PREVENTION AND CONTROL

iv.

Context in developing the

community health plan
1. Philippine Health Care Delivery
System
a. Executive Order 102 (The
Department of Health)
b. RA 7160 (Local Health Systems)
c. Levels of Health Care and Referral
System
2. Global Health Situation (Millennium
Development Goals)
3. National Health Situation
(FOURmula One)
4. Primary Health Care as an Approach
to Health Care Delivery

IV.

Implementing the
Community Health
Nursing Services
a. Components of program
implementation
i. Coordinating the health
program
ii. Monitoring health
programs
iii. Supervising the
program staff

 b. Public Health Programs of the DOH

i. Family Health Services
1. Maternal Health
2. Family Planning
3. Child Health
a. Infant and Young Child Feeding
b. Expanded Program on Immunization
c. Integrated Management of Childhood

Illness
4. Nutrition Program
5. Oral Health Program
6. Essential Health Packages for the
Adolescent,
Adult Men and Women and Older
Persons

 ii.

Control of Non-Communicable
Diseases
1. Integrated Community-Based
Noncommunicable Disease
Prevention Program
2. Programs for the Prevention of
Other Noncommunicable Diseases
a. National Prevention of Blindness
b. Mental Health and Mental
Disorders
c. Renal Disease Control Program
d. Community-Based Rehabilitation
Program

 Programs

aimed at preventing noncommunicable diseases.

1. Integrated Community-Based
Noncommunicable Disease Prevention
Program
Aimed at preventing the 4 major
NC/CHRONIC/ LIFESTYLE related
diseases, cancers, chronic obstructive
pulmonary diseases and DM.

 THROUGH

the promotion of healthy

lifestyle aimed at preventing the 3
commonly shared major risk
factors;
Unhealthy diet,
Physical inactivity,
smoking

 chronic

diseases
Lifestyle related diseases
1. Cardiovascular diseases
2. Cancer
3. Chronic Obstructive Pulmonary
Disease
4. Diabetes Mellitus

 2005

estimated that 35% million

deaths would have occurred due to these
diseases, contributing to 60% of deaths
worldwide.
Out of the 36 million people who died
from NCDs in 2005, half were under age
70 and half were women.
Out of the 36 million people who died
from NCDs in 2005, half were under age
70 and half were women.
Of the 57 million global deaths in 2008,
36 million were due to NCDs.

 That

is approximately 63% of total

deaths worldwide.
Risk factors such as a person's
background, lifestyle and environment
are known to increase the likelihood of
certain NCDs.
Every year, at least 5 million people die
because of tobacco use and about 2.8
million die from being overweight.
High cholesterol accounts for roughly 2.6
million deaths and 7.5 million die
because of high blood pressure.

 1.

tobacco smoking
2. physical inactivity
3. unhealthy diet
2003 Natl Nutrition & Health Survey
Presently 90% of Filipinos has one or
more risk factors associated with
chronic, NC diseases.

 1.

physical inactivity 60.5%

2. Smoking
34.8%
3. hypertension
22.5% (>140/90)
4. hypercholesterolemia8.5% (TC >
240)
5. obesity
4.9% (BMI > 30)
6. Diabetes
4.6%

 ACTION

TO PREVENT these diseases

should therefore focus on controlling
risk factors in an INTEGRATED
MANNER.
A major STRATEGY is HEALTH
PROMOTION
Intervention at the level of family and
community is essential for prevention
Addressing the major risk factors
should be given the highest priority

 is operationally defined as a way of life that

promotes and protects health and well-being.
This would include practices that promote health
such as:

- healthy diet and nutrition,

- regular and adequate physical activity and

leisure,

- avoidance of substances that can be abused

such as tobacco, alcohol and other addicting
substances,

- adequate stress management and

relaxation;

- and practices that offer protection from

health risks such as safe sex and immunization.

 GOAL:
Reduce

the toll of morbidity, disability

and premature deaths due to chronic,
non-communicable lifestyle related
disease.

 1.

Analyze the social, economic,

political and behavioural determinants
of NCD that will serve as bases for:
a. Developing policy guidelines
b. Setting legislative and political
directions
c. Providing financial measures to
support NCD prevention and control.

2. reduce exposure of individuals and

population to major determinants of NCD while
preventing emergence of preventable common
risk factors.
- the health sector should lobby for a health
protective environment by:
a. proposing healthy public policies that
encourage health-promoting settings in school,
workplaces and communities.
b. encouraging governments to provide
protection against activities by industry and
commerce that promote unhealthy products
and lifestyles.
c. communicating the consequences of major
risk factors of NCD, paying particular attention
to the most vulnerable population.
3. strengthen health care for people with NCD
through health sector reforms and cost effective
interventions.

 A.

DISEASES OF THE HEART AND

BLOOD VESSELS ( CARDIOVASCULAR
DISEASES)
1. HYPERTENSION
- or High Blood Pressure
- defined as a sustained elevation in
mean arterial pressure.
- not a single disease state but a disorder
with many causes, a variety of
symptoms, and a range of responses to
therapy.

 Major

risk factor for the development of

other CVDs like coronary heart disease
and stroke.
ETIOLOGY/ CAUSE
1. PRIMARY NO definite cause
Essential hypertension or idiopathic
hypertension.
90% of all hypertensives have primary
HPN.
2. SECONDARY result of some other
primary diseases leading to HPN (renal
disease)

 No

single cause several risk factors:

Family history of hypertension
Obesity , advancing age, race and high
salt intake
Lifestyle factors:
Cigarette smoking
Heavy alcohol consumption
Elevated blood cholesterol levels
Continued exposure to stress

 Is

an umbrella term that refers to a

central nervous system (CNS)
functional abnormality due to the
disruption of the normal blood supply
in the brain.
CVA Cerebrovascular Accident/
Stroke is the primary cerebrovascular
disorder in the world.

 1.

ISCHEMIC STROKE
Brain attack there is disruption of
cerebral blood flow due to obstruction
of a blood vessel.
Occurs in 85% of patients
2. HEMOHHRAGIC STROKE
Account for 15% of CVA disorders and
are primarily caused by intracranial
and subarachnoid hemorrhage.

 A.

NON-MODIFIABLE RISK FACTORS

Heredity
Increasing age
Gender

 Hypertension
High

cholesterol
Cigarette smoking, tobacco use
DM
Lack of exercise
Personality
Obesity
Lack of estrogen in women
High coagulability of the blood

5-25

Copyright 2007 Thomson

Delmar Learning, a division of

Characteristics of
patient

Desired blood level

Patient with one or no risk factors

<160 mg/dl

Patient with two or more risk

factors

<130 mg/dl

Patients with CAD or at high risk

for CAD

<100 mg/dl

Patients at very high risk for an

acute coronary event

<70 mg/dl

High Density Lipoprotein

>60 mg/dl

5-27

Copyright 2007 Thomson

Delmar Learning, a division of

 Desired

Blood Cholesterol Levels

< 200 mg/ 100 ml.
Repeat every 5 years.
200 239 mg/ 100 ml
Elevated (may be at risk)
Repeat tests, take average of both
tests
240 mg/ 100 mL and above
Elevated ( at risk)
Further tests (lipid profile and
treatment)

 Processed

by the GIT into lipoprotein

globules CHYLOMICRONS
These are reprocessed in the liver as
lipoproteins to form lipoprotein-based
cell membranes.
When excessive low-density lipoproteins
or LDLs are produced, they adhere to
vulnerable points in the arterial
endothelium
Here, the macrophages ingest them,
leading to the formation of foam cells and
the beginning of plaque formation.

 Cancer

Disturbance of cellular growth

characterized primarily by an
abnormally excessive proliferation of
cells without apparent relation to the
physiological demands of the organ
involved

 Directly

extending into adjacent tissues.

Invading a nearby body cavity, such as
the abdomen or pleural space.
Invading along lymphatic vessels.
Traveling via lymphatic vessels to the
lymph nodes which drain the region in
which the cancer is situated
Traveling via the blood vessels to any
part of the body, but particularly to
the lungs, liver, and bones.

 Change in bowel or bladder habits

A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or

elsewhere
Indigestion or difficulty in swallowing
Obvious change wart or mole
Nagging cough or hoarseness
Unexplained anemia
Sudden unexplained

weight loss

 What

are Non-communicable
diseases (NCDs)?

 are

disease processes that are

not contagious
not transferable from one human
to another.
They

are by far the leading cause of

death globally, making up around

two-thirds of all deaths annually.
diseases

that are slow to develop

and of long duration.

 Most

NCDs are considered

preventable.

TRUE

OR FALSE?

 because

they are caused by

modifiable risk factors.

 WHAT

are the most common causes

for non-communicable diseases
(NCD) ?

 tobacco

use (smoking)
alcohol abuse
poor diets (high consumption of
sugar, salt, saturated fats
trans fatty acids)
physical inactivity
These are collectively called
lifestyle factors.

 What

are the mechanisms by which

the risk factors lead to NCDs?

 The

risk factors lead to four adverse

changes: high blood pressure,
overweight and obesity,
hyperglycemia, and hyperlipidemia
(including hypercholesterolemia)

 Which

NCDs are the biggest causes

of mortality?

 Cardiovascular

diseases account for

most of the deaths resulting from
NCDs.
After that, the top three offenders
are cancers, respiratory diseases,
and diabetes

1. Age incidence increases with age

2. Sex significant differences among
sexes, e.g. breast cancer
3. Race skin color, diet, custom
4. Occupational petrochemical
workers with higher rates of bladder
cancer
5. Health habits those who do not
smoke, protect themselves from the
sun and have a sensible diet have
lower incidence of cancer

6. Family history those with family

history of breast cancer and
colorectal cancer have increased
risk of developing these
7. Socio economic status
8. Lifestyle smoking, excessive
alcohol drinking, betel nut chewing,
diet, sexual activity and sun
exposure are associated with cancer

1/3

of all cancers are curable if

detected early and treated
properly
Treatment needs a
multidisciplinary approach.

 1.Surgery

Oldest

mode of treatment;
Removes principal deposit of cancer
Involved the removal of healthy tissues
surrounding the tumor and possibly
the adjacent lymph nodes

 2.

Radiation Theraphy
Localizes treatment where a beam of
high energy electromagnetic
radiation destroys cancer cells

3.

Chemotheraphy

Use

of chemicals in an attempt
to destroy tumor cells by
interfering with cellular
functions, including replication
Drugs may be taken orally,
parenterally or by topical
application
Those taken orally or
parenterally produce side effects

 Palliative

Care or Supportive Care:

Active, holistic care of patients and

their families given by a
multidisciplinary team of physicians,
nurses, nutritionists, social workers,
psychologists, rehabilitation medicine,
religious persons, relatives and friends.
This covers physical, psychological,
social and spiritual needs
Management is towards the patients
symptom free existence, with
spiritual and psychological support

 Increase

consumption of fresh vegetables

(especially those of the cabbage family)
since studies show that roughage and
vitamin rich foods help prevent certain
types of cancer
Increase fiber intake.
- This reduces the risk for breast, prostate
and colon cancer
Increase intake of food rich in Vitamin C
(E.g. citrus fruits and broccoli).
- This protects against stomach and
esophageal cancer

 Practice

weight control.
- Obesity is linked to cancer of the
uterus, gallbladder, breast and colon
Reduce intake of dietary fat since a
high fat diet increase the
risk for breast, colon
and prostate cancer
Practice

moderate consumption of salt

cured smoked and nitrate cured
food.
- These are linked to esophageal and
gastric cancers

 Stop

smoking cigarettes and cigars

Reduce

alcohol intake.
- Large amount of alcohol intake
increases the risk of liver cancer
avoid over exposure to the sun, wear
protective clothing and use
sunscreen to prevent skin damage
from ultraviolet rays which increases
the risk of skin cancer

Carcinogens are a class of substances that

are directly responsible for damaging DNA,
promoting or aiding cancer.
Tobacco, asbestos, arsenic, radiation such
as gamma and x-rays, the sun, and
compounds in car exhaust fumes are all
examples of carcinogens.
When our bodies are exposed to
carcinogens, free radicals are formed that
try to steal electrons from other molecules
in the body.
Theses free radicals damage cells and
affect their ability to function normally.

 Estimate

about 3 million Filipinos

are diabetic and 50% of them are
undiagnosed.
Diabetes mellitus:

A group of metabolic diseases

characterized by hyperglycemia
resulting from defects of insulin
secretion, insulin action or both of
these.

 Type

1
previously referred to as IDDM
Develops during childhood or
adolescence and affects about 10%
of all diabetic patients.
Sufferer require a lifetime of insulin
injection for survival since their
pancreas cannot produce insulin

 Type

II
referred as NIDDM Comprises
about 90% of all diabetic patients
who are mostly overweight or obese.
They usually have insulin resistance
Frequently undiagnosed for many
years because hyperglycemia
develop gradually, thus making the
symptoms go unnoticed

 Family

history of diabetes
Obesity
Age >45 years old
Previously identified impaired fasting
glucose or impaired glucose tolerance
Hypertension >140/90mmHg
HDL cholesterol level <35mg/dl
and/or triglyceride level >250mg/dl
History of gestational diabetes or
delivery of babies over 9 lbs.

1. Nutrition Management:
Avoid simple sugar like cakes and chocolates.
Instead have complex carbohydrates like rice,
pasta, cereals and fresh fruits
Do not skip or delay meals.
It causes fluctuations in blood sugar levels
Eat more fiber rich foods like vegetables
Cut down on salt
Avoid alcohol.
Dietary guidelines recommend no more than
2 drinks for men and no more than one drink
per day for women

Exercise:
Lowers blood glucose by increasing the uptake of
glucose by body muscles and by improving insulin
utilization Improves circulation and muscle tone
Resistance training increases lean muscle mass, thereby
increasing the resting metabolic rate Exercise should be
done at least 3 times a week for at least 30 minutes
each session General Precautions for Exercise in
Diabetics Always carry quick sugar sources like candy
or softdrink to avoid hypoglycemia during and after
exercise Use proper footwear and other protective
devices Avoid exercise in extreme heat or cold Inspect
feet daily after exercise Avoid exercise during periods of
poor metabolic control

 Monitoring:

Self monitoring of blood glucose

enables the diabetic to adjust the
treatment regimen to obtain optimal
blood glucose control

 Pharmacologic Therapy:

Exogenous insulin must

be
administered on a long term basis to
Type 1 diabetes because in Type 1, the
body loses its ability to produce insulin.
If diet and oral agents have failed in Type
2 diabetes, insulin may also be necessary
on a long term basis. Type 2 diabetic
patients may temporarily require insulin
during illness, infection, pregnancy,
surgery or some other stressful event

 Education:

Education on nutrition, medication

effects and side effects, exercise,
disease progression, prevention
strategies, monitoring techniques and
medication adjustment as part of their
self management behavior.

 COPD:
A

disease characterized by progressive

and irreversible air flow obstruction.
It could be due to emphysema,
chronic bronchitis or even both
Chronic bronchitis defined as a
productive cough that lasts 3 months
in each 2 consecutive years where
other possible causes for cough have
been excluded

 also

known as chronic obstructive lung

disease (COLD),
and chronic obstructive airway
disease(COAD)
a type of obstructive lung
disease characterized by chronically poor
airflow.
It typically worsens over time.
The main symptoms include shortness of
breath, cough, and sputum production.
Most people with chronic
bronchitis have COPD.

 Gross

pathology of a lung showing

centrilobular-type emphysema
characteristic of smoking. This closeup of the fixed, cut lung surface shows
multiple cavities lined by heavy black
carbon deposits.

 Tobacco

smoking is the most common

cause of COPD, with a number of
other factors such as air
pollution and genetics playing a
smaller role

In the developing world, one of the common

sources of air pollution is from poorly vented
cooking and heating fires.
Long-term exposure to these irritants causes
an inflammatory response in the lungs
resulting in narrowing of the small airways
and breakdown of lung tissue known
as emphysema.

The diagnosis is based on poor airflow as

measured by lung function tests.
In contrast to asthma, the airflow reduction does
not improve significantly with the administration
of medication.
COPD can be prevented by reducing exposure to
the known causes.
This includes efforts to decrease rates of smoking
and to improve indoor and outdoor air quality.
COPD treatments include:
quitting smoking, vaccinations, rehabilitation,
and often inhaled bronchodilators and steroids.
Some people may benefit from long-term oxygen
therapy or lung transplantation.
In those who have periods of acute worsening,
increased use of medications and hospitalization
may be needed.

Worldwide, COPD affects 329 million

people or nearly 5% of the population.
- In 2012, it ranked as the thirdleading cause of death, killing over
3 million people.
The number of deaths is projected to
increase due to higher smoking rates
and an aging population in many
countries.
- It resulted in an estimated
economic cost of $2.1 trillion in 2010.

 Emphysema

an end stage of a
slowly progressing process
characterized by an abnormal
distention of the air spaces beyond the
terminal bronchioles, with destruction
of the walls of the alveoli.

 Suspect

COPD in person with the

following::
> 50 years old Smoking for many
years With symptoms of progressive
and increasing shortness of breath on
exertion
Chronic productive cough

 Risk

Factors for COPD:

1. The primary risk factor for COPD
globally is tobacco smoking.
Of those who smoke about 20% will
get COPD, and of those who are
lifelong smokers about half will get
COPD
Exposure - Passive smoking - In nonsmokers, secondhand smoke is the
cause of about 20% of cases
2. Occupational exposure
- Ambient air pollution
3. Genetic abnormalities, including a
deficiency of alpha - antitrypsin

 Diagnostic

Procedure:
Pulmonary Function Studies Are used
to determine disease severity. Airflow
obstruction is determined by the ratio
of forced expiratory volume (FEV) to
force vital capacity (FVC) With
obstruction the patient cannot forcibly
exhale air from the lung, thus reducing
the FEV.

 Medical

Management:
Oxygen Therapy
Long term oxygen therapy improves
the quality of life and survival
Pulmonary Rehabilitation
Consists of educational, psychosocial,
behavioral and physical components
Breathing exercises, retraining and
exercise programs are used to improve
functional status

 Nursing Management:
Teaching patient about
COPD Breathing Exercises Activity
breathing techniques, such as pursed

lip breathing or diaphragmatic

breathing.
Pacing Inspiratory muscle training to
strengthen muscles used in breathing
Self care activities Physical
conditioning
Promoting smoking cessation
Supportive nursing care

Obesity is a condition in which people have

an excess of body fat.
According to (CDC), the prevalence of obesity
in the U.S more than doubled between the
years 1960 and 2000, with the greatest
increase from 1980 forward.
According to the National Institutes of
Health, almost one-third of Americans are
obese.
Obesity is growing problem across the globe.
Worldwide, more than 300 million adults
are obese, according to (WHO).
obesity is the second-leading cause
of preventable death in the U.S, surpassed only
by smoking.

At least 300,000 Americans die each year as a

result of factors attributed to
obesity, American Obesity Association

Obesity is a major risk factor for a number of

serious health conditions, including
Coronary heart disease.
Cancer.
Diabetes.
Fatty liver disease.
Gallbladder disease.
High blood pressure..
Osteoarthritis.
Stroke.
Sleep apnea and other breathing problems.

 What

actions does the WHO

recommend to combat NCDs?

 A:

The WHO recommend: reducing

tobacco use, improving unhealthy
diets, increasing physical activity, and
reducing the harmful use of alcohol
For more information: www.exercisefor-health.com/non-communicablediseases
Exercise For Health.

NCD Alliance
The NCD Alliance is a global partnership
founded in May 2009 by four international
federations representing cardiovascular
disease, diabetes, cancer, and chronic
respiratory disease.
The NCD Alliance brings together roughly 900
national member associations to fight noncommunicable disease. Long term aims of the
Alliance include:
NCD/disease national plans for all
A tobacco free world
Improved lifestyles
Strengthened health systems
Global access to affordable and good quality
medicines and technologies
Human rights for people with NCDs.

 2.

Programs for the Prevention of

Other Noncommunicable Diseases
a. National Prevention of Blindness
b. Mental Health and Mental
Disorders
c. Renal Disease Control Program
d. Community-Based Rehabilitation
Program

 Is

a national health program

implemented by the (DDO)
Degenerative Disease Office, the
National Center for Disease Prevention
and Control (NCDPC), in collaboration
with NGOs (National Committee for
Sight Prevention) and other
government agencies for the
elimination of avoidable blindness.

 Government

Mandates and Policies :

Administrative Order No. 179 s.2004:
Guidelines for the Implementation of the
National Prevention of Blindness
Program
Department Personnel Order No. 20050547: Creation of Program Management
Committee for the National Prevention of
Blindness Program
Subcommittees: Refractive Error/Low
Vision, Childhood Blindness, Cataract
Proclamation No. 40 declaring the
month of August every year as Sight
Saving Month

 Department

order no. 73-B s., 2001

(Vision 2020) Philippine Initiative
The Right to Sight
R.A. 6759 An act Declaring August 1
every year as the White Cane Safety
Day in the Philippines and for other
purposes.

 International

agency for the prevention

of Blindness 6th General Assembly,
September 5 10, 1999, Beijing,
China the Phil. Is a signtory in the
global elimination of avoidable
blindness: Vision 2020 the right to
sight.

Vision:
All Filipinos enjoy the right to
sight by year 2020
Mission:
The DOH, Local Health Unit
(LGU) partners and stakeholders commit to:
Strengthen partnership among and with
stakeholder to eliminate avoidable blindness
in the Philippines;
Empower communities to take proactive roles
in the promotion of eye health and prevention
of blindness;
Provide access to quality eye care services for
all; and
Work towards poverty alleviation through
preservation and restoration of sight to
indigent Filipinos.

 Goal:

Reduce the prevalence of

avoidable blindness in the Philippines
through the provision of quality eye
care.

The program has the following

objectives:

 b.

Mental Health and Mental

Disorders
NATIONAL MENTAL HEALTH
PROGRAM (NMHP)
Which is now under the degenerative
disease prevention and Control
(NCDPC) of the DOH aims to integrate
mental health within the total health
system, initially within the DOH
system, the local health system.

 Prevention

of blindness program
A national health program
implemented by the degenerative
Disease Prevention and Control in
collaboration with NGOs and other
government agencies for the
elimination of avoidable blindness.

 Healthy

vision for every Filipino

through eye health promotion and
disease prevention

 Elimination

of all avoidable blindness

by preventing and controlling diseases
through the development of human
resource, infrastructure, and
appropriate technology.

 Communities

or provinces with a
blindness prevalence rate of less than
1.0%

 Older

persons
Working age group
Adolescents
School children
AREA

OF COVERAGE: Nationwide