Breastfeeding TSEK

PrintPrintEmailEmailPDFPDF On February 23, 2011, the Department of Health (DOH) launched the exclusive breastfeeding campaign dubbed Breastfeeding TSEK: (Tama, Sapat, Eksklusibo). The primary target of this campaign is the new and expectant mothers in urban areas.

This campaign encourages mothers to exclusively breastfeed their babies from birth up to 6 months. Exclusive breastfeeding means that for the first six months from birth, nothing except breast milk will be given to babies.

Moreover, the campaign aims to establish a supportive community, as well as to promote public consciousness on the health benefits of breastfeeding. Among the many health benefits of breastfeeding are lower risk of diarrhea, pneumonia, and chronic illnesses.

Dental Health Program

PrintPrintEmailEmailPDFPDF Oral disease continues to be a serious public health problem in the Philippines. The prevalence of dental caries on permanent teeth has generally remained above 90% throughout the years. About 92.4% of Filipinos have tooth decay (dental caries) and 78% have gum diseases (periodontal diseases) (DOH, NMEDS 1998). Although preventable, these diseases affect almost every Filipino at one point or another in his or her lifetime. Table 1: Prevalence of the Two Most Common Oral Diseases by Year, Philippines

YEARPrevalenceDental CariesPeridontal Disease198793.9%65.5%199296.3%48.1%199892.4%78.3%

The oral health status of Filipino children is alarming. The 2006 National Oral Health Survey (Monse B. et al, NOHS 2006) investigated the oral health status of Philippine public elementary school students. It revealed that 97.1% of six-year-old children suffer from tooth decay. More than four out of every five children of this subgroup manifested symptoms of dentinogenic infection. In addition, 78.4% of twelve-year-old children suffer from dental caries and 49.7% of the same age group manifested symptoms of dentinogenic infections. The severity of dental caries, expressed as the average number of decayed teeth indicated for filling/extraction or filled permanent teeth (DMFT) or temporary teeth (dmft), was 8.4 dmft for the six-year-old age group and 2.9 DMFT for the twelve-year-old age group (NOHS 2006).

Table 2 - Dental caries Experience (Mean DMFT/dmft), per age groups, Philippines

Age in YearsNMEDS 1982NMEDS 1987NMEDS 1992 NMEDS 1998 NMEDS 20066 8.4 dmft126.395.525.434.582.915-19 8.518.256.3 35-4414.1814.8214.4215.04

Filipinos bear the burden of gum diseases early in their childhood. According to NOHS, 74% of twelve-year-old children suffer from gingivitis. If not treated early, these children become susceptible to irreversible periodontal disease as they enter adolescence and approach adulthood.

In general, tooth decay and gum diseases do not directly cause disability or death. However, these conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially dangerous systemic diseases and infections. Serious conditions include arthritis, heart disease, endocarditis, gastro-intestinal diseases, and ocular-skin-renal diseases. Aside from physical deformity, these two oral diseases may also cause disturbance of speechsignificant enough to affect work performance, nutrition, social interactions, income, and self-esteem. Poor oral health poses detrimental effects on school performance and mars success in later life. In fact, children who suffer from poor oral health are 12 times more likely to have restricted-activity days (USGAO 2000). In the Philippines, toothache is a common ailment among schoolchildren, and is the primary cause of absenteeism from school (Araojo 2003, 103-110). Indeed, dental and oral diseases create a silent epidemic, placing a heavy burden on Filipino schoolchildren.

VISION: Empowered and responsible Filipino citizens taking care of their own personal oral health for an enhanced quality of life MISSION: The state shall ensure quality, affordable, accessible and available oral health care delivery.

GOAL: Attainment of improved quality of life through promotion of oral health and quality oral health care.

Current Situation

Deaths among children have significantly decreased from previous years. In the 1998 NDHS, the infant mortality rate was 35 per 1000 livebirths, while neonatal death rate was 18 deaths per 1000 livebirths. Among regions IMR is highest in Eastern Visayas and lowest in Metro Manila and Central Visayas. Death is much higher among infants whose mothers had no antenatal care or medical assistance at the time of delivery. Top causes of illness among infants are infectious diseases (pneumonia, measles, diarrhea, meningitis, septicemia), nutritional deficiencies and birth-realted complications.

The probability of dying between birth and five years of age is 48 deaths per 1000 livebirths. The top five leading causes of deaths (which make up about 70%) of deaths in this age group) are pneumonia, diarrhea, measles, meningities and malnutrition. About 6% die of accidents i.e. submersion, foreign bodies, and vehicular accidents.

The decline in mortality rates may be attributed partly to the Expanded Program of Immunization (EPI), aimed to reduce infant and child mortality due to seven immunizable diseases (tuberculosis, diptheria, tetanus, pertussis, poliomyelities, Hepatitis B and measles).

The Philippines has been declared as polio-free druing the Kyoto Meeting on Poliomyelities Eradication in the Western Pacific Region last October 2000. This. however, is not a reason to be complacent. The risk of importing the poliovirus from neighboring countries remains high until global certification of polio eradication. There is an urrgent need for sustained vigilance, which includes strengthening the surveillance system, the capacity for rapid response to importation of wild poliovirus, adequate laboratory containment of wild poliovirus materials, and maintaining high routine immunization until global certification has been achieved.

Malnutrition is common among children. The 1998 FNRI survey show that three to four out of ten children 0-10 years old are underweight and stunted. The prevalence of low vitamin A serum levels and vitamin A deficiency even increased in 1998 compared to 1996 levels as reported by FNRI. Vitamin A supplementation coverage reached to more than 90%, however, a downward trend was evident in the succeeding years from as high as 97% in 1993 to 78% in 1997.

Breastfeeding rate is 88% (NSO 2000 MCH Survey), with percentage higher in rural areas (92%) than in urban areas (84%). Exclusive breastfeeding increased from 13.2% to 20% among children 4-5 mos of age (NDHS).

Several strategies were utilized to omprove child health. THe Integrated Management of Childhood Illness aims at reducing morbidity and deaths due to common chldhood illness. The IMCI strategy has been adopted nationwide and the process of integration into the medical, nursing, and midwifery curriculum is now underway.

The Enhanced Child Growth strategy is a community-based intervention that aims to improve the health and nutritional status of children through improved caring and seeking behaviors. It operates through health and nutrition posts established throughout the country.

Gaps and Challenges

Many Local Health Units were not adequately informed about the Framework for Children's Health as well as the policies. There is a need to disseminate the two documents, CHILD 21 and Children's Health 2025 to serve as the template for local planning for childrens health. There is also the need to update and reiterate the policies on children's health particularly on immunization, micronutrient supplementation and IMCI.

LGUs experienced problems in the availability of vaccines and essential drugs and micronutrients due to weakness in the procurement, allocation and distribution.

Pockets of low immunization coverage is attributed largely to the irregular supply of vaccines due to inadequate funds. Moreover, there is a need to revitalize the promotion of immunization.

Goal

The ultimate goal of Children's Health 2025 is to achieve good health for all Filipino children by the year 2025.

Medium-term Objectives for year 2001-2004

Health Status Objectives

1. Reduce infant mortality rate to 17 deaths per 1,000 live births

2. Reduce mortality rate among children 1-4 years old to 33.6% per 1000 livebirths 3. Reduce the mortality rate among adolescents and youths by 50%

Risk Reduction Objectives

1. Increse the percentage of fully immunized children to 90% 2. Increase the percentage of infants exclusively breastfed up to six months to 30% 3. Increase the percentage of infants given timely and proper complementary feeding at six months to 70% 4. Increase the percentage of mothers and caregivers who know and practice home management of childhood illness to 80% 5. Reduce the prevalence of protein-energy malnutrition among school-age children 6. Increase the health care-seeking behavior of adolescents to 50%

Services and Protection Objectives

1. Ensure 90% of infants and children are provided with essential health care package 2. Increase the percentage of health facilities with available stocks of vaccines and esential drugs and micronutrients to 80% 3. Increase the percentage of schools implementing school-based health and nutrition programs to 80% 4. Increase the percentage of health facilities providing basic health services including counseling for adolescents and youth to 70%

Strategies and Activities

* Enhance capacity and capability of health facilities in the early recognition, management and prevention of common childhood illness

This will entail improvements in the flow of services in the implementing faciities to ensure that every child receive the essential services for survival, growth and development in an organized and efficient manner. Facilities should be equipped with the essential instruments, equipment and supplies to provide the services. Health providers shall have the knowledge and skills to be able to provide quality services for children. Existing child health policies, guidelines and standards shall be reviewed and updated, and new ones formulated and disseminated to guide health providers in the standard of care.

* Strengthening community-based support systems and interventions for children's health

Notable community-based projects and interventions, such as the health and nutrition posts, mother support groups, community financing schemes shall be replicated for nationwide implementation. Model building and dissemination of best practices from pilot sites has proven effective in generating support and adoption in other sites. More of these shall be initiated particularly for developing interventions to increase care-seeking and prevention of malnutrition in children.

* Fostering linkages with advocacy groups and professional organizations and to promote children's health

Collaboration with the nongovernment sector and professional groups shall:

* Conduct national campaigns on children's health

* Conduct and support national campaigns for children

* Initiate and support legislations and researches on children's health and welfare

* Development of comprehensive monitoring and evaluation system for child health programs and projects

Expanded Program on Immunization

PrintPrintEmailEmailPDFPDFI. Rationale

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines. Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis and measles. In 1986, 21.3% fully immunized children less than fourteen months of age based on the EPI Comprehensive Program review.

II. Scenario

Global Situation

The burden

In 2002, WHO estimated that 1.4 million of deaths among children under 5 years due to diseases that could have been prevented by routine vaccination. This represents 14% of global total mortality in children under 5 years of age.

Source: Weekly Epidemiological Record, WHO: No.46,2011,86.509-520)

Burden of Diseases

The immunization coverage of all individual vaccines has improved as shown in Figure 1: (Demographic Health Survey 2003 and 2008). Fully Immunized Child (FIC) coverage improved by 10% and the Child Protected at Birth (CPAB) against Tetanus improved by 13% compared to any prior period. Thus, the Philippines has now historically the highest coverage for these two major indicators.

Figure 1: Comparison of the 2003 and 2008 EPI indicators, Source: NDHS

Comparison of the 2003 and 2008 EPI indicators, Source: NDHS

III. Interventions/ Strategies

Program Objectives/Goals:

Over-all Goal:

To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases.

Specific Goals:

1. To immunize all infants/children against the most common vaccine-preventable diseases.

2. To sustain the polio-free status of the Philippines.

3. To eliminate measles infection.

4. To eliminate maternal and neonatal tetanus

5. To control diphtheria, pertussis, hepatitis b and German measles.

6. To prevent extra pulmonary tuberculosis among children.

Mandates:

Republic Act No. 10152MandatoryInfants and Children Health Immunization Act of 2011Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5 including other types that will be determined by the Secretary of Health.

Strategies:

Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay (REB) strategy REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in 2004 aimed to improve the access to routine immunization and reduce drop-outs. There are 5 components of the strategy, namely: data analysis for action, re-establish outreach services, , strengthen links between the community and service, supportive supervision and maximizing resources.

Supplemental Immunization Activity (SIA)Supplementary immunization activities are used to reach children who have not been vaccinated or have not developed sufficient immunity after previous vaccinations. It can be conducted either national or sub-national in selected areas.

Strengthening Vaccine-Preventable Diseases SurveillanceThis is critical for the eradication/elimination efforts, especially in identifying true cases of measles and indigenous wild polio virus

Procurement of adequate and potent vaccines and needles and syringes to all health facilities nationwide

IV. Status of implementation/ Accomplishment

All health facilities (health centers and barangay health stations) have at least one (1) health staff trained on REB.

Polio Eradication:

The Philippines has sustained its polio-free status since October 2000.Declining Oral Polio Vaccine (OPV) third dose coverage since 2008 from 91% to 83%. A least 95% OPV3 coverage need to be achieved to produce the required herd immunity for protection.

Figure 2 OPV1 and OPV3 Coverage, Philippines, 2005-2010

OPV1 and OPV3 Coverage, Philippines, 2005-2010

There is an on-going polio mass immunization to all children ages 6 weeks up to 59 months old in the 10 highest risk areas for neonatal tetanus. These areas are the following: Abra, Banguet, Isabela City and Basilan, Lanao Norte, Cotabato City, Maguindanao, Lanao Sur, Marawi City and Sulu.

Acute Flaccid Paralysis (AFP) reporting rate has decreased from 1.44 in 2010 to 1.38 in 2011. Only regions III, V and VIII have achieved the AFP rate of 2/100,000 children below 15 years old. (Source: NEC, DOH). A decreasing AFP rate means we may not be able to find true cases of polio and may experience resurgence of polio cases

Measles Elimination

Conducted 4 rounds of mass measles campaign: 1998, 2004, 2007 and 2011.Implemented the 2-dose measles-containing vaccine (MCV) in 2009 MCV1 (monovalent measles) at 9-11 months old

MCV2 (MMR) at 12-15 months old.

Implemented and strengthened the laboratory surveillance for confirmation of measles. Blood samples are withdrawn from all measles suspect to confirm the case as measles infection.A supplemental immunization campaign for measles and rubella (German measles) was done in 2011. This was dubbed as Iligtas sa Tigdas ang Pinas 15.6 million (84%) out of the 18.5 million children ages 9 months to 8 years old were given 1 dose of the measles-rubella (MR) vaccine between April and June 2011.Rapid coverage assessment (RCA) were conducted in selected areas to validate immunization coverage, assess high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9 months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.

The Government of the Philippines spent PhP 635.7M for the successful conduct of the MR campaign.ss high quality and that there are NO missed child in every barangay. Overall RCA results showed that 70,594 (97.6%) out of 72,353 9 months to 8 years old living in the randomly selected barangays were vaccinated. There are 3,494 barangays with a population of 1000 and above that were randomly selected. 97.6% of all eligible children were given the MR vaccine during the immunization campaign.

As of Morbidity Week 8 of 2012, there were 92 confirmed cases: 60 cases were laboratory confirmed, 5 cases were epidemiologically-linked and 27 clinically confirmed. This means we have at least 60 true measles at present. Measles is said to be eliminated if we have 1 case per million or below 100 cases in a year

Maternal and Neonatal Tetanus Elimination

10 areas were classified as highest risk for neonatal tetanus (NT). Figure 3 shows the areas categorized as low risk, at risk and highest risk based on the NT surveillance, skilled birth attendants and facility based delivery and the tetanus toxoid 2+ (TT 2+) vaccination.

Figure 3: Level of Risk for NT, Philippines

Level of Risk for NT, Philippines 2005-2010

Three (3) rounds of TT vaccination are currently on-going in the 10 highest risk areas. An estimated 1,010,751 women age 15 - 40 year old women regardless of their TT immunization will receive the vaccine during these rounds. This is funded by the Kiwanis International through UNICEF and World Health Organization.

Control of other common vaccine-preventable diseases (Diphtheria, Pertussis, Hepatitis B and Meningitis/Encephalitis secondary to H. influenzae type B)

Continuous vaccination for infants and children with the DPT or the combination DPT-HepB-HiB Type B. Annex1 EPI Annual Accomplishment Report. DOH procures all the vaccines and needles and syringes for the immunization activities targeted to infants/children/mothers.

Hepatitis B Control

Republic Act No. 10152 has been signed. It is otherwise known as the Mandatory Infants and Children Health Immunization Act of 2011, which requires that all children under five years old be given basic immunization against vaccine-preventable diseases. Specifically, this bill provides for all infants to be given the birth dose of the Hepatitis-B vaccine within 24 hours of birth.One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and Newborn Care Package (EINC). In 2011, 11 tertiary hospitals are already EINC compliant.The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by HBsAg prevalence to less than 1% in five-year-olds born after routine vaccination started 100% Hepatitis B at birth vaccination.Figure 4 Hepatitis B Coverage. Philippines, 2001-2011

Timing of administration/dose20092010*2011*24 hours62%55%24%Hep B 3rd dose86%81%30%*both 2010 and 2011 data are as of October 2011

Vaccines and cold chain management

Upgraded the cold chain equipment in the 80 provinces, 38 cities and 16 regions since 2003.An effective vaccine management assessment was conducted last December 2011 and revealed cold chain capacity gaps from the national up to the implementers level.A total of PhP 267 million is required to address the gaps identified during the assessment.

Introduction to New Vaccines

For 2012, Rotavirus and Pneumococcal vaccines will be introduced in the national immunization program. Immunization will be prioritized among the infants of families listed in the National Housing and Targeting System (NHTS) for Poverty Reduction nationwide.The Government of the Philippines has allocated PhP 1.6 billion for the procurement of these 2 vaccines.

V. Future Plan/ Action

Strengthening the Cold Chain to support the Immunization ProgramCapacity Building for Health Workers for the Introduction of New Vaccines Advocacy for the financial sustainability for the newly introduced vaccines for expansion.Development of the comprehensive multi-year plan for immunization program.

VI. Other Significant information worth mentioning

One significant milestone is that the budget allocation for the immunization program has continued to increase year by yearThe Government of the Philippines allocated budget for the immunization of all infants/children/women/older persons nationwide. For 2012, the budget for EPI is PhP1.8 billion and another P1.5 Billion for the immunization for senior citizen and children for the NHTS families. This is great leap towards universal access to quality vaccines for the prevention of the most common vaccine-preventable diseases.

Program Managers:

Dr. Joyce Ducusin

Medical Specialist IV

National Center for Disease Prevention and Control - Family Health Office

Telephone Number: 651-7800 locals 1726-1730

Ms. Luzviminda Garcia

Supervising Health Program Officer

National Center for Disease Prevention and Control - Family Health Office

Telephone Number: 651-7800 locals 1726-1730

Essential Newborn Care

Profile/Rationale of the Health ProgramThe Child Survival Strategy published by the Department of Health has emphasized the need to strengthen health services of children throughout the stages. The neonatal period has been identified as one of the most crucial phase in the survival and development of the child. The United Nations Millennium Development Goal Number 4 of reducing under five child mortality can be achieved by the Philippines however if the neonatal mortality rates are not addressed from its non-moving trend of decline, MDG 4 might not be achieved.

Vision and Mission: None to mention as these are inclusive in the MNCHN Strategy and NOH 2011-2016

Goals: To reduce neonatal mortality rates by 2/3 from 1990 levels

Garantisadong Pambata

PrintPrintEmailEmailPDFPDFThe Mandate: A.O. 36, s2010

Aquino Health Agenda (AHA): Achieving Universal Health Care for All Filipinos

Goal

Achievement of better health outcomes, sustained health financing and responsive health system by ensuring that all Filipinos, esp. the disadvantaged group (lowest 2 income quintiles) have equitable access to affordable health careUniversal Health Care

Strategies:

Financial risk protection.Improved access to quality hospitals and facilitiesAttainment of health-related MDGs by:Deploy CHTs to actively assist families in assessing and acting on their health needsUtilize life cycle approach in providing needed services: FP, ANC, FBD, ENC, IPP, GP for 0-14 years oldAggressive promotion of healthy lifestyle changeHarness strengths of inter-agency and intersectoralcooperation with DepEd, DSWD and DILGEXPANDED GARANTISADONG PAMBATA

Comprehensive and integrated package of services and communication on health, nutrition and environment for children available everyday at various settings such as home, school, health facilities and communities by government and non-government organizations, private sectors and civic groups.

Objectives:

Contribute to the reduction of infant and child morbidity and mortality towards the attainment of MDG 1 and 4.Ensure that all Filipino children, especially the disadvantaged group (GIDA), have equitable access to affordable health, nutrition and environment care. Rationale for the New GP Design

Infant and Young Child Feeding (IYCF)

PrintPrintEmailEmailPDFPDFI. Profile/Rationale of the Health Program

A global strategy for Infant and Young Child Feeding (IYCF) was issued jointly by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) in 2002, to reverse the disturbing trends in infant and young child feeding practices. This global strategy was endorsed by the 55th World Health Assembly in May 2002 and by the UNICEF Executive Board in September 2002 respectively.

In 2004, infant and young child feeding practices were assessed using the WHO assessment protocol and rated poor to fair. Findings showed four out of ten newborns were initiated to breastfeeding within an hour after birth, three out of ten infants less than six months were exclusively breastfed and the median duration of breastfeeding was only thirteen months. The complementary feeding indicator was also rated as poor since only 57.9 percent of 6-9 months children received complementary foods while continuing to breastfed. The assessment also found out that complementary foods were introduced too early, at the age of less than two months. These poor practices needed urgent action and aggressive sustained interventions.

To address these problems on infant and young child feeding practices, the first National IYCF Plan of Action was formulated. It aimed to improve the nutritional status and health of children especially the under-three and consequently reduce infant and under-five mortality. Specifically, its objectives were to improve, protect and promote infant and young child feeding practices, increase political commitment at all levels, provide a supportive environment and ensure its sustainability. Figure 1 shows the identified key objectives, supportive strategies and key interventions to guide the overall implementation and evaluation of the 2005-2010 Plan of Action. The main efforts were directed towards creating a supportive environment for appropriate IYCF practices. The approval of the National Plan of Action in 2005 helped the Department of Health (DOH) and its partners, in the development of the first (1st) National Policy on Infant and Young Child Feeding. Thus on May 23, 2005, Administrative Order (AO) 2005-0014: National Policies on IYCF was signed and endorsed by the Secretary of Health. The policy was intended to guide health workers and other concerned parties in ensuring the protection, promotion and support of exclusive breastfeeding and adequate and appropriate complementary feeding with continued breastfeeding. (1)

GUIDING PRINCIPLES

The IYCF Strategic Plan of Action upholds the following guiding principles:

1. Children have the right to adequate nutrition and access to safe and nutritious food, and both are essential for fulfilling their right to the highest attainable standard of health. (5)

2. Mothers and Infants form a biological and social unit and improved IYCF begins with ensuring the health and nutritional status of women. (5)

3. Almost every woman can breastfeed provided they have accurate information and support from their families, communities and responsible health and non-health related institutions during critical settings and various circumstances including special and emergency situations.(5)

4. The national and local government, development partners, non-government organizations, business sectors, professional groups, academe and other stakeholders acknowledges their responsibilities and form alliances and partnerships for improving IYCF with no conflict of interest.

5. Strengthened communication approaches focusing on behavioral and social change is essential for demand generation and community empowerment.

GOAL, MAIN OBJECTIVE, OUTCOMES AND TARGETS

GOAL:

Reduction of child mortality and morbidity through optimal feeding of infants and young children

MAIN OBJECTIVE:

To ensure and accelerate the promotion, protection and support of good IYCF practice

OUTCOMES:

By 2016:

90 percent of newborns are initiated to breastfeeding within one hour after birth; 70 percent of infants are exclusively breastfeed for the first 6 months of life; and 95 percent of infants are given timely adequate and safe complementary food starting at 6 months of age.TARGETS:

By 2016:

50 percent of hospitals providing maternity and child health services are certified MBFHI; 60 percent of municipalities/cities have at least one functional IYCF support group; 50 percent of workplaces have lactation units and/or implementing nursing/lactation breaks; 100 percent of reported alleged Milk Code violations are acted upon and sanctions are implemented as appropriate; 100 percent of elementary, high school and tertiary schools are using the updated IYCF curricula including the inclusion of IYCF into the prescribed textbooks and teaching materials; and100 percent of IYCF related emergency/disaster response and evacuation are compliant to the IFE guidelines.

II. Target beneficiaries of the program are infants (0-11 months) and young children (12 to 36 months years old or 1 to 3 years old)