PREVENTIVE AND COMMUNITY MEDICINE NOTES

2. General Fertility Rate

Total number of live births
CONCEPT AND DEFINITION OF HEALTH AND DISEASE GFR = ----------------------------------------------------------------- x 1000
Midyear population of women15-44 years of age
Definition and Concept of Health and Disease
Health – complete physical, mental and social well-being and not merely the absence of disease
or infirmity (WHO). B. Mortality Rates
-- Successful defense of the host against forces tending to disturb body equilibrium. 1. Crude Death Rate
Disease – failure of the body defense mechanism to cope with forces tending to disturb body Number of deaths, all causes
equilibrium. CDR = -------------------------------------- x 1000
Midyear population
Premises of the Ecologic Concept of Disease Causation
 Disease is the result of the imbalance between the forces of the agent and the host. 2. Specific Death Rates
 The resulting imbalance depends on the nature of the agent and the host. Number of deaths in specified group
 The nature of the agent and the host and their interaction depend on the environment. SDR = ---------------------------------------------------- x F
Midyear population of specified group
Factors of Disease Causation - May be specified for age, sex, age and sex, race, socio-economic status, etc.
Agent – substance or force whose presence or absence causes disease
- Types: biologic, physical, chemical, nutrient 3. Cause-Specific Death Rate (mortality rate by cause)
- Characteristics: mode of transmission, virulence, organ of parasitism, immunity conferred, etc. Number of deaths due to a specific cause
Host – organic body where agent depends for survival CSDR = ------------------------------------------------------------ x F
-- resistance/susceptibility – influenced by age, sex, nutrition, race, previous experience, etc. Midyear population
-- Exposure – influenced by behavior, environment, occupation, etc.
4. Proportionate Mortality Rates
Environment – sum of all forces that influence the growth and development of an organism Number of deaths due to specific cause
-- Components: physical, biological, socio-cultural PMR = ---------------------------------------------------------- x 100
Total deaths
Natural History of Disease
 Complete disease process starting from without to within the individual resulting in changes in 5. Infant Mortality Rate
body form and function until equilibrium is reached or recovery, or death of the individual. Number of deaths below 1 year of age
Stages IMR = -------------------------------------------------------- x 1000
 Prepathogenesis – agent interacting in the environment Total number of live births
 Pathogenesis – agent interacts with host
 Incubation period – cellular/tissue reactions without signs or symptoms of disease.
 Clinical period – signs and symptoms of disease present 6. Neonatal Mortality Rate
 prodrome – mild, non-specific symptoms Number of deaths in a year of children <28 days of age
 frank illness – symptoms specific or characteristic NMR = --------------------------------------------------------------------------- x 1000
Midyear population of women 15-44 years of age
 chronic stage – disease is prolonged
 Recovery or Death
7. Fetal Death Ratio
Number of deaths* during the year
LEVELS OF PREVENTION
FD Ratio = -------------------------------------------- x 1000
Levels of Prevention Disease Stage Applied
Number of live births in same year
Primary Prevention Prepathogenesis
Health Promotion
8. Fetal Death Rate
Specific Protection
Number of deaths** during the year
Secondary Prevention
FD Rate = ------------------------------------------------------------------------- x 1000
Early Diagnosis and Prompt Early Treatment Early Pathogenesis
Number of live births and fetal deaths during same year
Disability Limitation Late Pathogenesis
Tertiary Prevention
9. Perinatal Mortality Rate
Rehabilitation Late Pathogenesis
Number of deaths 17 wks or more and infant deaths under 7 days of
age
MEASUREMENT OF HEALTH AND DISEASE
Perinatal Mortality Rate = -------------------------------------------------------------------------- x 1000
 determination of health problems (needs and demands) of the community; uses of statistics Number of live births and fetal deaths 28 weeks or more during the same year
Community Diagnosis
 determination of the extent of the health problems 10. Maternal Mortality Rate
 determination of the cause(s) of the problems Number of deaths from puerpueral causes in a year
Disease Indices MMR = ----------------------------------------------------------------------- x 1000
 Morbidity Total number of live births in same year
1. Incidence rate – risk of developing disease/year
2. Prevalence rate – proportion of people suffering from disease at a given instant of time 11. Case Fatality Rate
 Mortality Number deaths due to a particular cause
1. Cause-specific mortality rate – risk of dying from a specific disease. CFR = ---------------------------------------------------------- x 100
2. Age-specific mortality rate – risk of dying for a specific age group. Number of cases – same cause
3. Case-fatality rate – killing power of a disease; also reflects care given to patients.
4. Proportionate mortality rate – proportion of total deaths ascribed to a specific disease C. Morbidity Rates – measures frequency of illness within specific population groups.
5. Maternal mortality rate – risk of a woman dying associated with pregnancy, delivery and 1. Prevalence Rate – measures frequency of all current (existing) cases of a
puerperium. disease
6. Stillbirth or fetal mortality rate – risk of losing the product of conception before delivery.
7. Infant mortality rate – risk of dying during first year of life. Number of new and old cases within a period
8. Neonatal mortality rate – risk of dying during the first 28 days of life. PR = ---------------------------------------------------------------- x 100
9. Perinatal mortality rate – sum of stillbirth and neonatal death rates. Midyear population

FORMULA: Total cases (old & new) at fixed point of time

A. Fertility Rates Point Prevalence Rate = ------------------------------------------------------- x 100
1. Crude Birth Rate Total population at that time
Total number of live births 2. Incidence Rate
CBR = --------------------------------- x 1000 Number of new cases
Midyear population IR = --------------------------------- x F

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 Population at risk Slow population growth Median age = 26 - > 30 y/o
Dependency ratio = 1 to 2
Number of new cases during specified period Types of disease problems
Person Time --------------------------------------------------------------- x 1000 1. economic implications
IR/1000 Person Person-years of years observation 2. overpopulation/population explosion
 exists when economy cannot support the population in face of a
3. Attack Rate – incidence rate usually expressed in percent rapid population growth
- used for particular populations observed for limited period of time as an  economic support
epidemic  economic support is measured in terms of:
i. state of health and nutrition
Resources of health, sanitation, housing, public utilities, etc. ii. level of unemployment
iii. level of education
Statistical Methods iv. state of housing
 deals with the collection and treatment of statistical data Sources of population
A. Collection of Data  Census – process of collecting \, compiling, and publishing data pertaining to all persons
 Registration – routine and systematic collection of data as event occurs, usually required in a country or territory
by law o 2 ways:
 Review of hospital, clinic or laboratory records o de jure – assigns individuals to place of residence regardless where they were
 Census – complete enumeration of individuals or events in a geographic area at a given actually enumerated during the census]
time o de facto – people are allocated to areas where they were actually enumerated during
Survey – investigation to determine prevalence of disease or other events in a geographic area at the census
a given time  Sample surveys
B. Summarization
 Vital registration system
 Classification – grouping of individuals or events that are similar according to certain
 Others: continuing population registers, voter’s registry, school register, etc.
descriptive variables, qualitative or quantitative
Foci of demography
 Statistical Constants – measures of central tendency, dispersion
 Population distribution – urban/rural, population density
C. Presentation – textular, outline form, tabular, graphical
o Crowding index = total no. of persons in household/no. of rooms
 Tabular – summary table, master table, frequency distribution table, correlation table.
o The higher the index, the easier for disease transmission to occur
 Graphical – line graph, bar graph, component part diagram, histogram, frequency
 Population composition/structure
polygon, scatter point diagram, pictorial chart, statistical map
o Sex ratio = no. of males/females x 100
 Types of graph o Sex structure = compute for sex ratio of each group
Pie graph Used in qualitative variable, number of variables should be o Age [median age, age dependency ratio]
limited  Population size – age and sex composition = population pyramid
Component bar graph Qualitative variable, has a number of variables
Line diagram Used in time-series, show trend data / changes w/respect to Steps [read notes]

Scatter point diagram

variables
Quantitative data, correlation of data w/ quantitative variables
Types [look for the diagram]
D. Analysis and Interpretation Type 1 Broad base and gently sloping sides Countries w/ high birth and
Low median age and high death rates
 Central tendency – mean, median, mode
dependency ratio
 Dispersion – range, standard deviation, variance
Type 2 Broader base, sides bow and slant Countries beginning to grow
 Rates and Ratios
sharply rapidly due to reduced infant
 Frequency distribution Median age decreasing due to rapidly and child mortality, not
increasing population reducing fertility
Type 3 Old fashioned beehive Western European countries
DEMOGRAPHY Median age is highest and age
 Science of population, study of population and its effects on health, social and economic status dependency ratio is lowest due to low The dependents are mostly
 Empirical, statistical, mathematical study of population birth rates elderly individuals
Demographic characteristics of importance to health Type 4 Bell-shaped pyramid, transitional type
1. population size and growth , population experienced a marked
2. population structure and rapid decline in fertility
3. health related characteristics Measuring changes in population size
I. Population size and growth  Depends on: natality, mortality and migration
A. No. of people living in a specific geographical area Advantages of sampling
B. population growth – differences between birth and death rate, affected by migration  Cheaper
Assumptions:  Faster
1. arithmetic growth – increase by constant amount  Better quality
2. geometric growth – increase by constant rate  More comprehensive data
3. logistic growth – demographic transition  Only possible method for destructive procedure
II. Factors in population growth Population
A. births or fertility
 The entire group of individuals of interest in the study
1. Fecundity
 Categories:
 ovulation – potential for procreation, limited to fertility age
o Sampling population – from w/c sample will actually be taken
 spermatogenesis and ejaculation – unlimited potential after puberty
o Target population – group from w/c representation of info is desired to w/c
2. Coitus rate
inferences will be made
 affected by culture, religion, age of marriage
 total fertility rate – no. of births by Basic sampling design
Non-probability sampling Probability of each population to be selected in the
women have completed their fertile sample is difficult to determine or can’t be specified
Probability sampling Each unit in the population has a non-zero chance of
period being induced
Young population High fertility and death rates
Rapid population growth Median age = 15-20 y/o Types of sampling design
Dependency ratio = 1 to 1 Simple random Table of random numbers
Intermediate population Moderate fertility and death rate sampling Most basic type of sampling design
Moderate population growth Median age = 21-25 y/o Every element in the population has an equal chance of being
Dependency ration = 2 to 3 included
Old population Low fertility and death rate Systematic Sampling interval [k] is determined by k = N/m

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sampling Use when sampling units are numerous Qualities of statistical data [CAPRAT]
Stratified random Used to ensure that subgroups are adequately represented 1. timeliness
sampling Population is first divided into new overlapping groups [strata] 2. completeness
Cluster sampling Used when a sampling frame for the elementary units are not 3. accuracy
available or when cost consideration is important 4. precision
Wherein sampling units are cluster of element 5. relevance
Multi-stage Used when sample survey to be conducted has a wide coverage 6. adequacy
sampling Divided into primary and secondary sampling units
Sample size estimation RESEARCH
 Define primary objective  A problem-solving activity w/c is systematic, objective and reproducible
 Determine study design Steps in planning and conducting research
1. Identify and define research problem
 Define clinically significant difference one wishes to detect
A. selection of research topic
Population estimation
B. formulation of research objective
 Arithmetic method
 Factors in selection of topics: personal interest, training, previous experience
 Geometric method
 Nature of topic to be investigated: timeliness, relevance, duplication, applicability,
 Exponential method
cost-effective
 Feasibility and ethical considerations
2. Formulate research objectives
BIOSTATISTICS  Expressed either in the form of statement or question
 Science dealing w/ collection, organization, analysis and interpretation [COAI]  Category: general or specific
 Public health statistics = planning, monitoring, and evaluation of health services  Desired characteristics: Specific, Measurable, Attainable, Relevance, Time-bound
 Vital statistics = vital events [births, deaths, marriages] 3. Review of related literature
 Health statistics = morbidity, mortality, hospital and clinic statistics, service statistics 4. Formulation of testable hypothesis
 An assertion of proportion about relationship between 2 or more variables
Branches:  3 categories:
Descriptive statistics Inferential statistics i. Independent – cause, 1 describing the dependent]
Organize, summarize and present data Generalizations and conclusions to target ii. Dependent – outcome
population iii. Control variable – [Confounding variables and covariates} – like age
Table and graphs Estimate parameters 5. Construct research design
Measures of central tendency [averages] Test hypothesis  Strategy/plan of attack to objectives
Measures of variability/dispersion [range]  Internal validity: central biases to measure what is intended to measure
Constant – same values from person to person, time, or place [ex. Sex, race]  External validity: to generalize result of the study
Variable – values cannot be predicted w/ certainty [ex. Temperature, weight] 6. Design the tool for data collection
 Questionnaires, interview
Types of variables 7. Design the plan for data analysis
Type Examples Definition  Done before data collection
Qualitative Sex, religion, Labels to distinguish a group from another  By tables
urban/rural Numerically expressed 8. Data collection
Quantitative Can be measured and ordered according to  Most expensive and time-consuming place of the research project
amount, expressed numerically, either discrete 9. Data collection processing
or continuous  Editing of data collection forms
Discrete quantitative No. of beds Assume integral values or whole numbers  Coding of responses
Continuous quantitative Weight [kg] Any value [fractions or decimals] 10. Analyzing data
 Involves quantification, description and classification of data
Classification according to scale  Statistics play a vital role in the process
Nominal scale Qualitative variable Male/female or rich/poor 11. Write the research report
Ordinal scale Can be ranked / ordered 12. Disseminate the result
Qualitative Mild, moderate, severe  Thru: publication, news release, presentation of results by scientific meetings
Quantitative 1st, 2nd, 3rd 13. Utilize the results
Interval scale 0 point is arbitrary Temperature  Baseline studies
Ratio scale 0 point is fixed Kg, age, distance  Needs assessment
 Recommendations
Example DESCRIPTIVE STATISTICS
Educational status Description
Nominal Literate or illiterate Measures of central tendency
Ordinal None, elementary, high school, college Mean For numerical data and symmetric distribution [ex. hypothesis testing]
Ratio Number of years in school “center of gravity” in all observations
Classification based on gappeness Median Middlemost value in set of observations, Insensitive to extreme values
Continuos variable Weight, temperature For markedly skewed distributions [ordinal or numerical data]
Discrete variable [whole number, integral] 1,2,3,4, Mode Value of observation that occurs frequently
Data in ratio scale can be transformed to nominal scale but not vice versa For bimodal distributions
Data collection
1. tabular
Measures of dispersion or variability
Range Largest – smallest observation, very sensitive to extreme
2. graph
observation
3. narrative
For data to emphasize extreme values
Categories of data
A. based on source Variance Average squared deviations from mean
1. primary data – 1st hand data Standard deviation Square root of the variance
2. secondary data – data is already prepared [medical records] For mean [symmetric distributions of numerical data]
Sources of data on health and ill-health Coefficient of Relative dispersion w/c expresses standard deviation as
1. Census variation percentage of mean, used when units of measurement of the
2. registries of vital events [death, birth, marriages] variables being compared are different
3. reports of occurrence of notifiable disease [morbidity] For comparison of 2 numerical distributions on different scales
Methods of data collection Percentile Percentage of distribution that is equal or below that number
1. questionnaires For median, when mean is used its objective is to compares
2. interviews individual values w/ set of norms
3. observation Used to develop and interpret physical growth charts and

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 measurements of ability and intelligence, lab values
rate – frequency of occurrence of events
Measures of frequency over a given interval of time
Proportion No. of observations w/ a given characteristics / total number of
observations, Useful for ordinal and numerical data as well as Crude birth rate How fast people are No. of registered LB in a yr/midyear
nominal data, defined as part divided by the whole added in the population population x 1000
Percentage Proportion multiplied by 100 General fertility Population deemed to be No. of registered LB in a yr/midyear
rate capable of giving birth population [15-44 y/o] x 1000
Ratio Defined as part divided by another part
Crude death rate Mortality in a given No. of deaths in calendar yr/midyear
Rate Similar to ratio but denominator is the total observed
population population x 1000
characteristics and uses multiplier of base
Computed over a specified period of time Specific mortality Compare population w/ No. of deaths in specified group in
rates marked differences in calendar yr/midyear population of
Independent variable –presumed to cause, effect, and influence or stimulates the outcome [factor,
composition same specified group x F
exposure, predictor]
Dependent variable – refers to output, outcome or the response variable Cause of death Rate of dying secondary to No. of deaths from certain cause in
Confounding variable – “distorts” the truth of the study rate specific causes calendar year/midyear population x F
Infant mortality Sensitivity index of level of Deaths<1 y/o in a calendar yr/no. of
Measures of association rate health in a community LB in same yr x 1000
Correlation coefficient / Relationship btw 2 numerical characteristics, measures Neonatal mortality No. of deaths<28 days old in a yr/no.
pearson product moment only straight line relationship and does not imply rate of LB in same yr x 1000
correlation coefficient causation, value is independent of the particular units Post-neonatal No. of deaths<28 days old in a yr/no.
used mortality rate of LB in same yr x 1000
Spearman rank correlation / Describes relationship btw 2 ordinal characteristics, Maternal mortality Deaths due to diseases No. of deaths in pregnancy, delivery,
spearman’s rho [ordinal] used w/ numerical variables when their distributions are ratio directly related to puerperium in a calendar yr/no. of LB
skewed and there are outlying observations pregnancy, delivery and in same year x 1000
Relative risk [cohort] Ratio of incidence is exposed and non-exposed person puerperium
Odds ratio [case-control] Odds in favor of diseased among exposed individuals Proportionate Total deaths occurring in No. of deaths from particular cause of
mortality ratio particular population group population group in a yr / total deaths
INFERENTIAL STATISTICS or from particular cause in a yr x 1000
Approaches to statistical inference Swaroop’s index Sensitive indicator of the No. of deaths among those > 50 yrs
1. estimation standards of health care in calendar yr/total no. of deaths x
2. hypothesis testing 100
Case fatality rate How much of the afflicted No. of deaths from a specified
Estimation die from the disease cause/no. of cases of same disease
Point estimate Used to approximate population parameter Incidence rate Speed of development of No. of new case of disease
Interval estimate w/ upper and lower limit, used to determine degree of confidence a disease condition developing an a period of
Sampling designs time/population at risk of developing
 sampling – act of studying only a segment of population to represent the whole the disease during same period
 advantage: cheaper, faster, better quality, comprehensible Prevalence Proportion of existing No. of existing cases of a specified
 done for destructive procedures proportion cases [old and new],
useful in describing
disease/population examined x F
Population Entire groups of individuals of interest occurrence of chronic
a. Target population Representative information is desired to w/c inferences are made conditions
b. sampling population w/ which sample will actually be taken Dependency ratio [0-14 > 65 divided by 15-64 y/o ] x
c. elementary unit/element Measurement is actually taken when observation is made 100
d. sampling unit Non-overlapping collection of elements Population density Total population divided by area
e. sampling frame Collection of sampling units
g. sampling error difference between value of the parameter being estimated and the
estimates of this value based on different samples
EPIDEMIOLOGY
Criteria of good sampling design
 Study of the distribution, determinants of disease and other related conditions in
 sample is representative of whole population
human population and the factors that influence their distribution
 adequate sample size
ELEMENTS: Population, non-random distribution and factors responsible for such
 practicality and feasibility of sampling procedure distribution
 economy and efficiency of sampling design SCOPE
 Descriptive epidemiology – describes overall behavior of disease in particular setting
Probability sampling Non-probability sampling and time, amount and distribution of disease
Features Each unit has known non- Judgments play a role in sampling collection  Analytic epidemiology - use of prospective and retrospective studies in the analysis and
zero chance of being Can’t determine probability of each member investigation of health problems
included in a sample to be selected  Experimental epidemiology – studies the impact of varying some factors under the
Random selection investigators control
procedures VARIABLES: time, place, person
Types Simple random sampling Judgmental/purposive sampling BRANCHES:
Systematic sampling Accidental/haphazard sampling  Public health epidemiology – use of population distinguishes public health epidemiology
Stratified sampling Quota sampling from either biomedical sciences and clinical medicine
Cluster sampling Snow-ball techniques
 Clinical epidemiology – study of the determinants and effects of clinical decisions
Multi-stage sampling
EVIDENCE-BASED MEDICINE
 Test of hypothesis  Deals w/ generation of the best possible evidence from groups of subjects regarding
o α error – probability of rejecting a true null hypothesis efficiency and effectiveness of various clinical actions
o β error – probability of not rejecting a false hypothesis  Translate such evidence into rational clinical decisions pertaining to management of
 sex ratio = number of males to females individual patient
 age-dependency ratio – relates size of dependent segment of population to economically
productive group of population NATURAL HISTORY OF DISEASE
Stage of susceptibility Primary prevention Health promotion, specific
Vital statistical rates and ratios promotion
 counts – absolute no. of population or a demographic event Pre-symptomatic stage Secondary prevention Early diagnosis and
 ratios – relative size of 2 numbers treatment
 proportions – special type of ratio w/c the numerator is part of the denominator Stage of clinical disease Tertiary prevention Prevention of death and
disability
Stage of disability and recovery

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SP in – if test w/ high specificity is [+], then the disease is rued IN
SN out – if test w/ high sensitivity is [-], the disease is ruled OUT CLINICAL VS. PUBLIC HEALTH
Definitions
EPIDEMIOLOGY
Clinical epidemiology Public health epidemiology
Prepathogenesis Description of equilibrium, agent interacting in the environment
Focus of Individual patient [afflicted] Group of individuals [afflicted and
Pathogenesis Agent interacts w/ host observation non-afflicted]
Epidemic Group of illness of similar nature Observations Clinical manifestations [anatomic Mass phenomenon referable to
Endemic constant presence of a disease or infectious agent w/in an area lesion, clinical signs and whole group [type, extent and
Outbreak Infections symptoms] frequency of disease occurrence in
Cluster Uncommon relation to sex, age, etc.]
Incidence New cases among exposed susceptible [ex. diabetic foot] Objective To reach a clinical diagnosis and To reach epidemiologic diagnosis
Prevalence Existing cases [ex. DM] better understanding of the and better understanding of the
Sensitivity Ability to pick up or label as positive those who truly have the disease course of disease so that natural course of disease and the
Specificity Ability to pick up or label as negative those who truly do not have the dse adequate treatment may be given extent and significance of the
Predictive value The probability or chance that a positive or negative result is truly indicative to the individual to prevent problem so that adequate measures
[PV] of the presence or absence of the disease disease progression, disability or may be taken to institute prevention
[+] PV % of true positives among those who have the [+] result death at an early level
[-] PV % of true negatives among those who have a [-] result
Likelihood ratio Probability of [+] test for a person w/ disease divided by probability of [+] USES OF EPIDEMIOLOGY
test result for a person w/o the disease 1. explain local disease patterns
Receiver Used for tests that produce results along a continuous scale of 2. determine magnitude and impact of disease
operating cuve measurement 3. surveillance programs
Screening Use of test to detect presence of disease at an earlier time than it would be 4. know the natural history and clinical course of disease
detected in routine methods 5. identify causes of disease
Ultimate aims of epidemiology: prevention of disease and maintenance of health
Principles of screening INVESTIGATION OF EPIDEMICS
1. validity - refers to how closely they correspond to real or actual Refers to how closely Epidemic – occurrence of disease cases or deaths clearly in excess of normal expectancy
they correspond to real or actual 3 Premises of biologic laws
2. reliability / precision - ability of measuring device to give consistent results when  imbalance between disease agents and man
repeated observations are done  nature and characteristic of host and agent
3. yield – amount of previously unrecognized disease that is diagnosed and brought to  characteristic of agent and host on nature of the environment
treatment as a result of screening
Distorting principles – occurs when screening test detects slowly progressive disease that is less Factors considered before doing an extensive investigation of an epidemic
likely to cause a disease 1. severity of disease
1. lead time bias 2. mode of transmission
2. length-bias sampling 3. availability of preventive and control measures
Criteria for judging causal associations
 strength of associations TYPES OF EPIDEMIC
 dose-response relationship A. Common source - results from exposure to the same disease causing agent
 consistency of associations  Point source – cases were exposed to the same source during a brief period
 temporally correct associations of time
 specificity of association  Continuing source – intermittent point source
 coherence w/ coexisting information [biological plausibility] B. Propagated or progressive source – results from transmission of an infectious
Components of infectious disease process agent from susceptible host to another
 Infectious agents  Differs from point source in that it replicates in the host as part of transmission
cycle
 Intrinsic properties of agents
C. Mixed epidemics – involve both a single common exposure to an infectious agent
 Host-parasite interactions
and propagated spread to other individuals
 Pathogenic mechanisms
 Reservoirs TYPES OF EPIDEMIC CURVES [look for diagram]
 Mechanism of transmission of infections 1. Classical – common source, short ascending [rapid transmission], long
Host-parasite interactions descending [secondary cases]
 Infectivity - 2. inverted curve – long ascending, short descending, more complex
 Pathogenecity - transmission, longer IP [ex. malaria]
 Virulence – proportion of clinical cases resulting to severe clinical manifestations 3. bell-shaped curve – rapid ascending, rapid descending, rapid spread, simple
 Immunogenecity – ability to produce specific immunity transmission, rapid elimination of susceptible cases
4 types of carriers Attack of case rate – incidence express for a particular population when in special
 Inapparent throughout [ex. meningococcemia] circumstance or when an epidemic occurred
 Incubatory
 Convalescent COMMUNITY DIAGNOSIS
 Chronic carrier [ex. HBV, salmonella] 1. Definition of the Problem
Mechanism of transmission of infection  Determining the extent and magnitude of the problem
 Direct transmission  Comparison of rates and ratios; secular trend, with other places, with other
 Indirect transmission [vehicle, vector, airborne –droplet/dust] diseases
 Economic cost of disease; cost of early deaths, or disabilities, of treatment, of
prevention, etc.
DIFFERENT LEVELS OF DISEASE 2. Appraisal of Existing Facts
PREVENTION  Determining factors associated with the problem/disease
 State of knowledge of etiology (literature)
Level Type of prevention Goal of prevention
 Distribution of the disease/problem in terms of seasonal variation; geographic
Primary Modify the distribution of Prevent or postpone new occurrence of
distribution, persons affected
disease determinants in the disease
3. Formulation of Hypothesis
population
 Explanations for the existence and level of the disease/problem
Secondary Early detection of disease Improve prognosis of cases [shorten
4. Testing of Hypothesis
and subsequent treatment duration of disease or prolong life]
 Analysis of literature on population, environment and disease agents as well as
Tertiary Treatment and rehabilitation Reduce or prevent residual defect and
resources for health
dysfunction or prolong life [makes disease
5. Conclusion and Practical Application
outcome less severe]

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  Related to ability to pay for medical services and level of
Solutions to the Problem – provision of health services nutrition and education
OTHER CONCEPTS ON EPIDEMIOLOGY  State of Nutrition
 Study of disease occurrence in human population:  Communicable diseases more common among the
undernourished
 Lifestyle diseases more common among the obese
Distribution Determinants  Related to social class and ability to pay for medical services as
(Descriptive Epidemiology) (Analytic Epidemiology) well as level of education
 Is essentially the determination of causes or determinants of disease occurrence using one  Occupation
or more of the Epidemiologic methods or studies.  Existence of occupational diseases related to exposure to
Characteristics/Features of Epidemiology chemical and physical disease agents; among health
 It is a quantitative science workers to biological agents
 It is an applied science II. Investigation of Epidemic
 Its methods are generally observational Epidemic – the occurrence of a number of cases of a disease in excess of what usually
 Its focus is the group or community of persons prevails
 Its methods are systematic and orderly 1. Origin/Cause of Epidemic
I. Diseases Occurrence in Population -Descriptive Epidemiology New Disease
1. Level of Occurrence of Disease in Population  Introduction of disease to the community for the first time
 Absence of disease – no cases on record; disease absent from beginning;  Disease of lower animals affecting man for the first time
disease has been eradicated.  Disease is discovered for the first time
 Sporadic occurrence – occurrence of few and unrelated cases; stable relationship Old Disease
between agent and host in favor of the later, which is intermittently disturbed.  Introduction of a new strain of the disease
 Endemic occurrence – constant occurrence of disease.  Immigration of a large number of susceptibles
 Epidemic – occurrence of a number of cases of disease in excess of normal  Decreased resistance of the population due to catastrophe such as f
occurrence or expectancy. amine, earthquake, floods, etc.
 Increased virulence/pathogenecity of the agent
2. Descriptive Variables  Increased agent population
a. Time (Temporal Variation) 2. Type of Epidemic
 Secular Trend – long term fluctuation of disease occurrence over many According to Transmission
decades.  Common vehicle
 Declining Incidence Rate  Single exposure
 Improvement in preventive measure  Multiple exposure
 Expanding health service coverage  Propagated
 Declining Mortality Rate – Causes:  Contact-transmitted
 Declining incidence  Vector-transmitted
 Improvement in treatment According to Onset
 Changing population structures  Abrupt or explosive
 Changing method of recording cause of death  Gradual or slow
 Cyclic Intrinsic Variation – increase in number of cases more or less Types of Epidemic Curve
regularly every around five (5) years, due to accumulation of susceptibles  Classical – water-borne
through births; exhibited by diseases that confer long-lasting immunity  Point – food poisoning
 Seasonal Variation – fluctuation of disease occurrence during a year  Bell-shaped – contact transmitted
reflecting climatic (seasonal) changes  Inverted – vector-borne
 Epidemic – short term fluctuation of disease 3. Termination of Epidemic
b. Place  Exhaustion of susceptibles
 International Variation  Elimination of the agent
 Related to geographic variations as well as race, ethnicity and culture.  Closure of secondary transmission
 National Variations 4. Investigation of Epidemic
 Results from differences in socio-economic development as well as Definition of the Problem
cultural and geographic differences.  Verify the diagnosis
 Local Variations  Verify the existence of epidemic
 Related to environmental and access to health differences. Appraisal of Existing Facts
c. Person  Orient the epidemic as to time
 Age  Orient the epidemic as to place
 Different diseases have different age patterns  Orient the epidemic as to person
 Magnitude decreasing with age
- Disease confers long lasting immunity Formulation of Hypothesis
 Magnitude increasing with age  Formulate hypothesis as to mode of transmission
- Degenerative diseases
 Formulate hypothesis as to circumstances that gave rise to the epidemic
 Magnitude high at both extremes of age
Testing of Hypothesis
- Reflects low resistance of the young and the old
 Examination of suspected/identified source(s) of causative agent
 Magnitude height in middle age bracket
- Reflects great exposure to disease during the middle age
Conclusion and Practical Application
 Solutions or measures depend on the source of agent and mode of
 Sex
transmission
 Sex differential because of sexual constitution/make-up
 Immunization
 Greater exposure of males
 Closure of transmission
 Greater health consciousness of females
 Destruction of agent by treatment of cases, disinfection of
 Early consultation, diagnosis and treatment
inanimate source or destruction of animal sources such as
 More cases recorded vectors and animals.
 Civil Status Analytic Epidemiology
 Different risk factors, e.g. Principal Uses of Epidemiologic Methods
- Married – higher cervical Ca 1. Community Diagnosis
- Single – higher breast Ca 2. Investigation of Epidemic
 Greater family support among the married 3. Determination of Disease Etiology
 Social Class 4. Evaluation of Community Interventions and Programs
 Communicable diseases more common in lower class Epidemiologic Methods
 Lifestyle diseases more common in higher class 1. Definition of the Problem
2. Appraisal of Existing Facts

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3. Formulation of Hypothesis  These are essentially cohort studies except that the groups being studied
4. Testing of Hypothesis differ from each other only in the presence of a characteristic or exposure to
5. Conclusion and Practical Application some factor that is artificially induced.
Determination of Disease Etiology through Epidemiologic Research Types of Experimental Studies
Types of Epidemiologic` Studies a. Field/Community Trials – the selection of a population and the determination
1. Descriptive Studies – concerned primarily with the determination of distribution of disease in of its necessary size depend on prediction of incidence of the disease. [e.g.
terms of variables. field trials of immunizing agents]
Descriptive of: (to find clues to causes of disease) b. Clinical Trials – the expected incidence of the disease or unfavorable outcome
 Person – age, sex, civil status, ethnic group, etc. (e.g. death) and estimates of differences in outcome in the different groups is
 Place – international, local, national, urban, rural, etc. required for the determination of sizes of the groups. [e.g. therapeutic/surgical
 Time – secular, cyclic, intrinsic and extrinsic (seasonal variation), epidemics trials]
Other uses of Descriptive Studies: Other requirements:
 Delineation of the syndrome as a disease entity a. high incidence of the disease under study
 Establishment of the natural history of the disease b. availability of facilities for observation
 Classification of the disease; manifestation (pathologic and symptomatic) and c. accessibility of subjects of study
experimental (etiologic) d. availability of medical/health resources for precise diagnosis and adequate follow-up
Types of Descriptive Studies: Procedure of Establishing Cause of Disease
a. Mortality Studies 1. Determine if statistical association exists between the suspected factor and the
 Official mortality statistics alleged effect (disease).
Criteria of statistical association:
 Hospitals, morgues, etc.
 Incidence of the effect among the exposed  incidence among not exposed
 Special studies
b. Morbidity Studies  Prevalence of the factor among the diseased  prevalence among non-diseased
 Case series  Linear correlation in terms of correlation coefficient
- hospital 2. If there is, the association could be:
- pathological materials: smears, biopsies  Merely due to chance, hence, chance association or sampling variation.
- special groups  Due to some extraneous or confounding variables, hence, indirect or even
 Registers spurious/ artifactual association
- Hospital based  Applicable to other populations
- Population based  A cause and effect relationship or causal association
2. Cross-Sectional or Survey Studies 3. To handle the above issues:
 To identify risk factors/cause of disease  To determine if it is due to chance, do a significance test
 Ad Hoc Surveys  To handle extraneous and/or confounding variables
- Case finding - by prevention, appropriate matching of subjects and controls
- “Safari or fishing expeditions” - by specification, analyze by small specific groups
- special surveys to establish incidence and prevalence - by adjustment/standardization (direct or indirect)
3. Analytic Studies  To be certain to which population the association applies, specify from the
 Concerned primarily with determining causes of disease occurrence, specifically whether beginning the population involved.
a suspected factor is causally associated with disease using observational methods of  To determine if the association is causal, see next heading
testing hypothesis or cause. 4. Determine if the association is causal:
Criteria of causality:
Common Types of Analytic Studies a. Strength of Association
 Cohort  Relative Risk – ratio of incidence of effect or disease among exposed to
 Case-control incidence among unexposed
 Experimental  Odds ratio = a x d / b x c
1. Cohort – those in which the groups to be studied (cohorts) are defined in terms of whether b. Temporality
they are or are not exposed to the suspected factor; are followed for a period of time to  Time Sequence – exposure antedates the effect
determine the frequency (incidence) of the alleged effect (disease) among them c. Dose-Response Relationship
(exposed and not exposed).  gradient exposure and occurrence of disease
Two sub-types: Concurrent Cohort and Non-Concurrent Cohort d. Specificity
a. Concurrent – cohort studies in which the investigator follows up the cohorts from  suspected causal factor associated with only 1 or limited number of
exposure to the occurrence of the effect (disease). diseases
b. Non-concurrent – cohort studies in which both exposure and the effect have occurred e. Consistency of Findings
prior to the time of investigation.  Risk factor and disease have similar distribution according to time, place
2. Case-control Studies – those in which the study groups are defined or selected in terms of and person variables
whether they do have (cases or do not have controls) the effect or disease. f. Biologic Plausibility
 Consistency with existing knowledge on causation of the disease
The proportion with history of exposure to the suspected factor (prevalence) is determined in each
group and compared for presence of association.
1. Principles of Adult Learning
Cohort Studies
2. Preparation for a health education activity
Advantages
 know the audience
 Provide direct estimate of risk and with greater accuracy.
 set the objectives
 Less bias of recall of exposure.
 identify the barriers to achievement of objectives
 Controls easier to assemble.
 choose the methods of communication
 Change in subjects more easily ascertained.
 develop the communication materials
Disadvantages
 formulate the evaluation instrument
 More expensive in time (long follow-up) and resources.
3. Social preparation for the activity
 Inefficient if not impossible for rare diseases.
Social Mobilization
Case Control Studies
 a tool for enabling people to organize themselves for collective action by
Advantages
- pooling resources
 More economical in time and resources.
- building solidarity
 May be used even in rare diseases.
 empowers people and enables them to initiate and control their own
Disadvantages development
 Estimate of risk is indirect.
 a requirement of community advancement, resolving problems and achieving
 More bias of recall of exposure. common goals
 Controls more difficult to assemble. Community mobilization is a continuous process consisting of the following:
1. Sensitization, orientation and development of awareness
3. Experimental Studies The community is sensitized to and oriented on the objectives, concept, philosophy
 Primarily concerned with testing hypothesis of cause and process of the approach.

7
2. Motivation and social preparation b. External temperature – subtract or add 3% for every oC over or below
A stimulus and response process that involves the inducement of the people to contribute 10 oC
effectively and efficiently towards the assigned tasks. c. Physiologic state such as pregnancy, lactation, etc.
3. Organizational development d. Pathologic conditions such as fever, nephritis, etc.
The community is helped to become organized and develop networks to formulate collective e. Weight
and coordinated actions. *Proportion of essential nutrients:
4. Capacity-building a. Carbohydrates – 50-70%
Capacity building and training of the community leadership is a part of their empowerment b. Fat – 15-20%
to take up a new role and manage the programme. c. Protein – 15-30%, allowing about 1 gm/kg body weight
5. Bringing allies together
Intersectoral departments, organizations, stakeholders, opinion makers and political 3. Personal Cleanliness
leadership should be mobilized to foster partnerships and collaborative action towards the 4. Protection from external forces, injuries, infectious agents, etc.
goal of community development. 5. Proper personality development, development of healthy social life and sexual
life
6. Sharing information and communication B. Specific Protection Against Diseases
Important information about the developments in the program area. 1. Prophylactic Measures
7. Support and Incentives a. Immunization against communicable diseases
Technical support should be a continuous process to make the change effective and Use of immunizing agents categorized into:
sustainable.  For infants
8. Generation of resources  Following exposure
The creation of capital through mobilization of community savings, profit sharing and  For persons subject to unusual risk
contributions.  For travel
9. Focus for socio-economic development  For cases
Entails translating concept into reality. b. Chemoprophylaxis – administration of drugs to prevent occurrence of
Change sill comes about through multiple actions and practical interventions focused on infection, e.g. penicillin vs. gonorrhea and syphilis, antimalarial drugs,
specific objectives and the overall goal. INH vs tuberculosis, installation of penicillin in eyes of newborn vs.
10. Keeping up morale and pace to attain the goals gonorrhea.
Technical services team in the CBI area should continuously support the communities in c. Mechanical prophylaxis – placing mechanical barriers between course
order to maintain morale, continuity and the social mobilization process. of agent and host interaction, such as welder’s mask, use of mosquito
11. Community empowerment net.
Efforts towards becoming more self-sufficient in decision making and designing strategies 2. Control of the Environment
for their own future. Environmental sanitation
12. Self-sufficiency  The control of all these factors in man’s physical environment which exercise
Ultimate objective of social mobilization and community empowerment is attaining a or may exercise a deleterious effect on his physical development, health and
sufficient level of self-sufficiency. survival.
 Include public health activities in housing, water sanitation, waste disposal, air
HEALTH ACTIVITIES AND SERVICES pollution, food and milk sanitation, vector and vermin control, occupational health,
Principles and Strategies of Prevention and Control of Diseases radiation and accident hazard control, etc.
1. Levels of Prevention a. Housing Sanitation – sanitation of building used for human habitation. Poor housing
a. Primary Prevention – to prevent initiation of disease (Health Promotion, Specific contributes to ill health.
Protection)  Acceptable house must:
b. Secondary Prevention – to prevent progression of disease (Early Diagnosis,  Satisfy fundamental physiologic needs thru:
Disability Limitation) - Adequate space – at least 50 sq.ft. per person for the bedroom
c. Tertiary Prevention – to prevent serious outcome and complete dependence - adequate heat and ventilation
(Rehabilitation) Temperature – 20oC – 25oC
2. Strategies of Prevention Air movement – 15-25 ft./min
a. Population Approach Humidity – 50-80%
b. Risk Approach - lighting – intensity of illumination vary with activity, at least 100 ft.
candles for reading
I. PRIMARY PREVENTION - noise – not more than 30 decibels
Techniques of Disease Prevention and Control - water supply – for domestic use: 15-20 gallons per capita per day
Whether a disease is communicable or not, infectious or non-infectious, the cycle of disease - sanitary toilet facility
generally may be broken by: - vermin control
a. increasing host resistance - food storage
b. destruction of the agent in the environment - fire protection – proper electric wiring, refuse disposal, two exits
c. destruction of the agent in the source/reservoir of infection - protection against accidents
d. avoidance of exposure  satisfy fundamental psychological needs thru:
A. Health Promotion - Privacy – for sleeping, dressing, etc.
Increasing host resistance is achieved by general health promotion or personal - cleanliness and presence of convenience
hygiene and increasing resistance to specific diseases by immunization, chemoprophylaxis, - provision for normal family life
and mechanical prophylaxis. - provision for normal community life
Personal Hygiene include all activities to ensure body fitness which refers to proper  Characteristics of substandard housing:
development and vitality of musculo-skeletal, circulatory, respiratory, digestive, excretory,  water supply – none or contaminated; in city source is outside house
nervous, integumentary, and reproductive systems.  toilet – none or shared with other families; in city toilet is outside
1. Exercise, Posture, Rest, Relaxation, and Sleep dwelling
a. Exercise is necessary not only to strengthen the muscles but to keep the vitality  bathroom – none or shared or outside
of all organ systems. A sedentary life is injurious to health. Exercise must be  overcrowding esp. in sleeping room
adapted to age, sex, occupation, climate and the individual.
 lack of dual exits
b. Posture. A good posture consists of alignment of the parts of the body, in
 insufficient window area
relaxation rather than tension and in readiness for action, and should prevent
development of skeletal deformities.  serious disrepair or deterioration of house
c. Rest, relaxation, and sleep. The normal cycle is activity – fatigue – rest. When b. Water Sanitation – single most important preventive measure against diseases.
fatigue ensues, rest restores the individual to normal. Relaxation is necessary to More filtration of water reduces mortality not only of water-borne diseases but
keep or reconstruct the individual’s attitude and mood within normal limits. Sleep, mortality from other diseases (Mills-Reincke Phenomenon).
which is essential to life, is one of the best ways of resting.  Examination of water
2. Nutrition - refers to the proper intake and utilization of food.  Field Survey - to assess the situation of the watershed
 Adequate intake – basic requirement for Filipino adult is 2200 calories per day;  Laboratory analysis – for portability of water
adjustments: - physical – turbidity, color, taste, and odor
a. Age – subtract 5% for every 10 years over 25 years - chemical – pH, alkalinity, total solid, chlorides, hardness and iron

8
 - Bacteriological – the most important single test. Presence of coliform Air Pollution – introduction into the atmosphere of substance injurious to health or relatively
indicates fecal contamination harmless substances in such quantities that they may create a nuisance.
- biological – microorganisms responsible for bad odor and taste  General effects of air pollution
- radiological – done only for water receiving wastes from nuclear  Damage to health
installation or radioisotope lab  Irritation of eye, ear, nose and throat
 Water Purification  Damage to plants and animals
 Household treatment – boiling, filtration, chemical disinfection, storage  Objectionable odor
 Public water supply  Reduced visibility which may cause accidents
- basic – coagulation, sedimentation, filtration, disinfection  Damage to buildings, clothing, etc.
- others – aeration, softening, fluoridation  Sources of air pollutants
*residual chlorine – 0.1 ppm, to insure bacteriological safety of water  Motor vehicles
 Well  Industries
 Major water supply in rural areas  Power plants
 Should be located higher than and at a distance (100 ft) from source of  Burning of refuse
pollution
 Fires and volcanic eruptions
 Should be constructed only in places with sandy loam and not in clay or
 Radioactive explosions
limestone
 Factors favoring air pollutions
 Distribution of water
 High population density
 Part of urban water system
 Prevalence of heavy industries
 Must be adequate and well maintained to avoid water contamination
 Temperature inversion
and wastage
 Pollution and contamination of water  Humid, warm, slow-moving air
 Impairment of physical, chemical and bacteriological qualities of water  Mountain around a valley
Contamination – presence of deleterious chemicals and/or  Prevention of air pollution
microorganisms in water  Minimize production of waste
c. Proper Waste Disposal  Remove waste at source by filters, collectors, etc.
1. Sewage and Excreta should not:  Discharge waste into air through high stacks
 Contaminate drinking water, water used for culture of: shellfish and marine life and for  Proper zoning in town planning
recreational purposes  Build plants in elevated places and/or near extensive water surfaces
 Contaminate soil to prevent spread of intestinal parasites e. Food and Milk Sanitation
 Be accessible to flies, insects, rodents, etc.  Objectives of food sanitation
 Qualities of a good toilet  To insure consumption of safe and wholesome food (prevention of food-borne
- sanitary infections and food poisoning)
- simple and easy to construct  To prevent sale of food offensive to purchaser or of inferior quality (prevention
- economical and durable of adulteration)
- accessible and acceptable to users  To reduce spoilage and wastage of food
- easy to maintain  Types of food-borne diseases
- provide protection and privacy  Food-borne infections – caused by living organisms such as bacteria, viruses,
 Recommended systems of excreta disposal parasites, etc.
- rural areas – water-sealed, sanitary pit privy  Food poisoning or intoxication – caused by bacterial toxins, chemicals, or
- suburban – septic tank system naturally occurring poisons
- urban – sewerage system, separate type  Food technology for preservation
Other types:  Drying, dehydration and evaporation
- cathole  Refrigeration at 0-4oC
- straddle trench
 Cooking, boiling, sterilization
- antipolo type
 Smoking
- bored hole
- chemical toilet  Radiation
- pail system  Addition of preservatives
- overhung latrine  Salting
- oxidation pond  Pickling or souring
 Sewage treatment processes  Sugaring
- separation of large solids  Canning
- sedimentation and anaerobic decomposition  Essentials of food establishment sanitation
- aerobic decomposition  Healthy food handlers
- disinfection  Safety of food and drinks
 Final disposition of the effluent  Adequate clean water
- dilution in body of water  Lavatory facilities
- land (surface or subsurface irrigation)  Sanitary toilet
 Adequate lighting and ventilation
2. Refuse – solid and semisolid other than excreta; handling covers:
 Adequate food storage and refrigeration
 Essentials of sanitary milk production
 Storage in garbage cans with tight cover
 Healthy cows
 Adequate collection in trucks with cover
 Proper disposal  Clean milking barns
 Individual disposal  Adequate storage
- burying  Adequate clean water
- burning  Proper waste disposal
- animal feeding  Healthy milk handlers
- composting  Sanitation of milking equipment
- garbage grinding  Pasteurization
- dumping on land or water  Examination of milk
 Community disposal  Physical – for total solids, butterfat
- sanitary landfill  Chemical – for suspected preservatives added
- incineration  Bacteriological – plate count, direct microscopy
- composting  Others – reductase test, phosphatase test
- dumping  Ways by which food may be adultered
d. Control of Air Pollution  Mixing other substances to increase bulk
 Conceiling inferior quality

9
  Abstraction of an essential ingredient  Workmen’s Compensation Law requires employer to compensate employee
 Addition of poisonous substances who suffers injury or contracts disease directly caused by such employment.
 Selling of partly decomposed products
 Misbranding or mislabeling II. SECONDARY PREVENTION
f. Insect Vector and Rodent Control A. Preventing Progression of the Disease Process
Insect Control  Achieved by diagnosing the disease early and promptly initiating treatment
 Disease may be caused by insects directly by (a) hypersensitivity to bites or allergy to hair 1. improve utilization of services through health education
or scales, and (b) infestation or direct invasion by mites or parasitic larvae; or (c) indirectly 2. screening and case finding activities
by acting as a vector. 3. periodic health inventory
Vectors – arthropods or other invertebrates which transmit infection by inoculation into or 4. provision of medical care services
through the skin or mucous membrane by biting, or by deposit of infective materials on the B. Limiting Disabilities from Disease
skin or on food or other objects.  Permanent disabilities and deformities may be minimized by intensive
Types of Vector: care in the hospital with specialist service.
 Mechanical
 Biologic – as biologic vector the insect may be the definite host or III. TERTIARY PREVENTION
intermediate host of the agent A. Rehabilitation
 Control  Restoration of the disabled to useful place in society with maximum use of
Transmission of insect-borne diseases has 3 links: his remaining capabilities.
- sick person  Correction of deformities, physical therapy, retraining, placement, etc.
- vector
- well person DELIVERY OF HEALTH SERVICES
 Defensive measures – directed at the well person include: Definition of Terms
- protective clothing 1. Preventive Medicine
- repellants  Branch of medicine concerned with the prevention of initiation of disease
- use of nets or screens (conventional definition)
- avoidance of places with insects  The art and science of preventing diseases, promoting health and prolonging life
 Offensive or attack measures – directed towards control of the insect population (broad definition)
- Naturalistic or environmental control – proper waste disposal, drainage or flushing or 2. Social Medicine
stagnant water, damming, control of water, level, etc.  Branch of medicine that emphasizes the role of the environment in health and
- Mechanical control – fly paper, swatting, catching, etc. disease.
- chemical control – larvicide’s and insecticides 3. Public Health
- biologic control – release of sterile male insects  The art and science of preventing disease, promoting health and prolonging life
Rodent Control through organized community effort.
 Rodents cause harm by serving as reservoir of infection for plague, Weil’s disease, murine  The organized and systematized approach to the provision of health services.
typhus, rat-bite fever, salmonellosis, etc., and by destroying food, clothing, furniture’s, etc. 4. Community Medicine
 Control Measures  The branch of medicine concerned with the identification and solution of health
 Killing – poisoning, trapping, fumigation problems in groups of people in contrast to the identification and solution of
 Rodent stoppage and rat proofing – elimination of rodent entrance and avenues health problems in individuals.
 Environmental sanitation – cleanliness and proper waste disposal to deny rodents of
food Systems of Health Care Deliver
A. According to Method of Financing
3. Occupational Health 1. Socialized Medicine
Occupational Health (also occupational medicine or industrial hygiene) is the sum of all  Financed by general taxation
efforts to improve the health of workers.  Preventive oriented
a. Objectives of Occupational Health  Most regimented form
 To prevent the occurrence of occupational diseases and injuries 2. Compulsory Health Insurance
 To minimize the progression of any disease or injury Financed by payments/subscriptions to health insurance required by law
 To utilize maximally residual capacities Curative oriented; a separate public health system
 To promote the optimum health and well-being of the worker Complements the health sectors
b. Occupational diseases and injuries 3. Voluntary Health Insurance
 Chemical agents – dusts, gases, vapors, fumes, mists Financed by premiums to health insurance: not required but encouraged by
 Physical agents – abnormal pressures, extreme temperature or humidity, noise, the state
radiation, electricity Usually privately managed plan
 Mechanical agents – movements of machine, parts, cutting instruments Curative oriented; complimented by public health system
 Infectious agents – bacteria, fungus, parasites 4. Free Enterprise
c. Prevention and control of occupational diseases and injuries “No system” system
 Safe and healthful working conditions Curative care financed by individuals privately
- proper building design Public health system usually exist for preventive medicine
- Pleasant and safe work place in terms of space, ventilation, temperature, B. Organization
pressure, sound, lighting, color, etc. 1. Separate delivery of preventive, curative and rehabilitative
- safe design of machines and tools services
- control of chemical and physical factors in the plant 2. Comprehensive medicine – united approach in providing preventive, curative
 Control of personal causes of injuries and rehabilitative services
- placement of workers according to their age, sex, ability and physical and Health Resources
mental limitations A. Individual
- removal of stresses and related factors B. Organized Agencies
- promotion of good human relations 1. Official of government
 Provision of medical services 2. Private
- pre-employment and periodic medical examinations a. voluntary – financed by contributions, personnel are responsible only to
- health education and other preventive measures the officers, not under government control
- treatment of occupational and non-occupational diseases b. for profit organizations
d. Legal control of occupational health service Principles of Administration
 Administrative Code, Sect. 938 charges the Bu. Of Health with the protection of the Elements of Administration
health of the workers. Sound structure or organization with:
Well defined units
 The Woman and Child Labor Law (R.A. 679 and 1131) regulates employment of
Well defined functions
women and children in industries.
Good management
 R.A. 1054 provides for free emergency medical and dental assistance to laborers in
Functions of Management
industries.
1. Planning involves:

10
  Definition of problems o Control of communicable disease
 Setting of objectives o Immunization
 Choosing the course of action to take o Heath education
2. Organizing – setting up the structure o Maternal and child heath and family planning
 Listing and grouping of necessary tasks and activities o Adequate food and proper nutrition
 Establishing units for all groups of tasks and activities o Provision of medical care and emergency treatment
 Establishing relationships of units o Treatment of locally endemic diseases
3. Staffing involves o Provision of essential drugs
 Formulating job description and qualifications  4 cornerstone/pillars of PHC
 Hiring and training of personnel o Active community participation
 Promotion and retirement of personnel o Intra/inter-sectoral linkages
4. Directing o Use of appropriate technology
 Guiding the performance towards the institutional goals and objectives o Support mechanism made available
 Supervision of personnel; may use tools of:  Services should be: promotive: preventive, ax and tx, rehabilitative
 Delegation of responsibility with corresponding authority and  Levels of PHC workers: village or barangay health workers and intermediate health
accountability workers [MD, PHN, RSI, MW]
 communication  Traditional and alternative health care practice
5. Analyzing o Herbals
 Periodic review of performance and accomplishments o acupressure
 Guiding performance back on tract
 Reproductive health: state of complete physical, mental and social well being and not
6. Controlling
merely absence of disease or infirmity
 Regulating expenses o Elements:
7. Budgeting
 Maternal and child health and nutrition
 Preparation of budget
 Family planning
8. Reporting  Prevention and management of abortion complications prevention and management of
 Preparation of report of performance after every cycle reproductive tract infections [STD, HIV, AIDS]
Components of Health System  Education and counseling on sexuality and sexual health
1. Organization  Breast and reproductive tract cancers and other gynecological conditions
 Administrative Organization  Men’s and adolescent reproductive health
 Levels of Management  Violence against women
 Powers and Responsibilities of Each Level  Prevention and treatment of infertility and sexual disorder
2. Regulation  Maternal and child health: mother and child relationship to one another and
 Health Human Resource Production consideration of entire family as well as culture and socioeconomic environment
 Licensure and practice
 Health Facilities: Hospitals, Clinics, Laboratories PRIMARY HEALTH CARE IN THE PHILIPPINES
3. Production Definition of terms:
 Health Professionals and Workers 1. accessibility – continuing an organized supply of care that is geographically,
 Science and Technology financially, culturally and finally w/in easy reach of the whole community
 Equipment, Reagents, Medicines, Supplies, etc. 2. geographical accessibility – the distance, travel time, and means of
4. Financial Support transportations are acceptable to the people
 Taxation 3. financial accessibility – whatever the methods of payment used, the services can
 Insurance Premium be attended by community
4. cultural accessibility – that financial and managerial method used are in keeping
 Contributions, Donations, Foreign Aid
w/ cultural patterns of community
 Direct Payment of Patients
5. functional accessibility – that the right kind of care is available on a continuous
5. Delivery
basis to those who need it whenever they need it, and that is provided by the
 General Population health team required for its proper delivery
 Employed People – Private, Government AIMS OF PHC
 School Community – Students, teachers, etc. 1. to mobilize the community
 Military Personnel 2. to maintain good health
3. to serve as channel for total delivery of health
Strategies of Delivery of Services  Ultimate aims of PHC are to develop self-reliance in individuals, families and
A. Population Approach communities.
Health services are provided the community emphasizing primary prevention. The basic ELEMENTS OF PHC
services are: 1. education concerning and understanding of prevailing health problems
1. Vital statistics 2. promotion of adequate food supply and proper nutrition
2. Medical Care 3. adequate supply of safe water and basic sanitation
3. Environmental Sanitation 4. maternal and child health [family planning]
4. Control of Communicable Disease 5. immunization against major infectious disease
5. Maternal and Child Health 6. prevention and control of locally endemic disease
6. Health Education and the Public 7. treatment of common disease and injuries
7. Public Health Nursing 8. provisions of essential drugs
8. Laboratory Services COORDINATION MECHANISM FOR PHC
9. Control of Chronic Diseases 1. At national level – Social Development Committee [SDC] of NEDA shall be
10. Mental Health the control of coordinating body
B. Risk Approach 2. At regional level – Regional Development Council shall serve as coordinating
Identification of high risk individuals who are then provided specific preventive measures body of PHC program in the region
against the discovered risk factors. 3. At local level – provincial, municipal, and barangay development councils
Usually undertaken through periodic health inventory in special or captive groups. shall serve as coordinating, monitoring, and evaluating bodies for their
C. Primary Health Care and Traditional Care respective levels
LEGAL BASIS OF PHC
 LETTER OF Instruction no. 949 provides the legal basis for officially adapting PHC
PRIMARY HEALTH CARE as the approach providing the basic need of the community.
 Essential health care made universally accessible to individuals and families in community by  It gives DOH the mandate to design, develop, and implement program w/c focus on
means acceptable to them, thru their full participation and at a cost that the community and health development at community level [rural areas]
country can afford at every stage of development PHC ACTIVITIES THAT ARE UNDERTAKEN AT BARANGAY LEVEL
 Components:  Social preparation and organization of barangay for PHC
o Environmental sanitation  Survey of basic health, social and economic needs

11
  Health related activities 4. Reduction of demands for curative care.
BARANGAY HEALTH SERVICES
 Periodic medical consultation services on barangay
 Preparation of site where doctor shall conduct check-up and other services in the absence
Comparison of Traditional Health Care
of formal health facility System and Primary Health Care Approach
 Ensuring availability of appropriate medicines and supplies Traditional health care system Primary health care approach
ROLE OF HOSPITAL IN PHC Heath system separate from other Functions best thru intersectoral
 Support health activities undertaken at community level sample program of lab treatments government departments cooperation
 Accept and follow-up referrals from the community level Emphasis on curative medicine using Emphasis on promotive and preventive
 Support necessary training needed at community level treatment and drugs, doctors and care [sanitation, education,
 Support development of appropriate technology for health at the community level hospitals, health centers immunization, nutrition]
DIFFERENT ASPECTS OF HEALTH Emphasis on high tech and Emphasis on common technology at
 Health – condition of body and mind of a person wherein all parts and systems function specialization risk groups and child survival
effectively without disturbances. Auxillaries are assistant/substitute of Auxillaries are main agents of health
 It means physical, mental and social well-being of a person, and not only absence of a doctors promotion and of change
disease Health is seen as technology from Health promotion is a family and
1. Physical health – condition w/c enables a person to maintain strong and healthy body outside community activity
2. Mental health – made of emotional and attitudinal health, refers to a way a person thinks Discourages traditional medicine and Encourages traditional medicine and
of himself, controls and adjust his emotions, deals w/ family, friends and neighbors. ignores cultures culture
3. Social health – way how a person feels, thinks and acts towards everybody around him. Is expensive w/ strong bias towards Is less expensive, w/ bias for equal
How he carries himself in the community. urban areas and hospitals distribution, rural areas and urban poor
5 STAR DOCTOR [WHO] QUALITIES Often paid for by central government Partly supported by community self-
1. Care-giver finance reliance
2. Communicator Causes the patient to be dependent on Helps the individuals and community to
3. Decision-maker doctor, nurse and health services become more capable of looking for
4. Educator themslves
5. Collaborator

OTHER CONCEPTS ON PRIMARY HEALTH CARE

Intent: OCCUPATIONAL HEALTH
Equal Access to Health Care  Science that deals w/ relationship of man to his work and working environment
Self Reliance in Health  Aim: adaptation of work to man both physically and mentally
Spirit:
Community Participation Industrial hygiene
Collaboration and Linkage  Deals w/ recognition, evaluation, and control of environmental factors arising from
Essential Health Care workplace w/c may impair health
Characterized  3 steps: recognition, evaluation and control of occupational health hazards
 Community-Based
 Accessible Occupational Health Hazards
 Acceptable  Workplace condition or factors in work environment that impair health
 Affordable
 Participatory Environmental factors to w/c workers may be exposed to: chemical, biological, physical and
Component/Elements ergonomic factors
E – Education Environmental provisions
L – Local/Endemic Disease Control  Control of atmospheric contaminants
E – Expanded Program of Immunization  Control of infectious agents
M – Maternal and Child Health  Control of possible sources of radiation hazards
E – Essential Drugs  Noise
N – Nutrition  Illumination
T – Technology Transfer  Ventilation
S – Sanitation Routes of entry of diseases:
 Skin absorption
Approach
 Inhalation
Utilizes following strategies
 Partnership between government and private  Ingestion
Degree of exposure or severity of effect is determined by:
 Integration of preventive and curative
 Nature or type of materials/substances
 Linkage with other sectors, e.g. children, livelihood, public works, etc.
 Duration – length of exposure
 Use of village health workers
 Intensity – amount of exposure
 Cooperation with traditional medical system
 Individual susceptibility
 Community organizing
CHEMICAL AGENTS
After Alma Ata
1. toxic dust [lead, mercury] or fibrosis-producing dust [silica, asbestos]
Health
2. fumes [NH4Cl]
 Not a result of medical intervention
3. mists [from electroplating]
 But a product of inter twinning economic, socio-political and cultural 4. vapors [toluene, trichloroethylene, CCl4, mercury]
circumstances 5. gases [CO, NH3, H2S, NO2]
Development PHYSICAL AGENTS
 Not measured by investments on infrastructure 1. electromagnetic radiation [welding and UV generators]
 But by the quality of the people’s lives  ionizing, UV light, infrared, microwave, visible light
Socio-economic structure 2. noise
 Characterized by inequities and dual economy to 3. extremes of temperature and humidity
 One characterized by equality and greater distribution of wealth 4. abnormal air pressure
Role of the community 5. vibration and shock
 From passive recipient to BIOLOGIC AGENTS
 Actively sharing responsibility for the maintenance of its own health 1. slaughterhouse workers and farmers handling infected swine’s and goats –
Some Indicators of Health Development in PHC undulant fever
1. Proportion of population with access to basic health services. 2. grain handlers – farmer’s lung
2. Existence of active community organization for health. 3. engineers, farmers, lifeguards – athlete’s foot
3. Level of community self-reliance in health.

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ERGONOMICS 1. acclimatization – physiological and psychological adjustments that occur during
 Science that deals w/ interaction between man and his total working environment [ex. heat, 1st weeks or so of exposure to hot environment
light, sound] 2. habituation – altered sensation in unchanged stimuli characterized by
 It takes consideration the total physiological and psychological demands of job upon the disappearance of pain by immersing hands in cold water following repeated
worker [ex. tools, work areas, lifting or reaching, repeated motions in awkward position] exposures
NOISE 3. behavior adaptation –make use of clothing and shelter to minimize exposure
 Unwanted sound  clinical disorders:
 Transmitted to ear in the form of pressure wave in air A. Heat-induced disorders
1. Heat stroke – most serious, unable to cope w/ excessive heat load
 Threshold limit values for noise 2. hat exhaustion – characterized by clammy, moist skin, weakness, fatigue,
Duration per day Sound level [dBA] anorexia, NAV, headache, gliddiness and muscle cramps
[hours] 3. heat cramps – characterized by painful spasms of skeletal muscles
16 80 4. heat hyperpyrexia – consequence of partial failure of sweating mechanism,
8 85 mild heat stroke
4 90 5. heat syncope – pooling of blood in peripheral body areas by attempt to
2 95 dissipate heat load
1 100 6. heat rash / prickly heat – from prolonged exposure of skin to hot or humid
 No exposure is allowed to continuous intermittent excess of 115 dBA. conditions
7. anhidrotic heat exhaustion – characterized by numerous discrete vesicles
 Threshold limit values for impulsive or [millaria profunda] in skin especially on trunk and proximal parts of limbs
B. Cold-induced disorders
impact noise 1. Hypothermia – most serious, progressive lowering of body core temperature
Sound Permitted number of impulses or from its normal [37 C / 98 F] to 26.7 C / 80 F or below where
level impacts per day unconsciousness followed by death occurs
140 100 2. frostbite – occurs during exposures to temperatures well below freezing and
130 1,000 is the result of actual freezing, damage can vary from mild superficial tissue
120 10,000 damage and gangrene
3. Immersion foot – result of prolonged exposure to cold water and occurs at
 Decibels peek at sound pressure level: re 20 uPa air temperature above freezing point, sx: numbness, edema, hyperemia,
 Sources of noise: industry [most serious], road and air traffic, sonic boom anhidrosis, and gangrene
VIBRATION AND HEALTH EFFECTS 4. Trench foot – is a “wet / cold disease” resulting from exposure to several
 Vibration – physical factor w/c acts on man by transmission of mechanical energy from days to moisture at or near freezing point.
sources of oscillation LIGHT
 Subdivided into: general/whole body vibration and local vibration  light is an electromagnetic radiation
1. whole body vibration – acts on body on sitting or standing thru supporting surfaces  velocity of light
Subdivision by source: o 186,000 miles/second in air
 transport vibration – due to o 140,000 miles/second in water
locomotion o 124,000 miles/second in glass
 mixed technical and transport  Function of eyes
vibration – by machines in fixed position 1. accommodation – lens
 technical vibration – by stationary 2. control amount of light – pupil
machines or transmitted to workplaces w/o vibration source 3. color vision – fovea
2. Local vibration – transmitted to hands and arms 4. convergence – lens and eye muscles
Subdivision by source: Color sensitivity
 pneumatic – rock drills and pneumatic picks in quarrying  more sensitive to green and yellow, less to blue and red
 engine powered – chain saw in logging  increases w/ age [3x more sensitive at 40-49 y/o and 7-10x in 50-70 y/o]
 electrical – hammers, grinders in mechanical engineering Defects of vision
Vibration disease 1. Emmetropia – image focuses directly on retina
 Vascular syndrome accompanied by spells of “white finger” after general or local body 2. myopia – nearsightedness
cooling resembling Raynaud’s phenomenon, and also by impaired sensitivity to vibration, 3. hyperopia – farsightedness
pain and temperature – if local vibration.
 CNS changes associated w/ general polyneuritis syndrome more pronounced in lower Quantities and units of light
extremities – if whole body vibration.  luminous flux – quantity of light emitted per second by a light source [lumen]
 Initial stage – pain, paresthesia in hands, loss of sensitivity in finger tip  luminous intensity – luminous flux emitted per unit of solid angled in a given direction
 Stage of inadequately pronounced changes – pain, numbness are more persistent, loss of [candela]
sensitivity to fingers and arms, cyanosis and hyperhydrosis of hands  illumination – luminous flux that strikes a unit of area [lux]
 Stage of pronounced changes – fingers become white, hands are cold and moist,  luminance – luminous flux that is reflected by a surface [cd/m2]
edematous fingers, muscular changes are more pronounced  Contrast – relative luminance difference between an object and its background, a
 Fourth stage – generalized changes, vascular spasms may involved cardiac and cerebral dimensionless magnitude with a value between 0-1.
vessels  Glare – produced by excessive light stimuli w/c disturb adaptation process of retina
Health and safety measures
 Technical Factor to be considered for optimum illumination
 Organizational /administrative  Reflectance [color, material] of work objects and environment
 Prophylactic/therapeutic  Differences in relation to natural daylight
 Necessity of using artificial light during the day
HEAT AND COLD STRESS  Age of persons carrying out the task
Physiologic effects
 Hot environment Factors to be considered for visibility of objects
o Vasodilatation occurs leads to increase cardiac output and circulating blood volume  Contrast
o Removal of heat from deep body tissues  Luminance
o Acclimatization to heat – process through w/c humans are able to adjust to hot  Size
environment [physiological or psychological]  Time/speed
 Cold environment  Eye adaptation
o Reduction of heat loss from skin thru vasoconstriction of blood vessels in ski and
underlying tissues, Improved insulation – reduction in plasma volume
o Increase in metabolic heat production rate thru voluntary movements and shivering FAMILY MEDICINE
[increases metabolic heat production by 5-7x for short period f time]  Folsom committee report [National Health Council]
 Adaptations to cold:

13
 o Every individual should have a personal physician who is a central point for integration and  SCREEM [ social, cultural, religious, economic, education, medical]
continuity of all medical and medically related services to patient  DRAFT [draw a family test]
o Every hospital should have a service for personal physician who has a staff appointment in
1 or more accredited hospitals FAMILY HEALTH CARE
Article II section 12  Process w/c encompasses screening for abnormalities, early detection of disorders that
 The state recognizes sanctity of family life and shall protect and strengthen the family as a can be alleviated and prevention of ill-health
basic autonomous social institution  Vision: freedom from disease or threat of disease
 Objectives:
Article II section 15 o Alert and educate about responsibilities in maintaining own health
 The state shall protect and promote the right to health of people and instill health o Detect disease at an early stage and alter its progression
consciousness among them. o Provide entry into health care system
o Improve health care
Article XIII section 2 o Understand disease trends both in population and individual
 The state shall adopt integrated and comprehensive approach to health development, w/c shall o To make the best use of proven, cost beneficial techniques, especially in screening
endeavor to make essential goods, health, and other social services available to all the people and early detection
at affordable cost.
 Components: prevention, screening, periodic health examination and early detection
Article XV section 1
Evaluating family in crisis
 The state recognizes the Filipino Family as the foundation of nation. Accordingly, it shall
 Assess family hx of coping w/ family problem
strengthen its solidarity promote its total development
 Determine family style
FAMILY STRUCTURE  Role of px in the family
 Nuclear – parent, dependent children, w/ separate house from family of origin  Monitoring role disruption
o Typical economically independent subsisting from occupational earnings of the husband.
Family’s reaction to death
 Extended – can be unilateral or bilateral, w/ 3 generations, family-centered
 Stage of denial
o Lives together as a group and through its kinship network provides support functions to all
 Anger
members.
 Bargaining
 Single parent family – children < 17 y/o living in a family until w/ single parent, another relative
or a non-relative  Depression
o May result from loss of spouse by death, divorce, separation, desertion  Acceptance
 Blended family – includes step parents, and step-children
Definitions
o Caused by divorce, annulment w/ re-marriage and separation
 Disease – primarily psychological and biologic disorder
 Communal / corporate family – formed for specific ideological or societal purposes
 Illness – includes experience of the disease and broad range of dislocation felt by both
o An alternative lifestyle for people who feel alienated from the predominantly economically
the sufferer and his family
oriented society
 Trajectory – normal course of psychosocial aspect of disease for the patient and the
ORDINAL POSITION / BEHAVIORAL DIFFERENCES
family
 First born: persevering, serious, responsive to adults, achievement-oriented
 Middle child: optimistic, sociable, aggressive, competitive, manipulative Stages of Family illness trajectory
 Youngest: demanding, outgoing, narcissistic, affectionate  Onset of illness
5 BASIC FAMILY FUNCTIONS
 Impact phase
 Provide support to each other
 Major therapeutic efforts
 Established autonomy and independence for each person
 Recovery phase
 Create rules that govern conduct
 Adjustment to permanency of the outcome
 Adapt to change in the environment
 Communicate w/ each other 2 planes of family and patient reaction
 Emotional plane – denial, disbelief, anxiety, upheaval to accommodation
STAGES OF FAMILY LIFE CYCLE
 Cognitive plane - tension and confusion
 Unattached young adult – “between families” formulate personal goals as an individual forming
a new family HEALTH ETHICS
 Newly married couple – transition stage of couple from their lives as an individual to life as  4 PRINCIPLES
couple o Beneficence – to do good, avoid evil, to provide net benefits w/ minimal harm
 Family w/ young children – starts w/ pregnancy until child goes to school involving then conflicts o Nonmaleficence – we ought not to inflict harm, related to right not to be killed, not to
in home and school
have bodily injury or pain, not to have one’s confidence revealed to others
 Family w/ adolescents – parents reapproaching middle life stage, grandparents in later stage o Principle of double effect – a person may perform an act w/c has risks evil effects
 Launching family – when 1st child leaves home and ends when last child leaves home o Autonomy – obligation to respect decision-making capacities, moral right to choose
 Family in later years – begins w/ departure of last child and continues thru retirement of one or  When there is danger that respecting a person’s autonomy may harm or impose
both of the couple and ends when both are dead burden on another, then principles of autonomy is overruled by principle of non-
maleficence
FAMILY ASSESSMENT INSTRUMENTS o Justice – obligation of fairness in distribution of benefits and risks
 Family genogram
 Role of health professionals – must possess knowledge, skill and diligence
o Family tree or pedigree chart
o Functional chart – contains the psychosocial and interactional data
o Medical history or family illness NOTE: READ ON DEPARTMENT OF HEALTH NATIONAL PROGRAMS]
NATIONAL TB CONTROL PROGRAM
 Family circle
MALARIA CONTROL PRORAM
 Family APGAR – rapid screening instrument for family dysfunction w/ adequate reliability and
ELLIMINATION PROGRAM FOR LEPROSY
validity
LISTING OF PHILIPPINE MEDICINAL PLANTS
o Adaptation – to utilize and share resources
PHILIPPINE NATIONAL AIDS-STD PREVENTION AND CONTROL PROGRAM
o Partnership – sharing of decision making DEPARTMENT OF HEALTH COMPREHENSIVE NUTRITION PROGRAM
o Growth – physical, emotional growth EXPANDED PROGRAM ON IMMUNIZATION
o Affection – emotions like love, anger and hatred are shared
o Resolve – time, space and money are shared PEARLS in PCM
o APGAR II – delineates patient’s relationship w/ other members, identifies person who can  Salk - inactivated vaccine given IM
give assistance, w/ conflict  Sabin – live attenuated vaccine given PO
o Score: 8-10 [highly functional], 4-7 [moderately functional], 0-3 [severely dysfunctional]  2,200 calories – basic requirement for Filipino
 FACES [family adaptability and cohesion evaluation scale]  Milk code = E.O 51
 FES [family environmental scale]  Asin law = RA 8172
 Clinical biography  Most predominant type of malnutrition in RP = Kwashiorkor

14
 Conventional water treatment processes include: Incubatory Chickenpox
o Coagulation Convalescent Salmonella, shigella
o Flocculation Chronic Salmonella, HAV, HBV
o Sedimentation
o Filtration
o Chlorination
 TT immunization schedule for women
TT 1 ASAP during pregnancy [5-6 MOS.]
 An acceptable house should have the ffg:
o Bedroom = 50 ft2/person TT 2 At least 4 weeks later, gives 3 yrs protection to mother
TT 3 At least 5-6 months later, gives 5 yrs protection to
o Temperature = 20-25 C
mother
o Air movement = 15-25 ft/min
TT 4 At least 1 year later, gives 10 years protection to
o Humidity = 50-80%
mother
o Lighting = 100 candles feet for reading
TT 5 At least 1 yr later, gives lifetime protection to mother
o Noise = < 30 dB
 If the woman received 3 doses DPT in infancy, this should be considered TT1 and TT2.
o Water supply = 15-20 gallons per capita per day
The succeeding dose will be TT3 and so forth.
 Cohort studies [relative risk]
o Prospective  EXPANDED PROGRAM ON IMMUNIZATION [see DOH notes]
o Incidence and attack rate Vaccine Minimum age at Doses Minimum Contents
 Case control [odds ratio] 1st dose interval between
o Retrospective BCG At birth, or any 1 Live attenuated
o Prevalence time after birth
DPT At 6 wks 3 4 wks DT = toxoid, P =
 Epidemic curves killed bacteris
Classical Water-borne OPV At 6 wks 3 4 wks Live attenuated
Point Food-poisoning HEPA B At 6 wks 3 4 wks Recombinant
Bell-shaped Contact dermatitis MEASLES At 9 mos. 1 Live attenuated
Inverted Vector-borne  Tetanus toxoid contains weakened toxin
 Recommended system of excreta disposal
Rural Water-seated / sanitary pit piling
Suburban Septic tank system
Targets for disease reduction initiatives
Urban Sewerage system / separate type Polio Children 0-59 mos. during NID or ORI
Neonatal tetanus Pregnant women and all mothers who bring their children to health
 Adulteration of food centers, all women 15-44 y/o DURING nid
o Mixing other substance to increase bulk MEASLES 1 DOSE VACCINATION FOR ALL 9-12 MOS. OLD INFANTS
o Concealing inferior quality General principles when screening children for vaccination
1. repeat BCG vaccination if child doesn’t develop a scar after 1 st injection
o Abstraction of an essential ingredient
2. all EPI vaccines can be safely and effectively administered to an eligible
o Addition of poisonous substance
subject on the same day at different body sites
o Selling of partly decomposed products 3. measles vaccine should be given at 9 mos. old
o Misbranding or mislabeling 4. vaccination schedule should not be restarted even if proper interval is missed
 Sangkap pinoy components: vitamin A cap [200,00 IU for 12-59 mos. old], iodine oil capsule or delayed by months or years
and iron tablets [200 mg ferrous sulfate for pregnant and lactating mothers] or iron syrup drops 5. moderate fever, malnutrition, mild respiratory tract infection, cough, diarrhea,
 FIDEL –Fortification for Iodine Deficiency Elimination and vomiting are NOT CONTRAINDICATIONS to vaccination [unless child is
 FVR – fortified high value rice or iron fortified rice very sick]
 Types of error 6. ONLY contraindications are: history of convulsions or shock w/in 3 days after
o Type 1 [alpha] – error of rejecting a true null hypothesis DPT1 or DPT2 and BCG vaccination to a child w/ clinical AIDS
o Type 2 [beta] – error of not rejecting a false null hypothesis
 Death certificate issuance SENTRONG SIGLA
o Immediate cause  Aims to promote availability of quality health services in health centers and hospitals and
o Intervening antecedent cause to make these services accessible to every Filipino
o Underlying antecedent cause  Includes: EPI, disease surveillance, control of acute respiratory infections, control of
 Direct transmission thru droplet spray = < 6 feet diarrhea disease, micronutrients supplementation/nutrition, family planning program,
STD/AIDS prevention and control program, environmental health and sanitation
 Airborne spread = 1-5 micrometers in size
program, cancer control program: cervical cancer screening
 Tutok gamutan – DOTS
STRENGTHENED NATIONAL TUBERCULOSIS CONTROL PROGRAM
 Puksain : “pesteng akyat bahay gang” or new malaria control program
 Case finding: direct sputum microscopy for identified TB symptomatic, CXR for Tb
 Polio eradication – 1995 symptomatic, who are negative after 2 or more sputum exams
 Birth by attendance [from APMC 2nd ed.]  Treatment:
o 35% = MD
o 35% = traditional birth attendant Paucibacillary [tuberculoid Rifampicin 600 mg [once a month], dapsone 100 mg
o 28% = midwives and indeterminate] daily x 9 mos.
o 1% = nurse Multibacillary [lepromatous Rifampicin 600 mg [once a moth], clofazimine 300 mg,
o 1% = others and borderline] dapsone 100 mg x 18 mos.
 APGAR = 0.3 Patients w/ single lesion + [-] Rifampicin 600 mg, ofoxacin 400 mg, minocycline 100
 Severe DHN = IV = 110 ml/kg until w/ palpable pulse, give ORESOL [NaCl, KCl, Glucose] slit skin smear mg single dose
 Decreases algae growth – copper sulfate in water purification
 Residual chlorine = 0.1 ppm to insure bacteriological safety of water
 Well – major supply of water in rural areas, 50 ft from source of pollution
TB treatment category
Type 1 RIPE New PTB whose sputum is [+]
 Examination of milk Type 2 RIPES Previously treated pxs who are overlapses or failure
Physical For total solids, butterfat Type 4 RIP Sputum smear [-] 3x, minimal PTB on CXR, for extra-PTB
Chemical For suspected preservatives added
Bacteriological Plate count, direct microscopy o Category 1 – for new pulmonary TB pxs whose sputum is [+]
Others Reductase test, phosphatase test  Intensive phase: INH 300 mg, Rifampicin 450 mg, Pyrazinamide 500 mg x 2 tabs,
Ethambutol 400 mg 2 tabs OD x 2 mos.
 Refrigeration = 0-4 C to preserve food  Begins maintenance phase if still [+] sputum after 2 mos.
 Add: PZA 500 mg, INH 100 mg, and Ethambutol 400 mg for pxs > 50 KBW
 Human carriers
Subclinical HAV

15
  Ethambutol is not used for children < 6 y/o who are too young to report visual
disturbances
COMMON DCOMMUNICABLE DISEASES
 Maintenance phase: rifampicin 450 mg, INH 300 mg Schistosomiasis Bilharziasis, snail fever 2-6 wks Contact w/ h2o
 Add INH 100 mg for pxs > 50 KBW Chicken pox Varicella 2-3 wks Droplet, contact
o Category 2 – for previously treated pxs who are relapses, failures or others: Mumps Epidemic parotitis 12-25 d Droplet, saliva
 Intensive phase: rifampicin 450 mg, INH 300 mg, PZA 500 mg x 2 tabs, ethambutol 400 Pertussis Whooping cough 7-10 d Airborne
mg x 2 tabs, streptomycin sulfate 1 gm x 2 mos. then remove it and give all the other Bacillary dysentery Shigellosis 1-3 d Fecal-oral
drugs for 1 month Hepatitis A Infectious heap, epidemic 15-50 d Fecal-oral
 Streptomycin should not be given in pregnant women heap, catarrhal hepa
 Maintenance phase: rifampicin 450 mg, INH 300 mg, ethambutol 400 mg x 2 tabs x 5 Leptospirosis Weil’s disease, mud fever/ 10 d Skin contact
mos., trench/flood/canicola fever,
o Category 3 – for new PTB pxs whose sputum smear [-] x 3 times and CXR result is PTB hemorrhagic jaundice,
minimal and for extrapulmonary cases: Japanese 7 days fever
 Intensive phase: rifampicin 450 mg, INH 300 mg, PZA 500 mg x 2 tabs x 2 months Red tide poisoning Paralytic shellfish 24-48 hrs Shellfish
 Maintenance phase: rifampicin 450 mg, INH 300 mg x 2 months. poisoning ingestion
 DOTS: strategy with w/c primary health services around the world are using to detect Rabies Hydrophobia, Lyssa 2-8 wks Dog bite, saliva
and cure TB pxs. Anthrax Malignant pustule/edemia, 2-7 d Contact of skin
woolsorter’s disease, w/ animals
ragpicker’s disease
Prioritization of patients for PTB treatment Gonorrhea GC, clap, drip, strain, gleet 2-7 d Sex contact
1st Smear [+] cases whether new, relapse or treatment failures Syphilis SY,bad blood,the pox, lues 10d-3mos Direct contact
2nd Smear [-] but seriously ill [i.e. extra pulmonary TB, or w/ extensive parenchymal
involvement]
3rd Smear [-] w/ CXR consistent w/ PTB but w/o extensive pulmonary lesion Disease Agent Sign and symptoms IP Transmission
4th Children at high risk for developing progressive primary TB [PTB in malnourished or Hepa B Hepadna virus Jaundice 60-90 d Body secretions,
immunocompromised] blood, semen
5th Children w/ primary TB [0-6 y/o w/ [+] clinical S/Sx of PTB and [+] tuberculin test Measles Measles virus Koplik spots 8-13 d Droplet, dust
6th Chronic excretors of TB bacilli [tx failures after 5 drug regimen or chronic drug Mumps Paramyxovirus Parotid enlargement 12-25 d Droplet, saliva
resistant cases] Tetanus Retrovirus Hydrophobia 3-21 d Wounds
TB M. TB Hemoptysis 4-12 wk Droplet, dust
LEPROSY [HANSEN’S DISEASE] CONTROL PROGRAM
Leprosy Hansen’s Clawing of fingers and 9 mos. – 20 Droplet, contact
 Treatment: pregnant leper – standard treatment bacillus toes yrs
 Relapse – prednisone x 2 mos. should be started and confirmed relapse should receive another Cholera V. cholerae Rice watery stools Few hrs-5 d Fecal-oral, h2o
course of standard NOT REGIMEN AIDS Retrovirus/HIV P. carinii pneumonia 1-3 mos. Sex contact, blood
 Short course therapy for TB Rabies Rhabdovirus Hydrophobia 2-8 wks Saliva of dogs
Phase Treatment Malaria P. falciparum Fever, chills, sweating 7-14 d Mosquito bite
Intensive phase [2 mos.] RFP = 450 mg OD, INH = 300 mg OD, PZA = 1000

Maintenance phase [4 mos.]

mg OD
RFP = 450 mg OD, INH = 300 mg OD
COMMUNICABLE DISEASE CONTROL
NON-COMMUNICABLE DISEASE COMMUNICABLE DISEASE
From non-living agents of disease Depends on outcome of biologic phenomenon
Paucibacillary type RFP once a month and dapsone OD x 9 mos.
Due to heredity, physiologic Due to bacteria, virus, fungi
Multibacillary type RFP once a month, dapsone OD, and clofazimine 300 mg OD x 18
functioning
mos.
Multiple causation of disease
SCHISTOSOMIASIS
 environmental
 Endemic in: sorsogon, oriental mindoro, samara, leyte, bohol, parts of Mindanao
 economic and social
 Principal vector in RP: snail [oncomelania hypannois]
 host factors/reservoir agent
 Species in RP: Schistosoma japonicum
 Diagnostic test: stool exam [concentration technique] and quantitative [ kato katz
Disease Infectious IP Reservoir Transmission Communicab
technique] agent ility
Philippine schistosomiasis control program
Diphtheria c. diptheriae 2-5 d Man Contact, 2-4 wks
1. chemotherapy [emphasis]
droplets
2. health education
Pertussis B-pertussis 7-10 d Man Airborne, Catarrhal
3. snail control
contact stage
4. environmental sanitation
5. integration of program into PHC Tetanus C. tetani 3-21 d Man, soil, Wounds, Not directly
6. monitoring and evaluation GIT of horse unsteriile, transmitted
infected from person
umbilical to person
Priority vaccines for acute respiratory infections stump
Measles For ALRI Poliomyelitis Polio virus 7-14 d Man Fecal-oral, Not known
Diphtheria Pneumococcal vaccine 1,2,3 direct contact accurately
Pertussis h. infkuenzae vaccine Measles Morbillivirus 8-13 d Man Droplet, dust Prodromal
inhalation period
CONTROL OF RESPIRATORY INFECTIONS Tuberculosis M. TB 4-12 Man, cattle Droplet, dust Indefinite
wks inhalation
Pneumonia classification for children < 2 Pneumonia Strep, H. 1-3 d Man Airborne, Symptomatic
mos. – 5 yrs of age influenzae
etc.
droplets phase
Very severe RR Not feeding well,
Varicella Alpha- - 2-3 Man Contact, 1-2 days
disease convulsions, fever, not
infection herpes virus wks droplet, before rash
able to drink, stridor,
[chickenpox or 3 transplacent appears, but
undernourished
shingles] al not >5 days
Severe RR Severe chest
pneumonia indrawing
Typhoid fever S. typhi 8-14 d Water Fecal-oral Indefinite
No RR < 60 cpm No chest indrawing
Rabies Rhabdovirus 2-8 Mammals Saliva of 3-7 days b4
pneumonia
wks animals s/sx appears
Dengue fever Flaviviruses 3-14 d Man and Mosquito bite Indirectly

16
 or 7-10 mosquito  GUIDE FOR POST-EXPOSURE TREATMENT
Leprosy M. leprae 9 mos- Man Droplets, Infxn is lost  Local treatment of wounds should always be carried out. On the basis of the
20 yrs contact w/in 3 mos. information available at the time, the eighth report of the WHO Expert Committee
Malaria Plasmodium 7-12 d Man Mosquito bite 1-3 yrs recommended that persons who had previously received full pre- or post-exposure
Schistosomiasi S. japonicum 2-6 Man, dogs, Skin contact Not thru treatment with a potent cell-culture vaccine should be given only two booster doses,
s wks cats, etc. thru water person either intramuscularly or intradermally, on days 0 and 3, but no rabies immunoglobulin.
Filariasis W. bancrofti, 1-3 Man Mosquito bite Not thru Persons who have previously received pre- or post-exposure treatment with vaccines of
B. malayi mos. person unproven potency, and those who have not demonstrated an acceptable rabies
Leptospirosis l. interrogans 10 d Animals Skin contact Rare neutralizing antibody titer, should receive a complete post-exposure course, including
Amebiasis E. histolytica 2-4 wk Man Fecal-oral Cyst period rabies immunoglobulin if indicated.
Ascariasis A. 4-8 Man, ascarid Ingestion of Indefinite  Start vaccine immediately: IM at deltoid, anterolateral part of thigh, never in gluteal
lumbrocoides wks eggs in soil eggs in H2O region
Botulism C. 12-36 Spores in Food Not thru o Essen regimen: 0.5 ml at days 0, 3, 7, 14, 28
boptulinum hrs soil ingestion person o Zegreb regimen: [2-1-1] at D0, 0, 7, 21
Candidiasis c. albicans 2-5 d Man Sex contact [+} lesions  SCHEDULE:
ETEC ETEC 10-12 Man Contaminate Depends on o Pre-exposure immunization: 3 injection regimen [WHO] at D0, D7, D28
Hrs d food excretion o Booster at one year and every 3 years
Giardiasis G. lamblia 5-25 d Man Fecal-oral Entire period
Influenza H. influenzae 1-5 d Man Airborne 3-5 d FOOD AND NUTRITION
Salmonellosis S. typhi 6-72 H Animals Fecal-oral Days-weeks MALNUTRITION
Scabies S. scabiei 2-6 W Man Skin contact 1 week  Relative/absolute deficiency or excess of one or more essential nutrients
Trichomoniasis T. vaginalis 7 days Man Sex contact Indefinite  Anthropometrics:
Viral warts HPV 2-3 Man Direct Unknown o Wasting = weight for height
mos. contact o Stunting = height for age
o Malnutrition = weight for age
DIPTHERIA  Malnutritional states
o Marasmus [clorie]
 Diagnostic criteria [WHO] o Kwashiorkor [protein]
Suspected Acute pharyngitis w/ pseudomembrane, acute laryngitis w/  Detected by biochemical [vitamin, Hb, serum pH levels], anthropometric or physiologic
case pseudomembrane tests
Probable case Above + airway obstruction, neuritis, myocarditis, hx of exposure  Forms:
Confirmed Culture o Undernutrition: inadequate quantity of food
 Treatment: o Specific deficiency
o DAT – main tx o Overnutrition
o Antibiotics: pen G or erythromycin o Imbalance: disproportion among essential nutrients w/ or w/o absolute deficiency of
o Supportive + immunization any nutrients
PROTEIN-ENERGY MALNUTRITION
PNEUMONIA  Proportion of essential nutrients
 MC cause of morbidity and mortality Carbohydrates 50-70%
 Deaths are highest among children <5 y/o Fat 15-20%
 High risk: children 12-23 mos., children > 6 y/o, children in rural areas Protein 15-3%
Principal Features of Protein-Calories Deficiency
VARICELLA-ZOSTER [1 virus w/ 2 diseases] Marasmus Kwashiorkor
 Primary Varicella a. usual age 0-2 years 1-3 years
 In pregnancy: affect fetus on 5th month of life b. essential features
 Immunizations: given after 12 mos. if w/o hx of varicella 1. edema none lower legs, sometimes face or
generalized
HERPES-ZOSTER [endogenous reactivation] 2. wasting gross loss of sometimes hidden; sometimes fat,
 Virus persists in latent state in ganglia and cranial nerves subcutaneous fat blubbery
 Reactivated as a result of cellular immunity, trauma, intercurrent disease “all skin and
bones”
TYPHOID FEVER 3. muscle wasting obvious sometimes hidden
 Dx: blood and stool culture, typhidot 4. growth retardation obvious sometimes hidden
 Tx: chloramphenicol and cotrimazole 5. mental changes usually apathetic, usually irritable, moaning, also apathetic
 Alternative: quinolone, amoxicillin, ampicillin quiet
 In pregnancy: ceftriaxone, amoxicillin, ampicillin c. variable features
1. appetite usually good usually poor
TETANUS 2. diarrhea often [past or often [past or present]
 Local treatment of wounds: present]
o Washing and flushing of water then apply ethanol 3. skin changes seldom often – diffuse depigmentation
o Apply anti-rabbies Ig by infiltrating around the wound occasional – flaky paint or enamel
o Postpone suturing dermatosis
o Begin anti-tetanus treatment + antibiotics 4. hair changes seldom often – sparse, straight, silky,
dyspigmentation; grayish or reddish “flag
 Prophylaxis sign”
History of TT Clean minor wounds All others 5. moonface seldom often
doses Td TIG Td TIG 6. hepatic enlargement seldom always
Unknown < 3 Yes No Yes Yes d. biochemistry
Unknown > 3 No No No No 1. serum albumin normal or low low
2. urinary urea / g normal or low low
 Tetanus toxoid immunization in pregnancy creatinine
3. urinary hydroxy- low low
Previously unimmunized 2 doses at least 4 wks apart, 2nd dose to be
Proline / g creatinine
mother given at least 2 wks before delivery
4. serum essential AA normal low
Previously immunized 1 dose for each pregnancy for a total of 6
mother [w/ 2 doses] injection w/in her reproductive year 5. anemia uncommon megaloblastic; IDA
6. liver biopsy normal or atrophic fatty change
RABIES

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PREVENTIVE PEDIATRICS RA 7846 Required compulsory immunization against heap B for infants and children
Pediatrician’s Focus below 8 y/o
1. health supervision of healthy infants, children, and adolescents RA 6615 All government and private hospitals are required to render immediate
2. practical approaches to some common issues presenting during emergency medical assistance
health supervision RA 4226 Hospital licensure act
3. health supervision of children with chronic conditions RA 4073 Liberalized treatment of leprosy
PRIMARY PREVENTION RA 4826 Malaria eradication law
- avoiding disorders before they begin RA 5921 Pharmacy law
SECONDARY PREVENTION RA 7277 Act providing for rehabilitation, self-development and self-reliance of
- recognition and elimination of the precursors of the dse/ reverse dse Disabled persons
in its early stage
RA 7600 Rooming-in and breastfeeding act of 1992
TERTIARY PREVENTION
RA 7719 Act promoting voluntary blood donation, adequate supply at regular blood
- includes care for chronic illnesses and disabilities present in childhood
banks
NUTRITIONAL ANEMIA RA 7875 PHILHEALTH as amended by RA 9241 or National health insurance Act of
1995
 Types:
o Hypochromic, microcytic anemia RA 7883 Barangay health workers benefits and incentives act of 1995
o Megaloblastic anemia RA 8172 Promoting salt iodination nationwide / ASIN law
RA 8504 Philippine AIDS prevention and control act of 1988
 MC affect infants
RA 8423 Act creating Philippine institute of traditional and alternative health care
 Etiology:
[PITAHC]
o IDA –
RA 6425 Dangerous drugs act
o Folate deficiency anemia - MC cause: pregnancy and lactation
RA 8749 Clean air act of 2000
 Tx: IDA
RA 6365 Established a national policy on population and created the commission on
o Adults: 200 mg TID
population
o Children: 30 mg/kg/d x 2-3 mos.
RA 4826 Malaria eradication law
 Tx: Folate deficiency anemia RA 6675 Generics act of 1988
o Folic acid: 1 mg per day w/ vitamin B12 to prevent neurologc symptoms
RA 7305 Magna carta for public health workers w/c aims to promote and improve
 Control: supplementation, food fortification, education, social and economic well-being of health workers
RA 7432 Act to maximize contribution of senior citizens to nation building, grant
VITAMIN A DEFICIENCY benefits and special privileges
 Insufficient intake of vitamin A PD 881 Regulate labeling and sale of hazardous products
PD 651 All health workers shall identify and encourage registration of all births w/in
ENDEMIC GOITER 30 days following delivery
 Low dietary iodine intake PD 996 Compulsory immunization of all children below 8 y/o against the 6 childhood
 Types: immunizable diseases
o Sporadic type/hypothyroidism PD 825 Provides penalty for improper disposal of garbage
o Endemic type/fetal iodine deficiency PD 965 Requires applicants for marriage license to receive instruction on family
planning and responsible parenthood
CASES NOT COVERED BY PHILHEALTH PD 856 Code on sanitation
1. cosmetic surgery
PD 169 Failure to report treatment of physical injuries
2. optometric services
PD 280 Act for BFAD administration to suspend, revoke and cancel the license of
3. psychiatric illness
manufacturer, sale and distribution of products
4. purely diagnostic services
5. normal delivery or childbirth w/o complications [other than the first] PD 603/ RA Child and youth welfare code
6. primary consultation 7610
7. home and rehabilitation services Letter Of Legal basis of primary health care instructs minister of health and all
8. drugs and OH abuse dependency treatment Instruction no. officials and personnel of the ministry to design, develop, and implement
9. non-prescription drugs and devices 949 programs w/c will focus on health development at community level [rural
areas]
CA no. 3573 Control of dangerous communicable disease
DIFFERENT LEVELS OF DISEASE AC sec. 938 DOH for protection of health of workers
PREVENTION Ministry circular
no. 21986
Included AIDS as notifiable disease
Level Type of prevention Goal of prevention
Primary Modify the distribution of disease Prevent or postpone new occurrence of
LISTING OF PHILIPPINE HERBAL MEDICINAL PLANTS
determinants in the population disease
[initiation] A. Scientifically validated
Secondary Early detection of disease and Improve prognosis of cases [shorten Common name Scientific name Use
subsequent treatment duration of disease or prolong life] Lagundi Vitex negundo Anti-cough/asthma, anti-pyretic
[progression] Tsaang-gubat Carmona retusa Anti-motility
Tertiary Treatment and rehabilitation Reduce or prevent residual defect and Sambong Blumea balsamifera Diuretic
[outcome] dysfunction or prolong life [makes Yerba Buena Menthe cordifolia opiz Analgesic/antipyretic
disease outcome less severe]
Akapulko Cassia alata Antifungal
Ampalaya Momordica charantia Anti-diabetes
Bawang Allium sativum Anti-cholesterol
PUBLIC HEALTH LAWS Bayabas Psidium guajava Oral/skin antiseptic
RA 7160 Local government code of 1991 Niyug-niyogan Quisquidis indica Anti-helminthic
RA 9165 Comprehensive dangerous drugs act of 2002 Ulasiman bato Peperomia pellucida Anti-hyperuricemia
RA 7170 Organ donation act of 1991
RA 679 Women labor law
RA 1131 Child labor law B. Folklorically validated – needs
RA 1054 Free emergency either medical and dental assistance to laborers in further study
industries Malunggay Moringa oleifera Arthritis, scabies, wounds, constipation
RA 2382 Philippine medical act [amended by RA 4224] Avocado Persea Americana Diarrhea, wounds
RA 3573 All communicable diseases shall be reported to nearest health station Abutra Arcangelista flava Wounds, pruritus
[1329]
Alagaw Pernia odorata Fever, headache, gaseous distention,
RA 3753 Issuance of birth certificate cough, aromatic bath
RA 1553 Issuance of death certificate

18
Anis Foeniculum vulgare Gaseous distention, dizziness, fainting,
hysteria
Balanoy Oeimum basilieum Dizziness, fainting, hysteria, toothache,
cough, arthritis, wounds, antifungal
Balatong aso Cassia occidentalis Antifungal
Balimbing Averrhoa carambola Antipyretic
Bani Pangmia pinnata Gaseous distention, wounds, pruritus
Barak Curcuma zedoaria Gaseous distention
Dalanghita Citrus nobilis Dizziness, fainting, hysteria, aromatic bath
Damong maria Artemmista vulgaris Headache, wounds, gaseous distention
Dayap Ditrus aurantifolia Fever, dizziness, fainting, hysteria, aromatic
bath
Dilaw Curcuma longa Wounds, gaseous distention
Duhat Syzygium cumini Swollen gums, wounds
Eucalyptus Encalyptus sp. Wounds, cough
Gatas-gatas Euphorbia hirta Skin antiseptic
Gugo Entada phaseoloides Hair growth stimulant
Gulasiman Portulacaoleracea Skin antiseptic
Gumamela Bibiscaa rosasimensis Superficial burns, abscess
Ikmo Piper betle Gaseous distention, sprain, wounds
Ipil-ipil Lineaena leucecephala Anti-helminthic
Kabling Pogotemon Arthritis, aromatic bath
Kabuyaw Citrus hystrix Dizziness, fainting, hysteria, aromatic bath
Kalawati Glicidia sepium Scabies, sprains, pruritus

DEFINITIONS OF TERMS IN PUBLIC HEALTH

1. CARRIER – a person or animal that harbors a specific infectious agent in the

absence of discernible clinical disease and serves as potential source of infection
2. Healthy/asymptomatic carrier – carrier state exists in an individual w/ an infection
that is in apparent throughout its course.
3. Chemoprophylaxis – administration of chemical [antibiotics], to prevent the
development of an infection or the progression of an infection to active manifest
disease.
4. Communicable disease – an illness due to specific infectious agent or its toxic
products w/c arises through transmission from person, animal or inanimate reservoir
to a susceptible host, either directly or indirectly through an intermediate plant,
animal, vector or inanimate environment.
5. Communicable period – time during w/c an infectious agent may be transferred
directly or indirectly from an infected person or animal.
6. Contact – a person or animal that has been in association w/ an infected person or
animal or contaminated environment that might provide an opportunity to acquire the
infective agent.
7. Endemic – the constant presence of a disease or infectious agent w/in a given
geographical area, may also refer to usual prevalence of a given disease in an area.
8. Epidemic – the occurrence in a community or region of cases of an illness [or an
outbreak], clearly in excess of expectancy.
9. Herd immunity – the immunity of a group or community. The resistance of a group to
invasion and spread of an infectious agent based on the resistance to infection of a
high proportion of individual members of a group.
10. incubation period – time interval between initial contact w/ an infectious agent and
the appearance of the first sign or symptom of the disease
11. pathogenecity – the capability of an infectious agent to cause disease in a
susceptible host
12. Susceptible – a person or animal presumably not possessing sufficient resistance
against a particular pathogenic agent to prevent contracting infection or disease if or
when exposed to the agent.
13. Suspect – a person whose medical history and symptoms suggest that he or she
may have or be developing some communicable disease.
14. virulence – the degree of pathogenecity of an infectious agent, indicated by case
fatality rates or its ability to invade and damage tissues of the host

19