Malaria, Rabies & DHF

7/31/2019 Malaria, Rabies & DHF

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malariaMalaria, the parasite-caused disease is the9th leading cause of morbidity in the country.As of this year, there are 58 out of 81

provinces that are malaria endemic and 14million people are at risk. In response to thishealth problem, the Department of Health(DOH) coordinated with its partnerorganizations and agencies to employ keyinterventions with regard to malaria control.


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Malaria

It is a parasite-caused disease that isusually acquired through the bite of afemale Anopheles mosquito.


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It can be transmitted in the

following ways:(1) Blood transfusion froman infected individual;

(2) Sharing of IV needles;and

(3) Transplacenta (transferof malaria parasites froman infected mother to its

unborn child).


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Early Diagnosis and Prompt Treatment

Early diagnosis is the identification of a

patient with malaria as soon as he/she isseen, through clinical and/or microscopic

method.

Clinical method is based on the signand symptom of the patient and the

history of his/her having visited amalaria-endemic area


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Early Diagnosis and Prompt Treatment

Microscopic Method is based on the

examination of the blood smear of thepatient through a microscope.

This shall be done by medicaltechnologist or microscopist at the MainHealth Center where there are

microscopy facilities during regularconsultations.


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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 giventhroughout the duration of pregnancy.


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Sustainable Preventive and Vector Control

Measures

a) Insecticide- treatment of MosquitoNet

b) House Sprayingc) On Scream Seeding

d) On Stream Clearing


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Other Preventive Measures

Wearing of clothing that covers arms

and legs in the evening

Avoiding outdoor night activities,

particularly during the vectors peakbiting hours from 9PM to 3AM.

Using mosquito repellents such as

mosquito coils, soap lotion or otherpersonal protection measures


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Planting of Neem tree or other herbal

plants which are (potential) mosquitorepellents

Zooprophylaxis- the typing of domesticanimals like the carabao, cow, etc., nearhuman dwellings to deviate mosquito

bites from man to these animals.


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Malaria Control Program

Vision:Malaria-free Philippines

Mission: To empower health workers,the population at risk and all others

concerned to eliminate malaria in thecountry.

Goal:To significantly reduce malaria

burden so that it will no longer affect thesocio-economic development ofindividuals and families in endemic

areas.


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Objectives:

Based on the 2011-2016 Malaria

Program Medium Term Plan, it aims to:

Ensure universal access to reliable

diagnosis, highly effective, andappropriate treatment and preventivemeasures;

Capacitate local government units(LGUs) to own, manage, and sustainthe Malaria Program in their respective

localities;


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Sustain financing of anti-malaria efforts

at all levels of operation; and

Ensure a functioning quality assurance

system for malaria operations.


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Beneficiaries:

The Malaria Control Program targets the

meager-resourced municipalities inendemic provinces, rural poor residing

near breeding areas, farmers relying onforest products, indigenous people withlimited access to quality health care

services, communities affected byarmed conflicts, as well as pregnantwomen and children aged five years old

and below


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Program Strategies:

The DOH, in coordination with its key

partners and the LGUs, implements thefollowing interventions:

1. Early diagnosis and prompt treatmentDiagnostic Centers were establishedand strengthened to achieve this

strategy.The utilization of these diagnosticcenters is promoted to sustain its

functionality.


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2. Vector control

The use of insecticide-treated mosquitonets, complemented with indoor residual

spraying, prevents malaria transmission.3. Enhancement of local capacity

LGUs are capacitated to manage and

implement community-based malariacontrol through social mobilization.


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Program Accomplishments:

For the development of health policies,

the Malaria Medium Term Plan (2011-2016) is already in its final draft while theMalaria Monitoring and EvaluationFramework and Plan are being drafted.

The Malaria Program is being monitored

in six provinces as the Philippine MalariaInformation System is being reviewedand enhanced.


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In strengthening the capabilities of the

LGUs, trainings are conducted. Theseinclude:

a) Series of Basic and Advance MalariaMicroscopy Training;

b) Malaria Program Management

Orientation and Training for the ruralhealth unit (RHU) staff; and

c) Data Utilization Training


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There is the Clinical Management for

Uncomplicated and Severe Malaria andthe Malaria Epidemic Management.

Health services are leveraged throughthe provision of anti-malariacommodities.


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Partner Organization/Agencies:

The following organizations/agencies take part

in achieving the goals of Malaria ControlProgram:

Pilipinas Shell Foundation, Inc, (PSFI)

Roll Back Malaria (RBM); World HealthOrganization (WHO)

Act Malaria Foundation, Inc

Field Epidemiology Training Program AlumniFoundation, Inc. (FETPAFI)


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Research Institute of Tropical Medicine (RITM)

University of the Philippines-College of PublicHealth (UP-CPH)

Philippine Malaria Network

Australian Agency for InternationalDevelopment (AusAID)

Asia Pacific Malaria Elimination Network

(APMEN)

Malaria Elimination Group (MEG)

Local Government Units (LGUs)


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Four-o'clock Habit (4 oclock habit)

Is an initiative of the Philippine government

that requests residents to practice thecleaning of their surroundings and drainingwater containers to prevent the spread of

mosquitoes, in support of the DengueControl Program and the Malaria ControlProgram.

This is also known as operation kayakulub (upside down).


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World Malaria Day Celebration

April 25, 2008, a day of unified

commemoration of the global effort toprovide effective control of malaria

around the world.

The theme: Malaria a diseasewithout borders.


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April 25 is a day of determination and

optimism as the global community nowhas enough evidence that the fight

against malaria can be won if partners

come together and harmonize the effortsfor an efficient collaboration of malaria

control strategies to fight this dreadeddisease.


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rabiesThe Philippines has one of the highestprevalence rates of rabies in the wholeworld. Approximately 300 to 600

Filipinos die of rabies every year.


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Rabies

Is an acute viral encephalomyelitis

caused by the rabies virus, arhabdovirus of the genus lyssavirus.

Two Kinds of Rabies:

1. Urban or Canine Rabies

2. Sylvatic Rabies


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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.


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Incubation Period

2 to 8 weeks.

It can long as a year or several yearsdepending on:

The severity of the wounds, Site of the wound as distance from the

brain,

Amount of virus introduced and

Protection provided by clothing.


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Period of Communicability

In dogs and cats, for 3 to 10 days before

onset of the clinical signs (rarely over 3days) and throughout the duration of the

disease.

Susceptibility and Resistance

All warm- blooded mammals aresusceptible.


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Signs and Symptoms

Sense of apprehension

Headache

Fever

Sensory change near site of animal biteParalysis

Delirium and convulsions.


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Management/Prevention

The wound must be immediately

and thoroughly washed with soapand water.

Antiseptics such as povidoneiodine or alcohol may be applied.

Antibiotics and anti-tetanus

immunization.


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Post- exposure treatmentisgiven to persons who are exposed torabies.

It consists of local wound treatment:1. Active immunization(vaccination)

Aims to induce the body todevelop antibodies against rabies

up to 3 years.


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2. Passive immunization

(administration of rabiesimmunoglobulin)

the process of giving an antibody to

persons in order to provide immediateprotection against rabies

Should be administered within the firstseven days of active immunization.

The effect of the immunoglobulin is only

short term.


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Management/Prevention

Then consult a veterinarian or trained personnel

to observe your pet for 14 days for signs ofrabies.

Be a Responsible Pet Owner

Have pet immunized at 3 months of age andevery year thereafter

Never allow pets to roam in the streets

Take care of your pet; bathe, feed themregularly with adequate food, provide themwith clean sleeping quarters

Your pet is your responsibility.


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National Rabies Prevention and Control Program

Goal: Human rabies is eliminated in the

Philippines and the country is declaredrabies-free

General Objectives

To reduce the incidence of Human Rabiesfrom 7 per million to 1 million per populationby 2010 and eliminate human rabies by 2015.

To reduce the incidence of canine rabies from70 per 100,000 to 7 per 100,000 dog by 2010,and eliminate canine rabies by 2015.


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The program is jointly implemented by:

Department of Agriculture

Department of Health

Department of EducationCulture and Sports

Department of Interior and LocalGovernment and Non-GovernmentOrganizations.


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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 andschool children in high incidence zones


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3. Health Education

Public awareness will be strengthenedthrough the Information, Education, and

Communication (IEC) campaign.

The rabies program shall be integratedinto the elementary curriculum and the

Responsible Pet Ownership (RPO) shallbe promoted.


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In coordination with the DOA, the DOH shall

intensify the promotion of dog vaccination,dog population control, as well as the controlof stray animals.

In accordance with RA 9482 or The RabiesAct of 2007, rabies control ordinances shallbe strictly implemented. In the same manner,

the public shall be informed on the propermanagement of animal bites and/or rabiesexposures.


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4. Advocacy

The rabies awareness and advocacycampaign is a year-round activity highlightedon two occasions March as the Rabies

Awareness Month and September 28 as theWorld Rabies Day.

5. Training/Capability Building

Medical doctors and Registered Nurses are tobe trained on the guidelines on managing avictim.


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6. DOH-DA joint evaluation and declaration of

Rabies-free islands7. Dog Immunization

Pre- Vaccination Activities

Identification of priority areas

Procurement/Distribution of dogs vaccines

Social Preparation

Conduct of dog vaccination

Post-Immunization Evaluation

d


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dengue

hemorrhagic feverPhilippine Hemorrhagic Fever was first

reported in 1953. In 1958, HemorrhagicFever became a notifiable disease in thecountry and was later reclassified asDengue Hemorrhagic Fever.


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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 commonhousehold mosquito.

The infected person.


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Dengue Hemorrhagic Fever

Description

is an acute febrile infection of suddenonset with clinical manifestation of 3

stages:

First 4 days: febrile or invasive stagestarts abruptly. High fever, abdominal

pain & headache; later flushing maybeaccompanied by vomiting, conjunctivalinfection and epitaxis.


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4th -7th day: toxic or hemorrhagic stage.

Lowering of temperature, severe abdominalpain, vomiting and frequent bleeding from GItract (hematamesis or melena).

Tourniquet test which maybe positive on 3rdday may become negative due to low orvasomotor collapse.

7th

10th

day: convalescent or recovery stage.Generalized flushing with intervening areas ofblanching appetite regained and BP already

stable.


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Classification

Severe, frank type- with flushing, sudden high fever,severe hemorrhage, follows by sudden drop oftemperature, shock and terminating in recovery ordeath.

Moderate- with high fever, less hemorrhage, noshock.

Mild- with slight fever, with or without petichial

hemorrhage but epidemiologically related to typicalcases usually discovered in the course oninvestigation of typical cases.


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Mode of Transmission:mosquito bite

(Aedes Aegypti)

Incubation Period:Uncertain. Probably 6days to one week


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Susceptibility, Resistance and Occurrence

All persons are susceptible.

Sporadic throughout the year. Epidemic

usually occurs during the rainy seasons

June November. Peak months areSeptember and October.

Occurs whenever vector mosquito exist.

Di ti T t


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Diagnostic Test

Tourniquet Test (Rumpel Leads Test)

Pump up a blood pressure cuff on one of the arm tomore 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 ispositive.

M t


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Management

Supportive

Symptomatice.g. For fever, give paracetamol for muscle pains.

For headache, give analgesic. Dont give ASPIRIN

Rapid replacement of body fluidsIntensive monitoring/ follow-up

Give ORESOL to replace fluid as in moderatedehydration at 75mL/kg in 4-6 hours or up to 2-3L inadults

Continue ORS intake until patients condition

improves.

M th d f P ti d C t l


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Methods of Prevention and Control

The infected individual, contracts and

environment:

Recognition of the disease

Isolation of patientEpidemiological investigation

Case finding and reporting

Health education

C t l M


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Control Measures:

Eliminate vector by:

Changing water and scrubbing sides of lowervases 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 insidethe house.

Residual spraying with insecticides.

Strategies in Preventing and Controlling


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g g g

Dengue Hemorrhagic Fever

1. Seek and destroy2. Say no to indiscriminate fogging (say

yes to fogging if there is an outbreak)

3. Self-protection

4. Seek early consultation or medication

P bli H lth N si R s sibilit


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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 educationprogram directed towards environmental

sanitation.Assist in diagnosis of suspect based onthe signs and symptoms.

Conduct e idemiolo ic investi ations.

N rsing Care


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Nursing Care

Hemorrhage

Keep patient at rest.

For nose bleeding, maintain an elevatedposition of trunk and promote

vasoconstriction in nasal mucosa membranethrough an ice bag over the forehead.

For melena, ice bag over the abdomen.

Avoid unnecessary movement

Nursing Care


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Nursing Care

If transfusion is given, support the

patient during the therapyObserve signs of shock.

ShockDorsal recumbent position facilitates

circulation

Diet low fat, low fiber, non-irritating, non-

carbonated.


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Batawang, Jefferson

Tolano, Marie Antonette

Jalon, Dahrren Grace

Malaria, Rabies & DHF

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