Ang Chikungunya ay isang sakit na dulot ng virus (Alphavirus) na nakukuha ng tao mula sa kagat ng isang lamok gaya ng Aedes

aegypti at Aedes albopictus. SINTOMAS Ang mga sintomas ay nararanasan sa pagitan ng ika-4 at ikawa-7 araw matapos makagat ang pasyente ng lamok. Mataas na lagnat (40C/ 104F) Masakit na kasukasuan (tuhod, balakang, atibapa) Pamamaga ng mga kasukasuan Rashes Pananakit ng ulo Pananakit ng muscle Pagkahilo Labis na pagkapagod

Ang mga sintomas ng chikungunya ay nagtatagal hanggang 2-3 araw. Ang virus ay nanatili sa katawan ng isang tao sa loob ng 5-7 araw at ang lamok na nakakagat sa taong nagdadala ng virus ay maari ring mahawa. Ang chikungunya ay naihahalintulad sa dengue lalo na kung napapanahon ang sakit na dengue. Ang chikungunya ay nakikita sa pamamagitan ng eksaminasyon sa dugo. Ang paggaling sa nasabing sakit ay nangangailangan ng panghabang buhay na imunisasyon.

Ang chikungunya ay isang sakit na nagmumula sa kagat ng isang lamok at naapektuhan ang karamihan sa mga matatanda, ito ay hindi ganun kalala kung ikukumpara sa dengue.

Ang chikungunya ay nagdududlot ng lagnat at matinding pananakit ng kasukasuan. Ang iba pang mga sintomas ay pananakit ng kalamnan, sakit ng ulo, pakiramdam na nasususka, pagkapagod at rashes.

Walang partikular na gamot sa sakit na ito, ang pinakapinagbibigyan ng pansin ay ang pagbibigay lunas sa mga sintomas na naidudulot ng sakit na ito.

Ang pananakit ng kasukasuan ay napakasakit subalit nawawala rin sa loob ng ilang araw o lingo. Karamihan sa mga kaso ng chikungunya ay nakakarecover ng buo subalit may ilan din na ang pagsakit ng kasukasuan ay umaabot ng ilang buwan o ilang taon. May mga kaso rin na naitala tungkol sa pagkakaroon ng problema sa mata, sa pag iisip at maging sa puso, pati na rin ang problema sa tiyan. Ang pinagkaiba ng dengue at chikungunya ay:

Ang dengue ay dulot ng aedes aegypti samantalang ang chikungunya ay dulot ng aedes aegypti at aedes albopictus Ang chikungunya ay walang masyadong naitalang pagkamatay dulot nito samantalang ang dengue ay may naitalang pagkamatay.
Ang sintomas ng dengue ay lumalabas sa pagitan ng 3-4 na araw at tumatagal ng isang lingo samantalang ang chikungunya ay tumatagal ng lingo bago pa Makita ang mga sintomas. Sa dengue ay may itinatalang pagdurugo samantalang sa chikungunya ay walang naitatalang pagdurugo. Maari itong maiwasan sa pamamagitan ng: 1. Pagpapanatili ng kailinisan ng ating kapaligiran. 2. Tamang paghihiwalay ng mga basura. 3. Pag iwas sa pag iimbak ng tubig ng walang takip. 4. Pag iwas sa pagsasampay ng mga damit sa loob ng bahay. 5. Pagsususot ng mahahabang damit at paggamit ng off lotion. 6. At kapag may chikungunya na, dalasan ang pag inom ng tubig at magpahinga ng sapat. Ang chikungunya virus ang mismong nagdadala ng sakit na chikungunya samantalang and dengue ay dulot ng 4 na klase ng serotypes.

Ang dengue ay mapapatunayan sa pamamagitan ng pag eeksamin sa IgM at IgG, platelet count, CBC. Samantalang sa chikungunya ay napapatunayan sa pamamagitan ng pag eeksamin gaya ng isolation of viruses, testing ng antibody of IgM at pati na rin ng pag alam sa genetic gene ng virus.

Integrated Management of Childhood Illness (IMCI)

Background

Every day, millions of parents seek health care for their sick children, taking them to hospitals, health centres, pharmacists, doctors and traditional healers. Surveys reveal that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised. At first-level health facilities in lowincome countries, diagnostic supports such as radiology and laboratory services are minimal or non-existent, and drugs and equipment are often scarce. Limited supplies and equipment, combined with an irregular flow of patients, leave health workers at this level with few opportunities to practice complicated clinical procedures. Instead, they often rely on history and signs and symptoms to determine a course of management that makes the best use of the available resources. These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called the Integrated Management of Childhood Illness (IMCI). What is IMCI? IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. The strategy includes three main components: Improving case management skills of health-care staff Improving overall health systems Improving family and community health practices. In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers, and speeds up the referral of severely ill children. In the home setting, it promotes appropriate care seeking behaviours, improved nutrition and preventative care, and the correct implementation of prescribed care. Why is IMCI better than single-condition approaches? Children brought for medical treatment in the developing world are often suffering from more than one condition, making a single diagnosis impossible. IMCI is an integrated strategy, which takes into account the variety of factors that put children at serious risk. It ensures the combined treatment of the major childhood illnesses, emphasizing prevention of disease through immunization and improved nutrition. How is IMCI implemented? Introducing and implementing the IMCI strategy in a country is a phased process that requires a great deal of coordination among existing health programmes and services. It involves working closely with local governments and ministries of health to plan and adapt the principles of the approach to local circumstances. The main steps are: Adopting an integrated approach to child health and development in the national health policy. Adapting the standard IMCI clinical guidelines to the countrys needs, availab le drugs, policies, and to the local foods and language used by the population. Upgrading care in local clinics by training health workers in new methods to examine and treat children, and to effectively counsel parents. Making upgraded care possible by ensuring that enough of the right low-cost medicines and simple equipment are available. Strengthening care in hospitals for those children too sick to be treated in an outpatient clinic. Developing support mechanisms within communities for preventing disease, for helping families to care for sick children, and for getting children to clinics or hospitals when needed. IMCI has already been introduced in more than 75 countries around the world. What has been done to evaluate the IMCI strategy? MCA has undertaken a Multi-Country Evaluation (MCE) to evaluate the impact, cost and effectiveness of the IMCI strategy. The results of the MCE support planning and advocacy for child health interventions by ministries of health in developing countries, and by national and international partners in development. The MCE was conducted in Brazil, Bangladesh, Peru, Uganda and the United Republic of Tanzania.

The results of the MCE indicate that: IMCI improves health worker performance and their quality of care; IMCI can reduce under-five mortality and improve nutritional status, if implemented well; IMCI is worth the investment, as it costs up to six times less per child correctly managed than current care; child survival programmes require more attention to activities that improve family and community behaviour; the implementation of child survival interventions needs to be complemented by activities that strengthen system support; a significant reduction in under-five mortality will not be attained unless large-scale intervention coverage is achieved.

One million children under five years old die each year in less developed countries. Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and malnutrition is often the underlying condition. Effective and affordable interventions to address these common conditions exist but they do not yet reach the populations most in need, the young and impoverish. The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. IMCI is a major strategy for child survival, healthy growth and development and is based on the combined delivery of essential interventions at

community, health facility and health systems levels. IMCI includes elements of prevention as well as curative and addresses the most common conditions that affect young children. The strategy was developed by the World Health Organization (WHO) and United Nations Childrens Fund (UNICEF). In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health workers and hospital staff were capacitated to implement the strategy at the frontline level.

Objectives of IMCI

Reduce death and frequency and severity of illness and disability, and Contribute to improved growth and development

Components of IMCI

Improving case management skills of health workers 11-day Basic Course for RHMs, PHNs and MOHs 5 - day Facilitators course 5 day Follow-up course for IMCI Supervisors

Improving over-all health systems

Improving family and community health practices

Rationale for an integrated approach in the management of sick children

Majority of these deaths are caused by 5 preventable and treatable conditions namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four (4) episodes of childhood illness are caused by these five conditions Most children have more than one illness at one time. This overlap means that a single diagnosis may not be possible or appropriate.

Who are the children covered by the IMCI protocol?

Sick children birth up to 2 months (Sick Young Infant) Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI

All sick children aged 2 months up to 5 years are examined for GENERAL DANGER signs and all Sick Young

Infants Birth up to 2 months are examined for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These signs indicate immediate referral or admission to hospital

The children and infants are then assessed for main symptoms. For sick children, the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear infection. For sick young infants, local bacterial infection, diarrhea and jaundice. All sick children are routinely assessed for nutritional, immunization and deworming status and for other problems

Only a limited number of clinical signs are used A combination of individual one or signs more leads to a childs classification within symptom

groups rather than a diagnosis.

IMCI management procedures use limited number of essential drugs and encourage active participation of caretakers in the treatment of children

Counseling of caretakers on home care, correct feeding and giving of fluids, and when to return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILDS ILLNESS (please see enclosed portion of the IMCI Chartbooklet) The childs illness is classified based on a color-coded triage system: PINKindicates urgent hospital referral or admission

YELLOW- indicates initiation of specific Outpatient Treatment GREEN indicates supportive home care

Steps of the IMCI Case management Process The following is the flow of the iMCI process. At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and other processes indicated in the chart below. Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. Once admitted, the hospital protocol is used in the management of the sick child.