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MALARIA, RABIES & DENGUE CONTROL PROGRAM

malaria
Malaria, the parasite-caused disease is the 9th leading cause of morbidity in the country. As of this year, there are 58 out of 81 provinces that are malaria endemic and 14 million people are at risk. In response to this health problem, the Department of Health (DOH) coordinated with its partner organizations and agencies to employ key interventions with regard to malaria control.

Malaria
It is a parasite-caused disease that is usually acquired through the bite of a female Anopheles mosquito.

It can be transmitted in the following ways: (1) Blood transfusion from an infected individual; (2) Sharing of IV needles; and (3) Transplacenta (transfer of malaria parasites from an infected mother to its unborn child).

Early Diagnosis and Prompt Treatment Early diagnosis is the identification of a patient with malaria as soon as he/she is seen, through clinical and/or microscopic method.

Clinical method is based on the sign


and symptom of the patient and the history of his/her having visited a malaria-endemic area

Early Diagnosis and Prompt Treatment Microscopic Method is based on the examination of the blood smear of the patient through a microscope. This shall be done by medical technologist or microscopist at the Main Health Center where there are microscopy facilities during regular consultations.

Chemoprophylaxis
Only Chloroquine drug should be given. It must be taken at weekly intervals, starting from 1-2 weeks before entering the endemic area. In pregnant women, in is given throughout the duration of pregnancy.

Sustainable Preventive and Vector Control Measures

a) Insecticide- treatment of Mosquito Net b) House Spraying c) On Scream Seeding d) On Stream Clearing

Other Preventive Measures


Wearing of clothing that covers arms and legs in the evening Avoiding outdoor night activities, particularly during the vectors peak biting hours from 9PM to 3AM. Using mosquito repellents such as mosquito coils, soap lotion or other personal protection measures

Planting of Neem tree or other herbal plants which are (potential) mosquito repellents Zooprophylaxis- the typing of domestic animals like the carabao, cow, etc., near human dwellings to deviate mosquito bites from man to these animals.

Malaria Control Program


Vision: Malaria-free Philippines Mission: To empower health workers, the population at risk and all others concerned to eliminate malaria in the country. Goal: To significantly reduce malaria burden so that it will no longer affect the socio-economic development of individuals and families in endemic areas.

Objectives:
Based on the 2011-2016 Malaria Program Medium Term Plan, it aims to: Ensure universal access to reliable diagnosis, highly effective, and appropriate treatment and preventive measures; Capacitate local government units (LGUs) to own, manage, and sustain the Malaria Program in their respective localities;

Sustain financing of anti-malaria efforts at all levels of operation; and Ensure a functioning quality assurance system for malaria operations.

Beneficiaries:
The Malaria Control Program targets the meager-resourced municipalities in endemic provinces, rural poor residing near breeding areas, farmers relying on forest products, indigenous people with limited access to quality health care services, communities affected by armed conflicts, as well as pregnant women and children aged five years old and below

Program Strategies:
The DOH, in coordination with its key partners and the LGUs, implements the following interventions: 1. Early diagnosis and prompt treatment Diagnostic Centers were established and strengthened to achieve this strategy. The utilization of these diagnostic centers is promoted to sustain its functionality.

2. Vector control The use of insecticide-treated mosquito nets, complemented with indoor residual spraying, prevents malaria transmission. 3. Enhancement of local capacity LGUs are capacitated to manage and implement community-based malaria control through social mobilization.

Program Accomplishments:
For the development of health policies, the Malaria Medium Term Plan (20112016) is already in its final draft while the Malaria Monitoring and Evaluation Framework and Plan are being drafted. The Malaria Program is being monitored in six provinces as the Philippine Malaria Information System is being reviewed and enhanced.

In strengthening the capabilities of the LGUs, trainings are conducted. These include: a) Series of Basic and Advance Malaria Microscopy Training; b) Malaria Program Management Orientation and Training for the rural health unit (RHU) staff; and c) Data Utilization Training

There is the Clinical Management for Uncomplicated and Severe Malaria and the Malaria Epidemic Management. Health services are leveraged through the provision of anti-malaria commodities.

Partner Organization/Agencies:
The following organizations/agencies take part in achieving the goals of Malaria Control Program: Pilipinas Shell Foundation, Inc, (PSFI) Roll Back Malaria (RBM); World Health Organization (WHO) Act Malaria Foundation, Inc Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI)

Research Institute of Tropical Medicine (RITM) University of the Philippines-College of Public Health (UP-CPH) Philippine Malaria Network Australian Agency for International Development (AusAID) Asia Pacific Malaria Elimination Network (APMEN) Malaria Elimination Group (MEG) Local Government Units (LGUs)

Four-o'clock Habit (4 oclock habit)


Is an initiative of the Philippine government that requests residents to practice the cleaning of their surroundings and draining water containers to prevent the spread of mosquitoes, in support of the Dengue Control Program and the Malaria Control Program. This is also known as operation

kaya

kulub (upside down).

World Malaria Day Celebration April 25, 2008, a day of unified commemoration of the global effort to provide effective control of malaria around the world. The theme: Malaria a disease without borders.

April 25 is a day of determination and optimism as the global community now has enough evidence that the fight against malaria can be won if partners come together and harmonize the efforts for an efficient collaboration of malaria control strategies to fight this dreaded disease.

rabies
The Philippines has one of the highest prevalence rates of rabies in the whole world. Approximately 300 to 600 Filipinos die of rabies every year.

Rabies
Is an acute viral encephalomyelitis caused by the rabies virus, a rhabdovirus of the genus lyssavirus.

Two Kinds of Rabies: 1. Urban or Canine Rabies 2. Sylvatic Rabies

Mode of transmission

Usually by bites of a rabid animal whose saliva has the virus. Virus may also introduce into a scratch or in a fresh breaks in the skin (very rare). Man to man.

Incubation Period

2 to 8 weeks. It can long as a year or several years depending on: The severity of the wounds, Site of the wound as distance from the brain, Amount of virus introduced and Protection provided by clothing.

Period of Communicability

In dogs and cats, for 3 to 10 days before onset of the clinical signs (rarely over 3 days) and throughout the duration of the disease. Susceptibility and Resistance All warm- blooded mammals are susceptible.

Signs and Symptoms


Sense of apprehension Headache Fever Sensory change near site of animal bite Paralysis Delirium and convulsions.

Management/Prevention The wound must be immediately and thoroughly washed with soap and water. Antiseptics such as povidone iodine or alcohol may be applied. Antibiotics and anti-tetanus immunization.

Post- exposure treatment is


given to persons who are exposed to rabies. It consists of local wound treatment:

1. Active immunization (vaccination) Aims to induce the body to develop antibodies against rabies up to 3 years.

2. Passive immunization (administration of rabies immunoglobulin) the process of giving an antibody to persons in order to provide immediate protection against rabies Should be administered within the first seven days of active immunization. The effect of the immunoglobulin is only short term.

Management/Prevention
Then consult a veterinarian or trained personnel to observe your pet for 14 days for signs of rabies. Be a Responsible Pet Owner Have pet immunized at 3 months of age and every year thereafter Never allow pets to roam in the streets Take care of your pet; bathe, feed them regularly with adequate food, provide them with clean sleeping quarters Your pet is your responsibility.

National Rabies Prevention and Control Program

Goal: Human rabies is eliminated in the Philippines and the country is declared rabies-free General Objectives To reduce the incidence of Human Rabies from 7 per million to 1 million per population by 2010 and eliminate human rabies by 2015. To reduce the incidence of canine rabies from 70 per 100,000 to 7 per 100,000 dog by 2010, and eliminate canine rabies by 2015.

The program is jointly implemented by: Department of Agriculture Department of Health Department of Education Culture and Sports Department of Interior and Local Government and Non-Government Organizations.

Program Strategies:
To attain its goal, the program employs the following strategies: 1. Provision of Post Exposure Prophylaxis (PEP) to all Animal Bite Treatment Centers (ABTCs) 2. Provision of Pre-Exposure Prophylaxis (PrEP) to high risk individuals and school children in high incidence zones

3. Health Education Public awareness will be strengthened through the Information, Education, and Communication (IEC) campaign. The rabies program shall be integrated into the elementary curriculum and the Responsible Pet Ownership (RPO) shall be promoted.

In coordination with the DOA, the DOH shall intensify the promotion of dog vaccination, dog population control, as well as the control of stray animals. In accordance with RA 9482 or The Rabies Act of 2007, rabies control ordinances shall be strictly implemented. In the same manner, the public shall be informed on the proper management of animal bites and/or rabies exposures.

4. Advocacy The rabies awareness and advocacy campaign is a year-round activity highlighted on two occasions March as the Rabies Awareness Month and September 28 as the World Rabies Day. 5. Training/Capability Building Medical doctors and Registered Nurses are to be trained on the guidelines on managing a victim.

6. DOH-DA joint evaluation and declaration of Rabies-free islands 7. Dog Immunization Pre- Vaccination Activities Identification of priority areas Procurement/Distribution of dogs vaccines Social Preparation Conduct of dog vaccination Post-Immunization Evaluation

dengue hemorrhagic fever


Philippine Hemorrhagic Fever was first reported in 1953. In 1958, Hemorrhagic Fever became a notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.

Etiologic Agent: Dengue Virus Types 1, 2, 3 & 4 and Chikungunya virus. Source of Infection Immediate source is a vector mosquito, the Aedes Aegypti or the common household mosquito. The infected person.

Dengue Hemorrhagic Fever

Description is an acute febrile infection of sudden onset with clinical manifestation of 3 stages: First 4 days: febrile or invasive stage starts abruptly. High fever, abdominal pain & headache; later flushing maybe accompanied by vomiting, conjunctival infection and epitaxis.

4th -7th day: toxic or hemorrhagic stage. Lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GI tract (hematamesis or melena). Tourniquet test which maybe positive on 3rd day may become negative due to low or vasomotor collapse. 7th 10th day: convalescent or recovery stage. Generalized flushing with intervening areas of blanching appetite regained and BP already stable.

Classification
Severe, frank type- with flushing, sudden high fever, severe hemorrhage, follows by sudden drop of temperature, shock and terminating in recovery or death. Moderate- with high fever, less hemorrhage, no shock. Mild- with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course on investigation of typical cases.

Mode of Transmission: mosquito bite (Aedes Aegypti) Incubation Period: Uncertain. Probably 6 days to one week

Susceptibility, Resistance and Occurrence

All persons are susceptible. Sporadic throughout the year. Epidemic usually occurs during the rainy seasons June November. Peak months are September and October. Occurs whenever vector mosquito exist.

Diagnostic Test
Tourniquet Test (Rumpel Leads Test) Pump up a blood pressure cuff on one of the arm to more than venous pressure (70 mm Hg) Keep it for 5 minutes and then ease the pressure. Examine the extremity of the pressure for petechiae. If there are more than 20 petechiae, the test is positive.

Management
Supportive Symptomatic e.g. For fever, give paracetamol for muscle pains. For headache, give analgesic. Dont give ASPIRIN Rapid replacement of body fluids Intensive monitoring/ follow-up Give ORESOL to replace fluid as in moderate dehydration at 75mL/kg in 4-6 hours or up to 2-3L in adults Continue ORS intake until patients condition improves.

Methods of Prevention and Control The infected individual, contracts and environment: Recognition of the disease Isolation of patient Epidemiological investigation Case finding and reporting Health education

Control Measures:
Eliminate vector by:
Changing water and scrubbing sides of lower vases once a week. Destroy breeding places by cleaning surroundings, proper disposal of rubber tires, empty bottles and cans. Keep water containers covered.

Avoid too many hanging clothes inside the house. Residual spraying with insecticides.

Strategies in Preventing and Controlling Dengue Hemorrhagic Fever

1. Seek and destroy 2. Say no to indiscriminate fogging (say yes to fogging if there is an outbreak) 3. Self-protection 4. Seek early consultation or medication

Public Health Nursing Responsibility Report immediately to the Municipal Health Office any known case outbreak. Refer immediately to the nearest hospital Conduct a strong health education program directed towards environmental sanitation. Assist in diagnosis of suspect based on the signs and symptoms. Conduct epidemiologic investigations.

Nursing Care
Hemorrhage Keep patient at rest. For nose bleeding, maintain an elevated position of trunk and promote vasoconstriction in nasal mucosa membrane through an ice bag over the forehead. For melena, ice bag over the abdomen. Avoid unnecessary movement

Nursing Care
If transfusion is given, support the patient during the therapy Observe signs of shock. Shock Dorsal recumbent position facilitates circulation Diet low fat, low fiber, non-irritating, noncarbonated.

Batawang, Jefferson Tolano, Marie Antonette Jalon, Dahrren Grace

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