Expanded Program on Immunization

Goal of EPI Morbidity and mortality reduction of immunizable disease

Types and Schedule of Vaccines

Side effects: BCG 2-3 weeks abscess will ulcerate then heals leaving a scar (approx. 12 weeks from vaccination) Kochs Phenomenon -inflammation on site after 2-4 days Deep Abscess at site -incision and drainage; powdered INH Indolent Ulceration -(ulcer after 12 weeks) INH powder Glandular Enlargement -treat as abscess Side Effects: DPT Fever for a day Soreness at site within 3-4 days Abscess after a week or more incision and drainage Convulsions

Side effects: Measles Fever after 5-7 days usually 1-3 days Mild rashes

Cold Chain Vaccines destroyed by heat BCG, DPT, OPV, TT, MEASLES, HEP B Most sensitive to heat OPV, MEASLES (-15 to -25oC, freezer) Destroyed by freezing DPT, TT, HEP B (2-8OC, body of ref)

Nutrition
Goal of Nutrition Program Reduce morbidity and mortality related to nutritional deficiencies: 1. protein-energy malnutrition 2. Vitamin A deficiency 3. Iron-deficiency anemia 4. Iodine-deficiency disorder Marasmus Deficiency in protein and energy that can occur even if the child is less than one year old. Signs: Very thin (no fat, muscle wasting) Very poor weight gain Old mans face Enlarged abdomen Prominent ribs Loose and wrinkled skin Anxious, always hungry

Kwashiorkor Disease of the older child when the next baby is born usually when the child one to three years old Signs: Very thin, fails to grow Light colored weak hair Moon-shaped unhappy face Muscle wasting Edematous extremities

Skin sores and peeling Apathetic, does not want to eat

Treatment: Food is the only cure! Increase protein and energy concentration of food prepared Increase frequency of feeding Increase variety of food offered

Family planning Fertility Regulation

Goal of Family Planning Program Maternal and child health through Proper timing of pregnancy Proper interval of pregnancy Proper number of pregnancy Major Program Policies Improvement of family welfare with main focus on womens health, safe motherhood and child survival Freedom of choice Promotion of family solidarity and responsible parenthood Family Planning Methods 1. Spacing methods Hormones (pills, injectibles) Intrauterine Device Condoms (male, female), cervical cap; diaphragm; sponge; spermicides Natural (Cervical Mucus, Basal Body Temp., Sympto-thermal, Lactational Amenorrhea Method) 2. Permanent Methods Tubal Ligation Vasectomy

Control of Diarrheal Diseases Control of Dehydration

Classification of Dehydration Mild Sunken fontanels and eyeballs dry lips, child is irritable but conscious (-) skin fold test Moderate Lethargic, normal blood pressure (+) skin fold test Severe Comatose, almost (-) unrine output Dry tear ducts (++) skin fold test

Treatment of Diarrhea Mild Dehydration: - Give ORS for 4 6 hours treatment - Reassess after 4 6 hours Moderate and Severe Dehydration:

Control of Acute Respiratory Infection = (CARI)

Goal of CARI Morbidity and mortality reduction of pneumonia Identify and treat pneumonia

Assessment History Age Cough and duration Able to drink or has stop feeding Fever and duration Convulsions

Assessment Physical Examination Respiratory rate Fast Breathing: > less than 2 months > 2 months year > 1 5 years Chest in-drawing Stridor during inhalation Wheeze during exhalation Level of consciousness Fever Malnutrition

: 60 min : 50 min : 40 min

Classification of Illness: For 2 months to 5 years 1. Very severe disease - not able to drink - convulsions - sleepy - stridor - severe malnutrition

2. Pneumonia a. Severe pneumonia - chest in-drawing - nasal flaring, grunting - cyanosis Treatment: First dose of anti-biotic/anti-malarial Refer urgently to hospital Treat fever and wheeze b. Not severe pneumonia - no chest in-drawing - fast breathing Treatment: Home Care Antibiotic Follow-up visit after 2 days After 2 days: Same: change antibiotic Worse: refer Improving: consume antibiotic

3. No pneumonia - no chest in-drawing - no fast breathing Treatment: If chronic, refer Treat ear discharge and sore throat Provide home care Assess for other problems

Classification of Illness: For infants less than 2 months

1. Very severe disease - stopped feeding well - convulsions - abnormally sleepy - stridor - wheeze - severe malnutrition - fever (38C) or hypothermia (below 35.5C)

Treatment: 1. Provide first dose of antibiotic 2. Keep warm 3. Refer urgently to hospital

2. Pneumonia - severe chest in-drawing or fast-breathing 3. No pneumonia