention on the emerging disease or infection. Policy development- formulation of policy in order to control the emergence and or spread of diseases that may cause health problems.

ESSENTIAL DATA IN EPIDEMIOLGY A. RATES  – the number of events in a given population over a specific period or at a given point point in time -rates can be expressed as CRUDE and SPECIFIC i. CRUDE BIRTH RATE (CBR)  = # of births x 1000   total # of population - Average annual number of births a year per 1000 persons in the population at the mid-year determining the rate of population growth - Dominant factor in determining ii.CRUDE DEATH RATE (CDR) = # of deaths x 1000    

total # of population

iii. INFANT MORTALITY RATE (IMR)= # of deaths under 1 year of age x1000 Total # of births

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iv. NEONATAL MORTALITY RATE (NMR) = # of deaths within the 1 st 27 days x 1000 Total # of births

 

v. SWAROOP’S INDEX  = # of death among 50 years old and above above x 100 Total # of deaths vi. MORBIDITY RATE **Incidence rate – the number of new cases of a disease in a population at risk in a given time period **Prevalence rate – total number of cases (old and new cases) of disease existing in a population **Attack rate – the proportion of those who became ill after a specified exposure

   

vii. CASE FATALITY RATE – is the percentage of cases that result in death -measure the severity of the disease and is proportionate to the virulence of a disease agent CFS = # of deaths from from a particular disease x 100 Total # of cases of that same disease DOH – Administrative order no. 2008-0009 -issuance of a list of notifiable diseases that every health system must be able to monitor and report on time - depending on the type of diseases, reporting can be done as frequent as weekly or immediately as the case is encountered in the field Example: Notifiable Diseases or events Reported immediately (must be reported within 24 hours) Acut Acute e Flac Flacci cid d Pa Para rallysi ysis

Pa Para raly lyti ticc shel shellf lfiish poisoning Notifiable Diseases or Syndrome Reported Weekly Dengue Malaria

-DOH adopts a “zero-case reporting” policy which means that even if a community has no reported case of any of the notifiable diseases or events, the health workers still have to report it as “zero case”

LIFE EXPECTANCY versus LIFE SPAN -  usually interchanged with each other however both are entirely different from each other. LIFE SPAN - refers to the number of years a person lives LIFE EXPECTANCY - refers to the number of years a person is expected to live from a specific starting point. Example of Life expectancy would be Disability-Adjusted Life Expectancy (DALE) and Health-Adjusted Life Expectancy (HALE). NOTE: A person can only have one life span but may have different life expectancy. METHODS OF COLLECTING DATA 1. Surveillance Reporting - health facilities are expected to submit monthly and annual reports pertaining to identified health data being monitored by the National Government. Example: Field Health Service Information System System (FHSIS) – collate data from their respective BHU, submitted to Provincial Health office and later to the Regional office of the DOH 2. Surveys -method of gathering any type of information or data from a sample of individuals. By sample it is meant that the data is only taken from a portion of the total population under study Example: National Household Targeting System (NHTS) of DSWD – databank and an information management system which identifies who and where the poor are in the country 3. Census PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

- opposite of survey. It is the counting of data gathered from the entire population. It is a regularly occurring and official count of the human population of a certain local administrative unit. Example: National Statistic Office – municipalities or cities would maintain a Community-based Health Information System 4. PORTFOLIO – profile data of each household, stored and regularly updated -include number of members of the household, immunization records, types of housing or dwelling place, access to safe water and even pet ownership.   Please watch the link for further information https://www.youtube.com/watch?v=r9poHB-ldqk

HUMAN BEHAVIOR - The behavior of a person may be contributed by their environment, social interactions and culture. This has great impact with regards to health situation can influence how they behave or act. According to Bandura (1986), people’s behaviors are driven by external factors and not by inner forces. Social cognitive theory- Human functioning can be explained by a triadic interaction of BEHAVIOR, PERSONAL, ENVIRONMENTAL factors.

Theory of Planned Behavior – behavior is dependent on one’s intention to perform the behavior. -intention is determined by an individual’s attitude (belief and values about the outcome of the behavior) and subjective norms (beliefs about what other people think the person should do or general social pressure). Perceived behavioral control – defined as an individual’s perceptions of their ability or feelings of self-efficacy to perform behavior Transtheoretical Model – AKA Stages of Change Model -A person undergoes at least SIX SI X STAGES OF CHANGE or transformation: i. Precontemplation – people are not intending to make a change in the near future (next 6 months) ii. Contemplation – people intend to change (within the next six months) iii. Preparation  – people have a plan of action and intend to take the action in the immediate future (within a month) iv. Action – people make the behavior change v. Maintenance – people work to prevent relapse vi. Termination  – individuals have 100 percent efficacy and will maintain their behavior. The most difficult to maintain INDIVIDUAL

  Since the main focus of public health is to prevent the spread of disease, one thing that must be considered is the immunity of an individual. According to studies, human body has various type of immune system that is used to fight pathogens. Immune system is categorized as Innate immune system and adaptive Immune system .  

Please watch this video using this link: https://www.youtube.com/watch?v=PzunOgYHeyg

Cells involved in the Innate Immune System:

White blood cells/Leukocytes Neutrophil Dendritic Cell

Basophil Eosinophil Mast cell

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Functions Most abundant; First to attack Present in tissues that are exposed to environment (Skin; mucosa); link between innate and adaptive immune system Releases histamine in response to parasitic infection Releases toxic substances to counteract bacterial or parasitic infection that damages tissue Releases heparin, histamines, chemokines, chemotaxic cytokines. Involved in allergic reaction/anaphylaxis and wound healing.

 

Macrophages Natural Killer cell

Phagocytic cell Destroys virus-infected cells and tumor cells   Cells involved in the Adaptive Immune System: B- and T-lymphocytes

(Nillos, 2015)

T-lymphocytes T Helper cell

Functions aka CD4+T cells; Releases cytokines, Assist in maturation of B cells; activates cytotoxic T cells and macrophages. Cytotoxic T cell Aka CD8+ T cells; destroy virus- infected cells Memory T cell can either be CD4+ or CD8+; Activated upon re-exposure to similar antigen Suppressor T cell Shuts down T cell-mediated immunity towards the end of an immune reaction Natural Killer T cell Produces cytokines and cytolytic (Cell destroying molecules)   (Nillos, 2015) ** B-lymphocytes are one of the cells involved in the production of Immunoglobulins or antibodies

  Please watch this video https://www.youtube.com/watch?v=Atrx1P2EkiQ 

RESEARCH ACTIVITY: 1. What are the top 10 leading causes of disease in the Philippines and Identify which among the discussed factors that affect health are associated with the diseases

ASSESSMENT TEST: Google form link:

PUBLICHEALTH REFERENCES: PREPARED BY: K A T H L E E N B U N C A B, R P h

 

           

  Books: Nillos, B. E. (2015). Introduction (2015). Introduction to Public Health first edition. Educational edition. Educational Publishing House Najorda, G.S (2019). Community and Public Health. Health. EDRIC Publishing House Internet sources: https://www.cdc.gov/healthywater/global/sanitation/index.html https://www.who.int/water_sanitation_health/dwq/gdwqvol32ed.pdf?ua=1 http://www.fao.org/3/x5624e/x5624e05.htm http://noair-rors.weebly.com/indoor-air-pollution.html https://www.doh.gov.ph/sites/default/files/publications/Chapter_16_Vermin_Control.pdf  https://courses.lumenlearning.com/boundless-biology/chapter/antibodies/

UNIT III. ETIOLOGY OF DISEASES OBJECTIVES:

   

 At the end of the topic, you will be able to   1. To differentiate the different factors of diseases 2. To understand the relationship of diseases and its causation   3. To explain the timeline of history of disease   4. To understand the ecologic ecologic con concepts cepts of disease

LECTURE NOTES

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DEFINITION OF TERMS ETIOLOGY- comes from the Greek etio-, which means 'causation' and -ology, which refers to the scientific study of something. - Etiology is the cause of a disease or the science that deals with such causes. INTRINSIC- means coming from within. Therefore, any pathological, or disease-causing, change that has occurred from inside the body has occurred as a result of intrinsic factors. Example: -hemophilia, a disorder that leads to excessive bleeding. - Metabolic and endocrine, or hormone, disorders. Diabetes mellitus is an endocrine disease that causes high blood sugar. - Neoplastic disorders or cancer where the t he cells of the body grow out of control. - Problems with immunity, such as allergies, which are an overreaction of the immune system.

EXTRINSIC - the cause of the disease, or pathological change, came from outside of the body. Example - Infectious agents like bacteria, viruses, fungi, and parasites - Animal bites or stings - Chemicals, electricity, and radiation

IATROGENIC CAUSES- problem resulted from a medical professional's actions or within a medical setting.

Ex. Anaphylaxis, and other drug induced diseases, wrong operating procedures and the like.

IDIOPHATIC- of unknown cause. An idiopathy is any disease with unknown cause or mechanism of apparently spontaneous origin. PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

- For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause may not be readily apparent or characterized. Example: - focal segmental glomerulosclerosis or ankylosing spondylitis is the majority of these cases are deemed idiopathic - pulmonary fibrosis - Some congenital conditions are idiopathic  

FACTOR OF DISEASE CAUSATION The analyzation of the cause of disease is very important not only for the purpose of diagnosis but also for the determination of appropriate intervention or medication and of course for the prevention of disease progression. A CAUSE OF A DISEASE is an event, condition, and characteristic of a combination of these factors. A cause is termed sufficient when it inevitably produces or initiates a disease (Conte, 1999). Diseases may be caused by a single or multiple factor.

Robert Koch, the father of modern bacteriology, Formulated theory of disease and they are as follows: i. The organisms must be present in every case of the disease. ii. The organisms must be able to isolate and grown in pure culture. iii. The organisms must cause the specific disease when inoculated into a susceptible animal. iv. The organisms must then be recovered from the animal and identified.

From the theory of Robert Koch’s, we can notice that according to him, diseases are caused by different organisms. However, as we discussed from our introduction, we learned that there are several factors why people acquire diseases and not just through organisms. With this, let us know several causations of diseases

FOUR FACTORS IN CAUSATION: 1. Predisposing factors such as age, sex and previous illness, whi which ch may create a state of susceptibility to a disease agent. 2. Enabling factors such as low income, poor nutrition, bad housing and inadequate medical care may favor the development of disease. 3. Precipitating factors such as exposure to a specific disease agent. 4. Reinforcing factors such as exposure and unduly hard work may aggravate an established disease or state.

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This model explains that the disease results from the interaction between the agent and the susceptible host in an environment that supports the transmission of the agent from a source to the host (Najorda, 2019)

NATURAL HISTORY OF DISEASE Some diseases that are caused by microorganisms is due to the compromised immune system of an individual wherein these organisms can easily penetrate the host. According to J.E Conte (1999), Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of treatment. For Example, the untreated infection with HIV causes a spectrum of clinical problems beginning at the time of seroconversion (primary HIV) and terminating with AIDS and usually death.

This timeline shows the progression of disease which starts with the exposure of the host and has met the factors for the host to become susceptible with disease Like for example, weak immune system, exposed to a sufficient number of microorganisms for them to become infected or exposure to a chemical such as asbestos, harmful components of cigarettes or tobacco or the idiosyncratic changes of body components (Cancer).

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  After the exposure of the host, and made susceptible by the disease-causing substances, this substance is now causing changes inside the body of the host without any distinct nor detection of signs and symptoms to be associated in a particular disease. This phase of timeline is now termed as the subclinical stage. From this phase up until the time that signs and symptoms are starting to appear is now called as incubation period. Though at this stage, signs and symptoms are not yet apparent,  some pathologic changes in the body of the host can be detected through different kinds of screening method. When the host shows a recognizable signs and symptoms and a diagnosis was made is now at the stage of clinical disease. During the timeline of disease, some host were able to conquer these pathologic factors and recover. Some unfortunately become disabled or even dead. This range of recovery or death is termed as spectr spectrum um of disease.

ECOLOGIC CONCEPT OF DISEASE

ECOLOGY is the science of relationship. It is a scientific study of relationship between different organisms and their environment. DISEASE ECOLOGIST are professionals the studies the overall patterns of disease in a certain population. They usually study the study the interactions between pathogens (e.g. viruses, bacteria, fungi) and their human or non-human hosts. Example of ecology of disease Outbreaks caused by infectious diseases could high affect the ecology of the host, the pathogen, or the environment. Therefore, understanding the incidence, prevalence, or timing of diseases requires understanding the ecology of the interaction.

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Parasites has a big contribution in the ecosystem. They have the ability to stimulate the number of an organism and may cause extinction of humans if not controlled.

AGENTS OF INFECTIOUS DISEASE

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Infectious agents come in many shapes and sizes. Bacteria and protozoans are microscopic one-celled organisms, while viruses are even smaller. Fungi grow like plants, and helminths resemble worms (Conte,1999) 

VIRUS- smaller than bacteria, which is made up of 3 major components such as genetic material, Protein coat, and envelope of lipids. - Virion- a complete virus particle which is composed of nucleic acid and is enclosed by a protective coat of protein called as capsid which are formed from its its identical protein subunits called capsomeres.

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HELICAL VIRUSES- composed of a single type of capsomer stacked around a central axis to form a helical structure. Ex. Tobacco mosaic virus (Nillos, 2015) POLYHEDRAL VIRUSES- composed of 20 faces with a minimum number of identical capsomers requires which is twelve. Ex. Rotavirus SPHERICL VIRUSES- “Ball-shaped”- aka “envelope” viruses. Helical structure that is enclosed by a lipid bilayer membrane. The infectivity of this virus is dependent on the envelope. Ex. Influenza virus, Hepatitis C and HIV COMPLEX VIRUSES- combination of icosahedral and helical shape and may have a complex outer wall or head-tail morphology. Ex. Pox virus

BACTERIUM- bacteria use to attach to surfaces and form dense aggregation called biofilm which may form into their secondary structures such as microcolonies.

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PROTOZOA- one-celled organism that can infect and multiply in human. They are usually seen in aqueous environment and soil. This group composed of flagellates, ciliates and amoebae. Protozoans that are infectious to humans are the following a. Sarcodina-e.g. ameba b. Mastigophora- flagellates c. Ciliophora- or he ciliates d. Sporoza- plasmodium

 

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FUNGUS- there are variety of types of fungus. Some are beneficial to the e environment nvironment and some are harmful to humans.

HELMITHS- worm-like parasites that survive by feeding on a living host to gain nourishment and protection, sometimes resulting in illness of the host.

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SOURCES OF INFECTION AND DISEASE IN THE COMMUNITY  and MEANS OF TRANSMISSION

The sources of infection can be divided into two main groups. These are exogenous and endogenous sources.

ENDOGENOUS- when the infectious agent comes from the patient’s own body, usually from his own normal flora. Endogenous sources of infections become important when the person’s own immunity against his normal flora becomes compromised such as in cases of contamination during surgery, malnutrition, impairment of blood supply and debilitating diseases such as AIDS, diabetes or any other accompanying infection. Examples: genera of staphylococci and streptococci which are normally found in the bod body, y, but can become pathogenic in certain circumstances.

EXOGENOUS - introduce organisms from anywhere outside outside to inside the body, which is the case most of the time. In addition to being exogenous, most of the time infections are transmitted from person to person or from animal to man. They can be either human, animal, or environmental in origin. Humans can be a source of infection in three cases: a. clinically infected (symptomatic infection) b. asymptomatically infected c. they are carriers.

Humans can be a source of organisms which cause diseases that are sexually transmitted such as Treponema pallidum which causes syphilis and N. gonorrhoae which causes gonorrheal infections or through blood when vectors act as vehicles as in the case of transmission of Borrelia that causes relapsing fev fever. er.

Animals  are another source of infection, and an infection derived from this source is called zoonotic infection. Such infections are usually maintained maintained in animals, and are acquired accidentally. An example of such infections could be brucellosis caused by brucella mainly from cows and their products such as milk , rabies caused by rabies virus from wild animals, and plague which is caused by by Pasteurella pestis. Moreover, animal products such as meat, milk and eggs can be sources of infection. Examples are E. Salmonella Salmonella species and E. Cam Cambylobacter. bylobacter.

Environmental  sources are numerous and few environmental saprophytes are pathogenic for man unless in cases of individuals with with severely compromised immune immune system. But still some parasites may result in compl complications ications if introduced into the body body from the environment. Examples are some sporing sporing bacilli of the genera Bacillus Bacillus and

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Clostridium. Food is another important important and very common so source urce of infection due to the the everyday pattern of dealing with such material. Food can be contaminated and hence a source of infection at several stages.

Water, the commonest and the most important material in life is a major source of infection only in case of being in contact with sewage. Examples of organisms derived from the previous two sources when contaminated with faeces are Salmonella typhi associated with food poisoning and Shigella associated with Bacillary dysentery, Brucella causing undulant fever, Leptospira and Clostridium causing botulism.

Air  can be contaminated with organisms shed from skin or the respiratory tract such as S. pneumoniae which causes pneumonia and S. pyogens which causes Scarlet fever, Corynebacterium diphtheriae which causes diphtheria, Haemophilus Influenzae, Influenzae, meningococci, anthrax bacilli and Measles and Mumps viruses. Infection with such organisms organisms occurs by inhalation or ingestion of pathogen-containing droplets produced either orally or by the respiratory tract.

Fomites  are another source of infection which can be defined as any porous substance that can absorb and pass on contagion and almost all the previously mentioned organisms can be derived through this source.

Nosocomial infections are infections that were not present or were incubating at the time of admittance to a health care facility. They include infections patients acquire during their stay in a healthcare healthcare facility or infections that may manifest after discharge. These infections are considered more difficult to prevent and treat, more unpredictable, and more resistant to cure than than infections contracted in the community. Patients who undergo surgical procedures have a PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

higher incidence of nosocomial infections than others. The source of microorganisms that cause nosocomial infections can be the patients themselves, the healthcare facility, or the healthcare personnel.

MEASURES OF DISEASE OUTBREAKS Measures of disease occurrence are used when we are interested only in quantifying an event (the outcome), and our analysis does not extend further to take into account exposures. When we want to relate the effect of a certain exposure to an outcome, we will then need to use what we call measures of effects.

RISK - represents a proportion of the number of people developing the disease divided by the number of people in the population. It can be presented as a proportion (ranging from 0 to 1) or as a a percentage (ranging from 0% to 100%), and expresses the probability of an outcome (health event, disease etc) in a certain group. RATES - are used when the occurrence of an event relates to units of time (for example the number of deaths per 100 persons-years). When measuring the occurrence of a new event in relation to units of time, we refer to incidence rates. PREVALENCE - is a proportion of how many events (for example, people with disease) are present at a specificpoint in time in a population. It is expressed as a percentage. ODDS OF AN EVENT ("odds", always plural) are the probability that this event will occur divided by the probability that the event will not occur. Therefore, a value of the odds of the event occurring can range from 0 to infinity. Odds are a measure rarely used, though the ratio of two odds (odds ratio) are one of the most commonly used measures of effect effect in epidemiology. Whenever using any of these measures it is important to consider the context in which they are used and whether or not they properly express what we want to measure.

EPIDEMIOLOGICALL METHODS and INVESTIGATION OF EPIDEMICS EPIDEMIOLOGICA techniques for gathering and analyzing epidemiological data vary depending on the type of disease being monitored PROCESS OF AN EPIDEMIOLOGICAL STUDY: 1. Establish that a problem exists 2. Confirm the homogeneity of the events 3. Collect all the events 4. Characterize the events as to epidemiological factors 5. Look for patterns and trends 6. Formulate a hypothesis 7. Test the hypothesis 8. Publish the results PUBLICHEALTH RESEARCH ACTIVITY: PREPARED BY: K A T H L E E N B U N C A B, R P h

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1. Choose five kinds of diseases and analyze its causation, what are is agents (If there is any) determine deter mine if its intrinsic or extrinsic.

ASSESSMENT TEST: Google form link:

REFERENCES:

 

  Books: Ciabal, Laura Evelyn P. Introduction I ntroduction to Public Health Issues. 1st ed. Manila Educational Publishing House, 1999. Conte, John E. Manual of Antibiotics and Infectious Diseases (Treatment and Prevention). 1st ed. Massachusetts, USA: Allen and Bacon Viacom Company, 1999. Nillos, B. E. (2015). Introduction (2015). Introduction to Public Health first edition. Educational edition. Educational Publishing House Najorda, G.S (2019). Community and Public Health. Health. EDRIC Publishing House Internet sources: https://courses.lumenlearning.com/boundless-microbiology/chapter/viral-ecology/

UNIT IV. DISEASE PREVENTION AND CONTROL OBJECTIVES:

   

 At the end of the topic, you will be able to   1. To be able to differentiate the different levels of prevention 2. To be able to formulate techniques in prevention of disease

LECTURE NOTES

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WHAT IS DISEASE PREVENTION

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The action of preventing, eradicating, eliminating or minimizing the impact of disease and disability (John M. Last) includes measures not only to prevent the occurrence of disease, such as risk factor reduction, but also to arrest its progress and reduce its consequences once e established. stablished.

Prevention depends upon:  knowledge of causation  dynamics of transmission  identification of risk factors and risk groups  availability of prophylactic or early detection of treatment measures  facilities of these treatment procedures  evaluation and development of these procedures WHAT IS DISEASE CONTROL  

 

describes ongoing operations aimed at reducing: -  the incidence of disease - Duration of disease - Effects of infection - Financial burden to the community

PUBLIC HEALTH APPROACH TO DISEASE CONTROL 1. Define problem 2. Identify the risk factors 3. Intervene 4. Evaluate intervention DISEASE CONTROL INCLUDES: 1. CONTROL- public policy intervention that restricts the circulation of an infectious agent beyond the level that would result from spontaneous individual behaviors to protect against infection 2. ELIMINATION- reduction to zero of the incidences of a specified disease in a defined geographical area as a result of a deliberate efforts 3. ERADICATION- termination of all transmission of infections by extermination of infectious agents 4. EXTINCTION- the specific infectious agent no longer exists in nature or in the laboratory. 5. MONITORING- Performance and analysis of routine measurements aimed at detecting changes in the environment or health status of a population. E.g. Monitoring of air poluution, water quality, growth and nutritional status 6. SURVEILLANCE-  continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill-health Primary activities - Collection of relevant data for a specified population, time period and/or geographic area - Meaningful analysis of data - Routine disseminatatin of data with accompanying interpretation DUTIES OF HEALTH CARE PROFESSIONALS IN SURVEILLANCE - Identify and describe each individual having an infection as quickly as possible after exposure.

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Determine the source of infection Identify exposed individuals to whom the infection may have transmitted Specify the frequency of occurrence of infection in population groups at risk by person, place and time Identify populations that are experiencing, or might experience, an increased frequency of infection Prepare and distribute surveillance reports to healthcare professionals participating in disease and control activities.

TYPES OF SURVEILLANCE A. PASSIVE SURVEILLANCE- receipt of reports of infections/disease from physicians, laboratories and other health care professionals required to submit such reports as defined by public health legislation.

B. ACTIVE SURVEILLANCE-  active disease surveillance is also based on public health legislation and refers to daily, weekly or monthly contacting of physicians, hospitals, laboratories, schools or others to “actively” search for cases

STAGES OF DISEASE DEVELOPMENT Prodromal period- occurs after the incubation period. During this phase, the pathogen continues to multiply, and the host begins to experience general signs and symptoms of illness, which typically result from activation of the immune system, such as fever, pain, soreness, swelling, or inflammation. Usually, such signs and symptoms are too general to indicate a particular disease. Period of illness-during which the signs and symptoms of disease are most obvious and severe. Period of decline- during which the number of pathogen particles begins to decrease, and the signs and symptoms of illness begin to decline. However, during the decline period, patients may become susceptible to developing secondary infections because their immune systems have been weakened by the primary infection. Period of convalescence-During this stage, the patient generally returns to normal functions, although some diseases may inflict permanent damage that the body cannot fully repair. LEVELS OF PREVENTION 1. PRIMORDIAL PREVENTION-  consist of actions and measures that inhibit the emergence and establishment of environmental, economic, social, and establishment of environmental, economic, social and behavioral conditions, cultural patterns of living known to increase risk of disease - It is the prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared 2. PRIMARY PREVENTION- Action taken to prior to the onset of disease will ever occur -It signifies intervention in the prepathogenesis phase of a disease or health problem 2.  SECONDARY PREVENTION- “Action which halts the progress of disease at its incipient stage and prevent compilations”- John M. Last 3. TERTIARY PREVENTION- this type of prevention is to limit the disability of the patient and minimize the suffering caused by existing departures from good health and to promote the pateint’s adjustment to irremediable conditions ** in ** in 2001 Froom and Benbassat formulated 7 categories of prevention and they are as follows: LEVEL 1- Reducing the exposure to an etiologic agent LEVEL 2- Increasing resistance to the disease

LEVEL 3-  Defining it as screening for risk factors for disease (in asymptomatic individuals) in order to reduce them e vent) LEVEL 4- Prevention of recurrence (in asymptomatic individuals after a disease related event) PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

LEVEL 5- treatment aimed at prevention of complications (in asymptomatic individuals after a disease related event) LEVEL 6- Treatment of symptomatic patients for cure, palliation, or reduction of mortality LEVEL 7- Rehabilitation for adjustment to irremediable conditions. TECHNIQUES   1. PRIMORD PRIMORDIAL IAL PREVENTIONPREVENTION- this includes formulation of programs and policies on:   - Food nutrition   - Against smoking and drugs   - Promote regular physical activity

 

2. PRIMARY PREVENTION-  A. health promotion- which enables the public to increase awareness and to control the development of disease ad also to improve the health. B. Specific protection-actions taken to prevent or protect themselves from a specific disease

3. SECONDARY PREVENTIONA. Early diagnosis – Screening test, case finding programs   B. Adequate/ Prompt treatment  

4. TERTIARY PREVENTIONA. Disability limitation- to prevent the transition of disease process from impairment to handicap B. Rehabilitation- physical restoration of a sick or disabled person by therapeutic measures and re-education- (webster’s New Medical Dictionary new edition)   TYPES OF REHABILITATION   1. PHYSICAL THERAPY   - exercises to reduce muscle pain, spasticity, and weakness, and improve your balance and coordination.  Examples of mobility devices include single-point or quad canes, motorized scooters, rolling walkers, and manual or power wheelchairs.

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2. OCCUPATIONAL THERAPY - focus on cognitive rehabilitation (helping you improving thinking, memory, reasoning, and concentration) and vocational rehabilitation (assessing job readiness and ways to maintain or find jobs that meet your needs).

 

       

 

3. SPEECH AND SWALLOW THERAPY   -include techniques to clear mucus from the throat, exercises to ease breathing, and medical therapies like nebulizers or oxygen in some people.   - A speech and swallow therapist may recommend eating techniques that will maximize nutritional intake while minimizing the risk of aspiration. These techniques often include: -resting before eating -sitting in an upright position -keeping your chin parallel to the table -performing double swallows.

4. COGNITIVE REHABILITATION - is a system of therapeutic activities, based on brain- behavior relationships, directed to achieve functional change by: Re-establishing or reinforcing previously learned patterns of behavior Establishing new patterns of cognitive activity through compensatory cognitive mechanisms Establishing new patterns of activity through external compensatory mechanisms Enabling persons to adapt to their cognitive disability to improve overall functioning

  PRINCIPLES OF REHABILITATION - Enable timely recovery

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Re-stabilize RE-train Re- motivate Re- integrate

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 ACTIVITY: 1. Make a COVID-19 prevention from level 1-4 and make a technique in order to prevent

ASSESSMENT TEST: Google form link:

REFERENCES:   Books: Ciabal, Laura Evelyn P. Introduction I ntroduction to Public Health Issues. 1st ed. Manila Educational Publishing House, 1999. Conte, John E. Manual of Antibiotics and Infectious Diseases (Treatment and Prevention). 1st ed. Massachusetts, USA: Allen and Bacon Viacom Company, 1999. Nillos, B. E. (2015). Introduction (2015). Introduction to Public Health first edition. Educational edition. Educational Publishing House Najorda, G.S (2019). Community and Public Health. Health. EDRIC Publishing House

Websters New Explorer Medical Dictionary  New  New Edition. Federal Street Press. pg. 664  

Internet sources: https://www.ump.edu.pl/files/8_483_epidemiology_and_prevention.pdf 

UNIT V. HEALTH PROMOTION IN INDUSTRY OBJECTIVES:

 

 At the end of the topic, you will be able to   1. To know the different objectives of occupational health

PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

 

2. To be familiar with the different hazards of occupational health 3. To know the different ways to prevent the occurrence of occupational hazards

LECTURE NOTES

HEALTH PROMOTION “the process of enabling people to increase control over, and to improve their health.” Health Promotion Glossary, 1998 - any combination of health education and related organizational, economic and political interventions designed to facilitate behavioral and environmental changes conductive to health (Green LW ,1972)

OCCUPATIONAL HEALTH

-

OBJECTIVES

OF

Referred to (WHS), as Occupational health and safety (OHS)   or workplace is a multidisciplinary field concerned with the health safety, and safety health, and welfare of people at work. The goal of occupational safety and health programs include to foster a safe and heathy work environment. OSH may also protect co-workers, family members, employers, customers, and many others who might be affected by the workplace environment (Najorda,2019)

OCCUPATIONAL

Joint ILO/WHO Committee stated that Occupational Health should aim at the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological capabilities; and, to summarize: the adaptation of work to man and of each e ach man to his job.

 Objectives by WHO Regional Office for Europe (Rantanen 1990) protecting workers' health against hazards at work (the protection and prevention principle)  adapting work and the work environment to the capabilities of workers (the adaptation  principle) enhancing the physical, mental and social well-being of workers (the health promotion principle)  minimizing the consequences of occupational hazards, accidents and injuries, and occupational  and work-related diseases (the cure and rehabilitation principle) providing general health care services for workers and their families, both curative and  preventive, at the workplace or from nearby facilities (the general primary health care principle). HEALTH AND SAFETY PROGRAMS Workplace hazards are controlled- at the source whenever possible    

Records of any exposure are maintained for many years  Both workers and employees are informed about health and safety risk in the workplace Worker health and safety efforts are ongoing

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OCCUPATIONAL HAZARD Danger to health, limb, or life that is inherent in, or is associated with, a particular occupation, industry, or work environment. Occupational hazards include risk of accident and of contracting occupational diseases.

TYPES OF OCCUPATIONAL Physical hazard   Heat  Cold Light Noise  Ultraviolet radiation  Vibration  Ionizing radiation  

 Chemical hazard  Local action- (formaldehyde, cleaning agent etc.)  Inhalation- (Cigarette smoke, carbon monoxide, carbon dioxide etc.) Biologic hazard   Exposure to infectious substances or microorganism  Mechanical hazard  lack of knowledge with the machine  Carelessness  Psychosocial hazard  Job insecurity  Lack of job satisfaction  Poor human relationship  Emotional tensions  Bullying in the workplace  Long working hours

 

MOST FREQUENT WORK-RELATED DISEASES AND INJURIES Lung diseases- caused by asbestos, lead, silica, cotton dust  Musculoskeletal injuries  Cancers 

Severe trauma Cardiovascular disorder  Disorder of Reproductive system  Neurotoxic disorders  

WAYS TO CONTROL A HAZARD  ELIMINATION- (including substitution): Remove the hazard from the workplace, or substitute (replace) hazardous materials or machines with less hazardous ones 

ENGINEERING CONTROLS- includes designs or modifications to plants, equipment, ventilation systems, and process that reduce the source of exposure. Ex. Process Control- involve changing the way a job j ob activity or process is done to reduce the risk. Monitoring should be done before and as well as after change is implemented to make sure the changes did, in fact, control the hazard.

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Enclosure and isolation- aim to keep the chemical “in” and the worker “out”. An enclosure keeps a selected hazard “physically” away from the worker. Examples include “Glove boxes”, abrasive blasting cabinets, or remote-control devices. Isolation places the places the hazardous process “geographically” away from the majority of the workers. Common isolation techniques are to create a contaminant-free or noise-free booth either around the equipment or around the employee workstation Ventilation-method of control that strategically “adds” and “removes” air in the work environment. Ventilation can remove or dilute an air contamination if designed properly. Local exhaust ventilation is very adaptable to almost all chemicals and operation. 

ADMINISTRATIVE CONTROLS-  controls that alter the way the work is done, including timing of ADMINISTRATIVE work, policies and other rules, and work practices such as standards and operating procedures (Including training, housekeeping, and equipment maintenance, and personal hygiene practices) Methods: - Restricting access to a work area - Restricting the task to only those competent or qualified to perform the work. - Scheduling maintenance and other high exposure operations for ties when few workers are present (such as evenings, weekends) - Using job-rotation schedule that limits the length of time a worker is exposure to hazard.  Work practices- developing and implementing safe work procedures or standard operating procedures Training and education of employees about the operating procedures as well as other necessary workplace training  Establishing and maintaining good housekeeping programs  Keeping equipment well maintained  Preparing and training for emergency response for incidents such as spills, fire or employee injury. 



PERSONAL PROTECTIVE EQUIPMENT- equipment worn by individuals to reduce exposure such as contact with chemicals or exposure to noise, eye and face protection, respiratory protection, head protection, hand and arm protection, safety belt, lifelines and safety nets, safety shoes

LEGAL CONTROL OF OCCUPATIONAL HEALTH SERVICES Preventive activities oriented to workers scree ning and periodic  assessment and surveillance of workers' health status by pre-placement, screening examinations which may be general as well as focused on the biological effects of particular hazards 

to which the workers may have been exposed Adaptation of the job, the work station and the workplace environment to promote workers' ongoing health and safety with special attention to such vulnerable groups as the t he very young, the elderly and those with acquired diseases and disabilities

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Providing workers with health education and training in proper work practices  providing education and training for owners/managers and supervisors that will inculcate awareness of the health needs of workers and motivation to initiate appropriate prevention and control measures.



  Curative activities  provide or arrange the delivery of the appropriate diagnostic, therapeutic and rehabilitative services for occupational injuries and diseases re habilitation to obviate avoidable disability and encourage and oversee  provide or arrange for early rehabilitation adjustments in the job that will permit early e arly return to work emerge ncy procedures   provide education and training (and periodic retraining) in first aid and emergency emerge ncies such as spills,  establish procedures and conduct training drills for coping with major emergencies fires, explosions and so on  provide or arrange for workers' involvement in programmes that promote general health and wellbeing. Record keeping and evaluation  make and retain appropriate records on occupational accidents, injuries and diseases and if possible, on exposure; evaluate the overall health and safety status of the enterprise on the basis of such data  monitor the effectiveness of hazard prevention and control measures.

REASERCH ACTIVITY: 1. Search for the Philippine laws that are made to protective workers. List down the article or section that pertains to the protection of health of the employees.

ASSESSMENT TEST: Google form link:

REFERENCES:   Books: Najorda, G.S (2019). Community and Public Health. Health. EDRIC Publishing House  

 

Internet sources: https://www.who.int/health-topics/health-promotion#tab=tab_1 https://www.who.int/occupational_health/topics/workplace/en/index1.html http://www.ilocis.org/documents/chpt16e.htm http://www.businessdictionary.com

UNIT VI. GOVERNMENT AND NON-GOVERNMENTAL NON-GOVERNM ENTAL HEALTH PROGRAMS AND SERVICES PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

OBJECTIVES:

   

 At the end of the topic, you will be able to 1. To know the different Health programs and services offered by the government and non-government agencies 2. To know the different rights of the public towards health

LECTURE NOTES  

 

     

GOVERNMEMNT HEALTH PROGRAMS AND SERVICES IN THE PHILIPPINES PUBLIC HEALTH SERVICES (Philippine Health services Delivery Profile, 2012) -The Department of Health (DOH) is responsible for developing health policies and programs regulation, performance monitoring and standards for public and private sectors, as well as provision of specialized and tertiary level care -The DOH Centers for health and Development (CHDs) are the implementing agencies in provinces, cities and municipalities, and link national programs to local government units (LGUs). -The CHDs are the DOH offices at the regional level. They assist the LGUs in the development of ordinances and localization of national policies, provide guidelines on the implementation of national programs at the LGU levels, monitor program implementation, and develop support system for the delivery of services by LGUs. Service Delivery Model

HEALTH AGENCIES The Department of Health (DOH) - is the principal health agency in the Philippines. It is responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services. PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

Philippine Health Insurance Company (PHIC) - ensure a sustainable national health insurance program for all. **Six major membership categories - "Formal" sector -Indigent sector - Sponsored members - Lifetime members -Senior citizen - Informal economy World Health Organization Primary role is to direct and coordinate c oordinate international health within the United Nations system. - support countries as they coordinate the efforts e fforts of governments and partners – including biand multilaterals, funds and foundations, civil society organizations and the private sector. **Main areas of work are health systems: - Health through the life-course - Noncommunicable and communicable diseases - Preparedness, surveillance and response United Nations International Children’s Emergency Fund -to save children’s lives, to defend their rights, and to help them fulfil their potential, from early childhood through adolescence. Programs: - Child protection and inclusion - Child survival HEALTH PROGRAM - aims to promote and protect the health of families, prevent and control non-communicable diseases and non-communicable diseases, and implement environmental health and sanitation activities

A. FAMILY HEALTH - it is concerned with the health of the mother and unborn, the newborn, infant, child, the adolescent and youth, the adult men and women and older persons. 1. The Maternal Health - Goal: to improve the survival, health and well-being of mothers and unborn through a package of services for the pre-pregnancy, pre-natal, natal and post-natal stages. - Essential Health Services Packages available in the Health Care Facilities - These are the packages and services that every woman has to receive before and after pregnancy and or delivery of a baby. 1. Antenatal Registration - guide the mother in pregnancy in care to make her prepare for childbirth Ex. Prenatal visits, dental check-ups 2. Tetanus Toxoid Immunization - to protect from deadly disease tetanus toxoid immunization - a series of 2 doses to tetanus toxoid vaccination must be received by a woman one month before delivery and 3 booster doses after childbirth. The mother then is called “Fully Immunized Mother (FIM)” 3. Micronutrient Supplementation - Vitamin A and Iron supplement for the prevention of anemia and Vit. A deficiency. 4. Treatment of disease and other conditions - Conditions that might occur among pregnant woman that may endanger he health and complication could occur. This includes: a. Obstruction of airway b. Unconscious c. Post-partum bleeding d. Intestinal parasite infection e. Malaria 5. Clean and Safe Delivery PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

- provide safe and non-traumatic care, recognize complications and also manage and refer the woman to a higher level of care when necessary 2. The Family Planning Program - Goal: to provide universal access to family planning information and services wherever and whenever these are needed. **Family planning aims to contribute to: Reduce infant deaths  Neonatal deaths  Under-five deaths  Maternal deaths 

Interventions: Promote and implement strategies through outreach program

3. The Child Health programs (Newborns, Infants and Children) - Newborns, infants and children are vulnerable are group for common childhood disease a. Infant and young Child feeding Objective: - To improve the survival of infants and young children by improving their nutritional status, growth and development through optimal feeding b. New born screening- To detect diseases such as G6PD to prevent complications

4. Expanded Program on Immunization (EPI) - Vaccination among infants and newborns (0-12 months) against the seven vaccine preventable diseases. These includes: a. Tuberculosis b. Diphtheria c. Pertussis d. Tetannus e. poliomyelitis f. Measles and hepatitis *** The EPI routine schedule of immunization - The child is said to be “Fully Immunized Child”  when a child receives one dose of BCG, 3 doses of OPV (Oral Polio Vaccine), 3 doses of DPT, 3 doses of Hep B and one dose of measles before a child’s first birthday Management of childhood illness Methods: a. Assess the patient b. Classify the disease c. Treat the patient d. counsel the patient 5. Micronutrient Supplementation/ Nutrition Program The common deficiencies are: a. Vitamin A PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

b. Iron c. Iodine - these deficiencies lead to a serious physical, mental, social and economic condition among children and women. Goal: To improve the quality of life of Filipinos through better nutrition, improved health and increased productivity PROGRAMS AND PROJECTS UNDER NUTRITIONAL PROGRAM: a. Micronutrient Supplementation - the twice-a-year distribution of vitamin A capsules through the “ Araw ng Sangkap Pinoy”, known as Garantisadong Pambata (GP), or Child health week b. Food fortification - the addition of essential nutrients to a widely consumed food product at levels above natural state is a cost effective and sustainable intervention to address micronutrient deficiency FOOD FORTIFICATION ACT OF 2000 - Provides the mandatory fortification of staples namely: Flour with iron and vitamin. A cooking oil and refined sugar with Vitamin A and rice with iron and the voluntary fortification of processed foods through the “Sangkap Pinoy Seal” c. Essential maternal and Child Health Services Package - includes the delivery of essential maternal and child health and nutrition package of services that will ensure the right to survival, development, protection and partition as follows: Breast feeding  Complementary feeding  Micronutrient supplementation  d. Nutrition Information Communication and Education - these includes the promotion to nutritional guidelines for Filipinos and other nutrition key messages and training of health workers e. Home School and Community food production - includes establishment of kitchens, gardens in homes, schools and in communities in urban and rural areas to serve as a source of additional food for the home and establishment of demonstration centers and nurseries and distribution of planting materials. 6. DENTAL HEALTH/ORAL HEALTH PROGRAM - dental caries and periodontal disease (gum disease) are the main health problems in the Philippines Intervention: a. Preventive services Oral examination  Oral hygiene  Pit and fissure sealant program  Fluoride utilization Program  b. Curative/ Treatment Services Permanent filling  Gum treatment  Atraumatic restorative treatmend  Temporary fillinf   Extraction  Treatment of post extraction complication  Drainage of localized oral abscesses and incision and drainage  c. Promotive services Health education activites 

7. THE ADOLESCENT HEALTH PROGRAM - WHO define adolescent as the period of life between 15- 24 years of age while youth refers to those who are between 15 and 24 years old PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

ESSENTIAL HEALTH CARE PACKAGE FOR THE ADOLESCENT AND YOUTH a. Management of illness b. Counselling on substance abuse, sexually and reproductive tract infections c. Nutrition and diet counseling d. Mental health e. Family planning and responsible sexual behavior f. Dental care 8. THE ADULT MEN AND WOMEN PROGRAM  (aged 25-59 years old) ESSENTIAL HEALTH CARE PACKAGE FOR THE ADULT MALE AND FEMALE a. Management of illness b. Counselling on substance abuse, sexuality and reproductive tract infections c. Nutrition and diet counselling d. Mental health e. Family planning and responsible sexual behavior f. Dental care g. Screening and management of lifestyle related and other degenerative disease

9. THE OLDER PERSON PROGRAM ESSENTIAL HEALTH CARE PACKAGE TO OLDER PERSON a. Management of illness b. Counselling on substance abuse, sexuality and reproductive tract infections c. Nutrition and diet counseling d. Mental health e. dental care g. Screening and management of lifestyle and other degenerative disease

 

h. Screening and management of chronic debilitating and infectious diseases i. Post productive care B. NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL PROGRAM (NCD PREVENTION AND CONTROL PROGRAM FOUR MAJOR NON-COMMUNICABLE DISEASE Cardiovascular disease  Cancer  Chronic pulmonary disease  Diabetes mellitus  INTERVENTION: o Advise smoking cessation o Encourage Proper nutrition o Drink alcoholic beverages in moderation o Promote physical activity C. COMMUNICABLE DISEASE PREVENTION AND CONTROL DOH covers the following communicable disease:  Tuberculosis  Leprosy  Schistosomiasis  Filariasis  Malaria o House spraying o On stream clearing  Dengue Hemorrhagic fever  Measles  Chicken pox  Mumps  Diphtheria  Pertussis Tetanus  Influenza  Pneumonias 

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Cholera  Typhoid fever  Bacillary dysentery  Hepatitis A ** Intervention usually starts with Immunization (Free vaccine shot) 

HEALTH SERVICES HEALTH SECTOR REFORM AGENDA 1. Provide fiscal autonomy to government hospitals 2. Secure funding for priority public health programs 3. Promote development of local health systems 4. Strengthen health regulatory agencies' capacities 5. Expand the coverage of the National Health Insurance Program. **GOALS - Better health outcomes - More responsive health system - More equitable healthcare financing. FOURmulaONE OBJECTIVES - Secure more, better and sustained financing for health - Assure the quality and affordability of health goods and services - Ensure access to and availability of essential and basic health packages - Improve performance of the health system

SENTRONG SIGLA Certifies primary health care facilities that comply with its list of quality standards. **Methods used: -Chi-squared tests- statistics -prevalence ratios- The ratio of the proportion of the persons with disease over the proportion with the exposure -Clustered sampling analysis-Linear regressions of the rates- values from an existing data PHILIPPINE GOVERNMENT HEALTH LAWS/PROGRAMS 1. Anti-drunk and Drugged Driving Act of 2013 - ensure road safety through the observance of the citizenry of responsible and ethical driving standards. 2. National Building Code - to safeguard life, health, property, and public welfare, consistent with the principles of sound environmental management and control; and to this end, make it the purpose of this Code to provide for all buildings and structures, a framework of minimum standards and requirements to regulate and control their location, site, design quality of materials, construction, use, occupancy, and maintenance

3. Anti-sexual Harassment Act of 1995 - value the dignity of every individual, enhance the development of its human resources, guarantee full respect for human rights, and uphold the dignity of workers, employees, applicants for employment, students or those undergoing training, instruction or education. Towards this end, all forms of sexual harassment in the employment, education or training environment are hereby declared unlawful. 4. The Philippine Mining Act of 1995 - protect and advance the right of the Filipino people to a balanced and healthful ecology in accord with the rhythm and harmony of nature;

NON-GOVERNMENT ORGANIZATION (NGO)

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- Defined by World Bank as Private organization that pursue activities to relieve suffering, promote interests of the poor, protect the environment, provide services or undertake community development. Types: -Charitable -Participatory - Service -Empowering

social

UNIVERSAL AREAS OF - Culture and recreation

-

NGO’S

Education and research Health Social services Environment Development and housing Law, advocacy and politics Voluntarism promotion Business and professional associations and unions  Religion

INTERNATIONAL NGO Wikimedia- Jimmy Wales - goal is to open source content, wiki based project to public for free Heifer international- Dan West - “Ending hunger, Caring for the earth” - focuses on sustainable development agro-ecology and sustainable development. Clinton Health access Initiative- Bill Clinton - Launches several health improvements programs, immunization programs and supply of  second line drugs at cheaper rates. Mercy Corps- ( Elsa Culver) - Engaged in transitional environment that have experienced sort of shocks such as natural disaster and the like. Oxfam International- composed of 11 NGO’s that works together to fight poverty and  injustice around the world CARE (Cooperative for assistance and relief everywhere) - One of the world’s largest NGO for relief and development - Famous for its “Care Packages” of food and other necessities - Goals: income; education; health and population services.

Local NGO Mercy in action- “Birth centers saves mother baby lives” Children’s joy Foundation-” Hel feed and send to school poor kids” CANVAS- (Center of Art, New ventures and sustainable Development) “ Give books to Children”

Tahanan Sta. Lucia- “ Empower Filipino teenage girl survivors of abuse” Reach out and feed Philippines Inc.- “#Projectbaon: School meals for 300 filipino kids Angel house orphanage- Care for children from 0-10 y/0 International disaster Volunteer- Build rescue boats in flood prone communities

REASERCH ACTIVITY: PUBLICHEALTH PREPARED BY: K A T H L E E N B U N C A B, R P h

 

1. Search for the following local health programs and identify the health services they cater: a. GCVP b. BnB c. NTP d. Tapat mo, linis mo e. SALINTUBIG f. VMNIS g. WNTD h. TB DOTS i. ASIN Law  j. Bring your own own bag k. MDIS l. Four o’clock habit 2. What are the Health programs available in your barangay? What are its benefits to your barangay?

ASSESSMENT TEST: Google form link:

REFERENCES:   Books: Public Health Nursing in the Philippines, 10th ed., 2017, pages 119-173 Health Services Delivery Profile Philippines 2012 page 3

         

Internet sources: https://www.officialgazette.gov.ph/2013/05/27/republic-act-no-10586/ http://ray.dilg.gov.ph/files/nati http://ray.dilg.gov.ph/files/national_building_code_o onal_building_code_of_the_philippines.p f_the_philippines.pdf  df  https://www.ombudsman.gov.ph/GAD/Laws%20and%20Mandates/republic_act_7877.pdf  https://www.officialgazette.gov.ph/2012/07/06/executive-order-no-79-s-2012/

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UNIT VI. INFECTIOUS DISEASE IN THE PHILIPPINES OBJECTIVES:

   

 At the end of the topic, you will be able to   1. To know the different infectious disease in the Philippines Philippines 2. To know the different treatments and management of diseases

LECTURE NOTES

 A. Water/ Food borne diseases

 

TYPHOID FEVER   

        

 

 

Aka. Enteric fevers Causative agent: Salmonella typhi  History: Spleen secretions and lymph nodes 1896: Serum from animals immunized with Typhoid bacterial cells. Serodiagnosis is made possible Typoid “Mary”-Mary Mallon Salmonella enterica serovar enterica serovar Typhi -infected 78 people; 5 deaths Transmission: ingestion of food and drinks. Parathyroid: Salmonella Paratyphi A,B, C Clinical Features: Septicemia features, Bradycaria, splenomegaly, abdominal symptoms and “Rose spots”and intestinal hemorrhage. Symptoms: Continuous headache, abdominal tenderness discomfort with constipation. Onset of disease: from 3 to 50 days (2 weeks) Test used: Widal test Treatment: Chloramphenicol,Trimethoprim-sulfamethoxazole (Bactrim), Ciprofloxacin; Vaccines Prevention: Proper hand washing Treatment: Antibiotics DOC: Chloramphenicol

HEPATITIS A 5 types of Hepatitis A- fecal-oral B- Transmission C- Blood to Blood D- Travels with B E-Fecal-oral transmission  Hepatitis A -Epidemic Jaundice -Naked RNA virus (Heptovirus)

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 Causative agent: Picorna virus (RNA)  Target: Humans are only host

high temperature, Formalin, chlorine  Intervention: Can be inactivated by high  Transmission:

-Contaminated food, water -Blood exposure  Treatment: HBV antiviral agent (interferon), HBC Ribavirin

 

CHOLERA Causative agent: Vibrio cholerae Characteristics: Comma shaped, gram negative Host factors: Children and elderly, low gastric levels; Blood type: (O,B,A,AB)  Risk factors: Poor sanitary condition, Raw or undercooked food,Hypochlorhydia,  Type O Transmission: Contaminated food,Casual contact    Incubation:1-3 days  Symptoms: Usually mild/ no symptom, cramps, painless diarrhea and vomiting of  clear liquid “Rice water” Treatment: Prevent dehydration - Hydration is the mainstay of treatment for cholera.  Antibiotics Vaccine against cholera  

 

AMEBIC DYSENTERY Causative agent: Entamoeba histolytica **3rd leading parasitic cause of death Two forms: Trophozoite and cyst form    -Cyst- Small intestine   -Trophozoite-large intestine Risk factors: Children, Pregnant who use corticosteroids, Malnourished.  Incubation: 2-4 weeks  S/S: Bloody diarrhea, abdominal tenderness, fever, vomiting, frequent loose stools,  abdominal pain, cramps (colic), fatigue, diarrhea with abdominal swelling, flatulence Tx: Metronidazole (DOC for invasive disease)    Paromomycin (DOC for non-invasive) 

E. COLI DIARRHEAL ILLNESS 

• • • • • • •

Escherichia coli- gram (-) Enterohemorrhagic E coli (EHEC)- cause disease and produces  exotoxins Verocytotoxic E. coli (VTEC) also known as Shiga toxin Producing  e.coli Transmission: Fecal oral, fomites Primary reservoir: Cattle/Sheep Transmission of humans: Food, contaminated water Incubation: 1-16 days S/s: diarrhea, vomiting, body malaise, Loss of appetite, dehydration Diagnosis: Stool analysis Treatment: resting/drinking water to replenish fluids, antibiotics and antimotility agents may be useful for traveler's diarrhea.

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BACILLARY DYSENTERY

• • • •

• • • •

aka- Shigellosis Place of lesion: Sigmoid and colon S/s: Fever, Abdominal pain, tenesmus, stool mixed with mucus and pus. Causative agents: S. dysenteriae: the most severe S. Flexneri- Easily turn to chronic S. Boydii- tropical S. sonnei- the most mild Route of administration: Fecal-oral route Incubation: 1-2 days S/s: Shiver, abdominal pain, Treatment: Ampicillin, Diet, Avoid over work

B. SEXUALLY TRANSMITTED DISEASE  

SYPHILIS 

Causative agent: Treponema pallidum  Stages: primary, secondary, latent, and tertiary a. primary syphilis - sore or sores on or around the genitals, around the anus or in the rectum, or in or around the mouth. b. secondary syphilis include skin rash, swollen lymph nodes, and fever. c. latent stage, there are no signs or symptoms   d. Tertiary syphilis is associated with severe medical problems. A doctor can usually diagnose tertiary syphilis with the help of multiple tests. It can affect the heart, brain, and other organs of tthe he body. Spread: direct contact with a syphilis sore during vaginal, anal, or oral sex. Syphilis can spread from an infected mother to her unborn baby.  Dx: blood sample  Treatment: antibiotics  For primary, secondary and early latent syphilis-Benzathine penicillin (IM 1),Doxycycline 100mg (2x 14days), tetracycline 500mg (4x, 14 days) For late latent –Benzathine (3 doses, 1 wk interval), Doxycycline 100mg(2x,28 days) tetracycline 500mg (4x for 28 days) For Neurosyphilis-Aqueous crystalline penicillin (IV, 4 hrs,10-14d) Procaine Penicillin (IM) +Probenecid (oral) (both 1014 days)



ACQUIRED IMMUNE DEFICIENCY SYNDROME  

  

 



Causative agent: HIV (human immunodeficiency virus) which attacks att acks the T-cells (CD-4 cells) in the immune system  HIV is a retrovirus. ** AIDS is a medical condition (syndrome) HIV infection can cause AIDS to develop. However, it is possible to be infected with HIV without developing AIDS. Without treatment, the HIV infection can progress and, eventually, it will develop into AIDS. Dx: blood test S/S: fever, chills, joint pain pain,, muscle aches, sore throat, sweats (particularly at night), enlarged glands, a red rash, tiredness, weakness, unintentional weight loss Treatment: currently no cure for HIV or AIDS. Treatments can slow the course of the condition - and allow most infected people the opportunity to live a long and relatively healthy life.

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NON-GONOCOCCAL URETHRITIS - Causative agent/s: Chlamydia trachomatis Ureaplasma urealyticum Trichomonas (rare) Herpes simplex virus (rare) Adenovirus Haemophilus vaginalis Mycoplasm genitalium. - S/S: Men (urethral infection): Discharge from the penis Burning or pain when urinating (peeing) Itching, irritation, or tenderness Underwear stain Women (vaginal/urethral infection): Discharge from the vagina Burning or bleeding

pain when urinating (peeing) Abdominal pain or abnormal vaginal may be an indication that the infection has progressed to Pelvic inflammatory Disease (PID) Anal or Oral Infections - Treatments: Azithromycin Tetracycline Alternatives are: Erythromycin Recommended treatment for recurrent/persistent urethritis: Metronidazole with Erythromycin

HERPLEX SIMPLEX GENITALIA 

Causative agent: herpes simplex virus type 1 (HSV-1), herpes simplex virus type 2 (HSV-2

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S/S: herpes simplex virus type 1 (HSV-1) and herpes simplex virus

type 2 (HSV-2 herpes type 1 causes sores around the mouth and lips (sometimes called fever blisters or cold sores). HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2.   In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist.  Dx: lab tests, including DNA -- or PCR -- tests and virus cultures  Treatment: Famvir, Zovirax, and Valtrex

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GONORRHEA Gale-”Flow of seed”

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Causative agent: Neisseria gonorrhoeae Culture media-Thayer martin Steps in pathogenesis -Adherence - Invasion -Tissue damage -Dissemination (ability (ability to resist killing of antibodies) S/S- Increased vaginal discharge, Dysuria, can infect both men and women. It can c an cause infections in the genitals, rectum, and throat. very common infection, especially among young people ages 15-24 years. Dx: performed on a vaginal swab on women, or urine from both men and women Treatment: ceftriaxone given as an injection combined with azithromycin (Zithromax, Zmax) or doxycycline (Monodox, Vibramycin) oral gemifloxacin (Factive) or injectable gentamicin, combined with oral azithromycin

 

C. AIRBORNE DISEASES/ DROPLET PULONARY TUBERCULOSIS

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Causative agent: Mycobacterium tuberculosis

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primarily attacks the lungs, however, it can spread to other organs. Pulmonary TB is curable with an early diagnosis *Latent TB - aren’t contagious and have no symptoms, it is possible for latent TB to develop into active TB. Being exposed to M. tuberculosis doesn’t necessarily mean you’ll get sick. Among the 2.2 billion people who carry the germ, most have latent TB. This means the immune system protects us from getting sick.

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S/S: cough almost continuously, cough up blood, have a consistent fever, including low-grade fevers, have night sweats, have chest pains, have unexplained weight loss

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Dx: check for lung fluids, ask about PMI, CXR, sputum test, blood test, PPD(skin test)

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Treatment: Treatment of Latent TB. The antimycobacterial rifapentine (Priftin), which was previously approved for use against active pulmonary TB caused by Mycobacterium tuberculosis, in combination with isoniazid.

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TB drugs – the “first line” drugs

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Isoniazid (H/Inh), Rifampicin (R/Rif), (R/Rif), Pyrazinamide (Z/Pza), Ethambutol (E/Emb), and Streptomycin (S/Stm)

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These are the TB drugs that generally have the greatest activity against TB bacteria. These drugs are particularly used for someone with active TB disease who has not had TB drug treatment before. All the other TB drugs are generally referred to as “second line” or reserve TB drugs.

CHICKENPOX 

Causative agent:varicella-Zoster virus (VZV)

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S/S: blister-like rash, itching, tiredness, and fever. The rash appears first on the stomach, back and face and then spreads over the entire body causing between 250 and 500 itchy blisters

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Dx: not usually need any medical tests to diagnose chickenpox. if there are the key symptoms of a mild fever followed by an itchy rash, blisters and scabs. If there's any doubt about the diagnosis, chickenpox can be confirmed with laboratory tests, including blood tests or a culture of lesion samples.

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Treatment: Acyclovir (Zovirax®), an antiviral medication, is licensed for treatment of chickenpox. Varivax, a two-dose vaccine for chickenpox, is highly recommended for healthy children, adolescents, and adults who did not have the disease during childhood.

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MEASLES 

Causative agent: togavirus that is enveloped and has a singlestranded RNA genome

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German measles, also known as rubella

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serious condition in pregnant women, as it may cause congenital rubella syndrome in the fetus

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S/S: rash, swollen lymphnodes, fever

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Dx: blood test

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Treatment: rest in bed and to take acetaminophen (Tylenol), which can help relieve discomfort from fever and aches. Pregnant women may be treated with antibodies called hyperimmune globulin that can fight off the virus.

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rubella vaccine is usually given to children when they’re between 12 and 15 months old, and then again when they’re between ages 4 and 6

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Causative agent: Streptococcus pneumoniae

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It often clears up in 2 to 3 weeks.

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bacteria or viruses usually cause pneumonia.

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S/S: Cough with mucus rusty or green or tinged with blood, Fever., Fast breathing and feeling short of breath, Shaking and "teethchattering" chills, Chest pain that often feels worse when you cough or breathe in, Fast heartbeat, Feeling very tired or very weak, Nausea and vomiting, Diarrhea.

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Dx: chest X-ray and a complete blood count (CBC)

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Treatment: antibiotics

PNEUMONIA

DIPHTHERIA

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Causative agent: bacterium Corynebacterium diphtheriae

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Diphtheria causes a thick covering in the back of the throat. It can lead to difficulty breathing, heart failure, paralysis, and even death.

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S/S: Diphtheria can cause a thick gray coating to build up in the throat or nose that makes it hard to breathe bre athe and swallow.

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Dx: blood, stool, respiratory secretions or body tissues sampling

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Treatment: two treatment strategies: antibiotics. The CDC recommends erythromycin intramuscular penicillin for younger patients, diphtheria antitoxin.

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MUMPS  Causative agent: paramyxovirus  S/S: It typically starts with a few days of fever, headache, muscle aches,

tiredness, and loss of appetite, followed by swollen salivary glands. Fatigue, body aches, headache, loss of appetite, low-grade fever  Dx: Check inside the mouth to see the position of the tonsils - when infected

with mumps, a person's tonsils can get pushed to the side. Take the patient's temperature. Take a sample of blood, urine, or saliva to confirm diagnosis.  Treatment: Rest, OTC pain relievers, such as acetaminophen and ibuprofen,

to bring down your fever, Soothe swollen glands by applying ice packs, Drink plenty of fluids to avoid dehydration due to fever, Eat a soft diet of soup, yogurt, and other foods that aren’t hard to chew (chewing may be painful when your glands are swollen), Avoid acidic foods and beverages that may cause more pain in your salivary glands.

D. VECTOR BORNE DISEASE

DENGUE HEMORRHAGIC FEVER (DHF) 

Vector: Aedes aegypti mosquitoes carrying the dengue virus

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S/S: mild, moderate, or high fever, headaches, nausea, vomi vomiting, ting, pain in the muscles, bones, or joints, rashes on the skin, low platelests, bleeding under the skin, frequent vomiting, abdominal pain\

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Dx: check your blood pressu pressure, re, examine your skin, eyes, and glands, perform blood tests and coagulation studies, take a chest X-ray

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Treatment: hydration with intravenous (IV) fluids, OTC or Rx drugs to manage pain, electrolyte therapy, blood transfusions, careful monitoring of blood pressure, oxygen therapy, skilled nursing observation

MALARIA 

Vector: Anopheles mosquitoes carrying the Plasmodium parasite

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S/S: Fever, Chills, Sweats, Headaches, Nausea and vomiting, Body aches, General malaise

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Dx: demonstration of parasites in the blood, usually by microscopy, laboratory findings may include mild anemia, mild decrease in blood platelets (thrombocytopenia), elevation of bilirubin, and elevation of aminotransferases.

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Treatment:Quinine (Qualaquin) Quinine is used for malaria treatment only; it has no role in prophylaxis. It is used with a second agent in drug-

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resistant P falciparum. For drug-resistant parasites, the second agent is doxycycline, tetracycline, pyrimethamine sulfadoxine, or clindamycin.

E. ZOONOTIC DISEASES

RABIES 

Causative agent: rhabdovirus

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viral infection that mainly spreads through a bite from an infected animal, it is an RNA virus of the rhabdovirus r habdovirus family

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There are two types of rabies. 1. Furious, or encephalitic rabies: This occurs in 80 percent of human cases. The person is more likely to experience hyperactivity and hydrophobia. 2. Paralytic or "dumb" rabies: paralysis is a dominant symptom Rabies progresses in five distinct stages:  Incubation - 3 to 12 weeks, but it can take as little as 5 days or more than 2 years anxiety, sore Prodrome  - a fever of 38o, headache, anxiety, throat and a cough, n/v, discomfort may occur at the site of the bite Acute neurologic period  - confusion and aggression, partial paralysis, involuntary muscle twitching, and rigid neck muscles, convulsions, hyperventilation and difficulty breathing, hypersalivation or producing a lot of saliva, and possibly frothing at the mouth, fear of water, or hydrophobia, due to difficulty swallowing, hallucinations, nightmares, and insomnia, priapism, or permanent erection, in males, photophobia, or a fear of light (2-10 days)   Coma  - If the person enters a coma, death will occur within a matter of hours, unless they are attached to a

ventilator. Rarely, a person may recover at this late stage. Death  Dx: Lab tests may show antibodies, but these may not appear until later in the development of the disease. The virus may be isolated from saliva or through a skin biopsy. However, by the time a diagnosis is confirmed, it may be too late to take action. For this reason, the patient will normally start a course of prophylactic treatment at once, without waiting for a confirmed diagnosis. 

Treatment: immediately wash any bites and scratches for 15 minutes with soapy water, povidone iodine, or detergent. Strategies include: A fast-acting dose of rabies immune globulin: Delivered as soon as possible, close to the bite wound, this can prevent the virus from infecting the individual. A series of rabies vaccines: These will be injected into the arm over the next 2 to 4 weeks. These will train the body to fight the virus whenever it finds it. •

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ANTHRAX 

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Causative agent: Bacillus anthracis that lives in soil

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can get anthrax by touching farm animals or game animals infected with anthrax, can also become infected by inhaling it, by eating undercooked meat from animals infected with anthrax.  S/S: Cutaneous - a small, raised sore that’s itchy. It usually looks like an insect bite. The sore quickly develops into a blister. It then becomes a skin ulcer with a black center. This doesn’t usually cause pain. The symptoms typically develop within one to five days after exposure. Ingestion – nausea, loss of of appetite, fever, swelling in the neck, bloody diarrhea, severe abdominal pain Inhalation - cold symptoms, a sore throat, a fever, achy muscles, a cough, shortness of breath, fatigue, shaking, chills, vomiting  Dx: blood tests, skin tests, stool samples, a spinal tap, chest X-rays, a CT scan, endoscopy  Treatment: the standard treatment for anthrax is a 60-day course of an antibiotic, such as ciprofloxacin (Cipro) or doxycycline (Monodox, Vibramycin) 

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FOOT AND MOUTH DISEASE

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Aka “Aphthous disease” Viral disease from Cloven-footed disease Causative agent: Aphthovirus, Picornaviridae

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Enterovirus family, most commonly the coxsackievirus A16, Aphthovirus family Picornaviridae from cloven-hoofed animals infection can affect people of all ages, but it usually occurs in children under age 5. It is generally a mild condition that goes away on its own within several days. These viruses can spread from person-to-person through direct contact with unwashed hands or surfaces contaminated with feces. It can also be transmitted through contact with an infected person’s saliva, stool, or respiratory secretions. S/S: fever, a poor poor appetite, a sore throat, a headache, irritability, painful, red blisters in the mouth, a red rash on the hands and the soles of the feet Dx: performing a physical exam, check the mouth and body for the appearance of blisters and rashes. Treatment:

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prescription or over-the-counter topical ointments to soothe blisters and rashes pain medication, such as acetaminophen or ibuprofen, to relieve headaches medicated syrups or lozenges to ease painful sore throats

BIRDS FLU 

Causative agent: deadly strain of bird flu, H5N1, pathogenic avian influenza (HPAI) virus  Acquired through H5N1 from cleaning or plucking infected birds, via inhalation of aerosolized materials in live bird markets, after swimming or bathing in water contaminated with the droppings of infected birds, handle fighting cocks  S/S: cough, diarrhea, respiratory difficulties, fever (over 100.4°F or 38°C), headache, muscle aches, malaise, runny nose, sore throat  Dx: auscultation, white blood cell differential, nasopharyngeal culture, chest X-ray

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Treatment: antiviral medication such as oseltamivir (Tamiflu) or zanamivir (Relenza), antiviral medications, amantadine and rimantadine (Flumadine)

MAD COW DISEASE    

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AKA bovine spongiform encephalopathy, or BSE Causative agent: prion, or an abnormal protein slowly destroys the brain and spinal cord (central nervous system) in cattle People cannot get mad cow disease. But in rare cases they may get a human form of mad cow disease called variant Creutzfeldt-Jakob disease (vCJD), which is fatal. It can c an happen by eating nerve tissue (the brain and spinal cord) of cattle that were infected with mad cow disease. Over time, vCJD destroys the brain and spinal cord. S/S: Tingling, burning, or prickling in the face, hands, feet, and legs, Dementia, Psychotic behavior, Problems moving parts of the body. As the disease gets worse, a person is no longer able to walk, Coma. Treatment: There is no cure for vCJD. Treatment includes managing the symptoms that occur as the disease gets worse.

F. OTHERS LEPROSY – Hansen’s disease     

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Causative agent: Mycobacterium leprae affects the nerves of the extremities, the lining of the nose, and the upper respiratory tract spreads through contact with the mucus of an infected person Two types of leprosy: tuberculoid and lepromatous S/S: Symptoms may not appear for as long as 20 years, muscle weakness, numbness in the hands, arms, feet, and legs, skin lesions Treatment: WHO developed a multidrug, it’s available free of charge worldwide. Additionally, several antibiotics treat leprosy by killing the bacteria that causes it. These antibiotics include: Dapsone, rifampin, Clofazamine, minocycline, Ofloxacin •

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REFERENCES:   Books:

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Ciabal, Laura Evelyn P. Introduction to Public Health Issues. 1st ed. Manila Educational Publishing House, 1999. 

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