TRADITIONAL AND ALTERNATIVE Herbal Medicine

HEALTH CARE - The use of it has been nuncupative

to address the rising cause of drugs
These are the examples of alternative by utilizing available resources in
therapies: the community.
● Body Massage to relieve body - Are medicinal products that contain
aches instead of taking mefenamic an active ingredient/s serial or
acid. underground part/s of plant or other
● Lighting a scented candle or materials or combination.
heating essential oils to quiet and
calm your mood instead of taking a Complementary and Alternative
pill. Medicines (CAM)
- A broad domain of healing resources
Philippines passed the Traditional and that encompasses all healthy
Alternative Medicine Act (TAMA) of 1997 systems, modalities, and practices
- Republic Act. 8423 coming from theories and beliefs,
- Creating the Philippine Institute of other than those intrinsic nepotically
Traditional and Alternative Health dominant health systems of a
Care (PITAHC) during the time of particular society or a culture.
Senator Juan Flavier. - A group of diverse medical and
- Purpose: Accelerate the health care interventions, practices,
development of traditional and products, or disciplines that are not
alternative health care in the generally considered part of
Philippines. conventional medicines.

Traditional And Alternative Health Care Complementary Medicine

- The knowledge, skills and practices, - Is used together with conventional
other than those embodied in medicine.
biomedicine, used in the prevention, Example: Aromatherapy to help
diagnosis and elimination of physical lessen a patient’s discomfort
or mental disorder. following surgery instead of taking a
pill.
Traditional Medicine
- It is the sum or total of all Alternative Medicine
knowledge, skills, and practice in - Is used in place of conventional
health care and is not necessarily medicine.
explicable in modern scientific Example: The use of a special diet
philosophical framework. that is to treat cancer instead of
- Practice on health care recognized undergoing surgery radiation or
by the people. chemotherapy.
- Help maintain and improve their
health towards the wholeness of Integrative Medicine
their being, the community and - Combination of evidence-based
society. medicine and alternative medicines.
- Focuses on the whole person.
Alternative Health Care Modalities - Treatment is done by making use of
- Are other forms of non-allopathic, all appropriate therapeutic and
occasionally non-indigenous or lifestyle approaches.
important healing methods. They are - Combining the use of special diets,
not necessarily practiced for herbs, acupuncture, mind-body
centuries, 200 down from 1 interventions, and massage therapy
generation to another. with conventional cancer care often
aids the healing process.
Examples:
1. Reflexology
2. Acupressure Types of CAM
3. Chiropractic Alternative Medical Systems
4. Nutritional Therapy Biologically Based Therapies
Manipulative Body Therapies
Mind-Body Therapies 4. Hyperbaric oxygen
● Iridology
Example: - IRIS can be used to reveal
emerging conditions in every
● Acupuncture part of the body and to
- The insertion of very fine/ identify inherited weaknesses
thin needles through your that may lead to physical and
skin at the strategic points in emotional disorders.
your body. - Is one of the traditional
● Homeopathy complementary medicines.
- Pseudoscientific system of ● Chelation Therapy
alternative medicine. It is - Used to rid the body of
based on the belief that the unnecessary and toxic
body can cure itself. metals.
- Homeopathic remedies are - Chelating agents, EDTA, with
dilutions of natural vitamins and minerals, are
substances from plants, administered intravenously.
minerals, and animals. They - Prevention of ailments linked
believe that these to atherosclerosis - coronary
substances stimulate the disease, strokes, peripheral
healing process. vascular disease and arterial
● Aromatherapy blockages.
- A holistic healing treatment ● Pranic Healing
that uses natural plant - A no-touch natural healing
extracts to promote health system that utilizes prana or
and well being. vital energy to cleanse and
- Most commonly used for: energize the human energy
1. Infections body and to accelerate the
2. Skin disorders natural healing power.
3. Immune deficiencies ● Acupressure
4. Stress - Application of pressure to the
● Ayurveda body to affect the flow of
- Ayurvedic medicine - energy in the meridians
“science of life” according to the principles of
- A form of complementary- traditional Chinese medicine.
alternative medicine. - A type of complementary-
- World's oldest holistic healing alternative medicine.
system. It was developed
more than 3000 years ago in Philippine Alternative Medicine (Herbal
India. Medicine)
- Balance between mind, ● 1992 Sen. Juan Flavier Traditional &
body, and spirit. Alternative Medicine Act 8423
● Chiropractic medicine (TAMA)
- The relationship between the ● Philippine pharmacopeia released in
structure of the spine and the 2004 lists 30 crude plant drugs
function coordinated by the ● Dita bark, sinta herb, kintsay leaf,
nervous system. And how sampaguita flower, ipil-ipil seeds,
this relationship affects makahiya herb, apatot fruit,
preservation and restoration malunggay bark, ikmo leaf, paminta,
of health. oregano leaf, mayana leaf, granada
● Detoxification Therapy rind, romero leaf, akasya leaf, duhat
- Helps to rid the body of bark, sampalok pulp, makabuhay
chemicals and pollutants and stem, ginger and banana.
can rejuvenate the body.
- Forms of detoxification: Recommended Procedures When
1. Fasting and specific Gathering & Processing of Herbal
diets Medical Plants
2. Colon hydrotherapy
3. Coffee enema
 1. Inspect the herbal parts of plant for - Is a vine known as “Chinese honey
organoleptic characteristics (color, suckle”
texture, odor) - Used to eliminate intestinal parasites
2. Inspect for the presence of foreign commonly in children and even in
matter, sand dirt, molds, or sign of adults.
decay.
3. Inspect for any presence of insects. 7. Sambong (Blumea balsamifera)
4. Make sure that your cookware is - “Ngai camphor or Blumea camphor”
non-corrosive (enamel glass or - Used to treat kidney stones,
stainless or palayok). wounds, and cuts, rheumatism, anti-
5. Use clean water. diarrhea, anti spasms, colds and
6. Best age of plant to gather- flowering coughs, and hypertension
stage (photosynthesis is most
active). 8. Tsaang Gubat (Ehretia
microphylla Lam.)
13 Medical Plants in the Philippines - “ Wild tea”
endorsed by DOH - Taken as tea to treat skin allergies
including eczema, scabies and
1. Akapulko (Cassia alata) itchiness, and wounds in childbirth.
- “Ringworm bush or shrub” and - Abdominal pain and antispasmodic.
“bayas-bayasan”
- Anti-fungal: tinea flava, ringworms, 9. Ulasimang Bato/ Pansit-Pansitan
and athlete’s foot. (Peperomia pellucida)
- Also used for insect bites, eczema, - Known for its effectiveness in
scabies, and itchiness. treating arthritis and gout.
- Lowers uric acid in blood.
2. Ampalaya (Momordica charantia)
- “Bitter melon” or “bitter gourd” 10. Yerba Buena (Clinopodium
- Lowers blood sugar levels diabetes douglasii)
mellitus (mild-non insulin dependent) - “Peppermint”
- Also used to treat hemorrhoids, - Used as analgesic to relieve body
coughs, burns, and scalds. aches and pain due to rheumatism
and gout.
3. Bawang (Allium sativum) - It is also used to treat coughs, colds,
- “Garlic” and insect bites.
- Has antibacterial, anti-inflammatory
and anticancer and antihypertensive 11. Malunggay
properties. - Superfood of the Filipinos but also
- Widely used to reduce cholesterol considered as a miracle tree around
level in blood. the globe.
- It can treat various ailments and
4. Bayabas (Psidium guajava) diseases.
- “Guava” - Some of its nutritional properties
- Anti-inflammatory, antispasmodic, include phosphorus, iron, potassium,
antioxidant hepatoprotective, anti- calcium, and vitamins A and C.
allergy, antimicrobial, antiplasmodial
properties. 12. Tawa-Tawa (Euphorbia hirta)
- Commonly used in washing wounds, - “Asthma Plant”
toothache, diarrhea. - Family: Euphorbiaceae
- Registered as a supplement, not
5. Lagundi (Vitex negundo) therapeutic.
- “5 - leaved chaste tree” - Effectivity in treating dengue.
- Used to treat cough, colds, and - It increases blood platelet count,
fever. maintains the upper respiratory, and
- Also used as a relief for asthma & boosts the immune system.
pharyngitis, rheumatism, dyspepsia,
boils and diarrhea 13. Banaba (Lagerstroemia specoisa)
- “ Giant crape myrtle”
6. Niyog-niyogan (Quisqualis indica) - Family: Lythraceae
 - A supplement for diabetes and Learning objectives:
kidney failure, helps regulate blood  Describe the practices in maternal and
newborn care and emergency management
pressure, aids the digestive system,
principles
and fights down obesity.  Identify the essential and immediate newborn
- According to popular belief, banaba care protocol.
as well can prevent constipation,  Enumerate the four time-bound intervention in
kidney inflammation, and urinary caring of newborn
dysfunctions. Moreover, it contains
T10 BMONC & EINC
high concentrations of dietary fiber  Basic emergency obstetrics and newborn care
and minerals such as zinc and and as well as the essential intrapartal and new
magnesium. born care
 Which are all related to the concept of
maternal and child health nursing
Cooking of Lagundi Syrup and Akapulko
Ointment Maternal and Child Health:
 Care of the woman and the family throughout
Akapulko Ointment pregnancy and childbirth and the health
Procedure: promotion and illness care of the children and
families.
1. Wash the leaves thoroughly.
2. Chop/ cut the leaves. Goal for the maternal and child health:
3. Heat vegetable oil and fry chopped  To ensuring that every expectant mother and
leaves. nursing mother maintains good health, learns
the art of child care, has normal delivery and
4. Wait until the leaves are crisp . Stir
bears health healthy child.
using a wooden ladle or stirrer.
5. Strain the leaves. Basic Emergency Obstetrics and Newborn
6. Pour into the pan. Care (BMONC)
7. Put the candle to the oil and mix well  Too many mother and children are dying
everyday and most maternal deaths occurs
until it dissolves. during labor, delivery and the immediate
8. Pour into containers. postpartum baby
9. Let it cold down and label.  So to avert death and disability, we need to
ensure that women have access to BEMONC
Lagundi Syrup  Furthermore, this concept pf BEMONC was
introduced by the following organizations:
Procedure:
WHO, UNICEF, UNFPA in 1997
1. Pour 2 cups of water into the pot.  As an organizing framework for the delivery of
2. Add a 1 cup chopped Lagundi evidence-based practice services and critical
leaves. component of any program to reduce maternal
3. Leave it for at least 15 minutes or and newborn mortality
after the water will reduce into half. Millennium Development Goal 5
This will make the mixture more  The Philippine Government is dedicated to
concentrated. achieve its millennium development goal
4. After 15 minutes, Filter the mixture number 5 which is to improve maternal health
using a strainer to remove the  To accomplish this, maternal death rate should
decrease to 75% in 2015
leaves.  In response, the Department of Health has
5. After filtering, continue to boil the affirmed its commitment to invest in women
filtered mixture to the pot and add 1 and the children’s health by adopting specific
cup of sugar or honey. Mix it until it strategies to reduce the maternal and infant
shows the right amount of mortality
consistency of the sysrup. Make BEMONC
sure not to stay in heat for too long  To decrease the maternal mortality, every
because this may cause it to women should have an access to BEMONC
become very sticky.  Refers to the functions that can be provided by
a team of experienced and trained skilled birth
6. Pour your Lagundi syrup in the
attendants composed of licensed doctor,
container. nurses and midwife who act as a team at the
7. Cover and label it. primary level in providing basic emergency care
to mothers and babies to avert maternal and
newborn morbidity and mortality

 The DOH launched and implements the Basic

Emergency Obstetric Care Strategy
 It entails the establishment of facilities that
provides basic emergency obstetric care
 The WHO recommends a ratio of one BEMOC labor where in the mother is on active labor n
facility per one hundred twenty five thousand about to give birth
(1:125,000) population
 INTERVENTION: Prepare for the delivery
Six (6) Basic Functions of a BEMONC Suggested actions is:
facility:  Ensure that delivery area is draft- free
This functions refers to the capability of a facility to  Room temperature between 25-28 degree
perform each of those functions that can be Celsius using a room thermometer ( this is to
provided by a team of experienced and trained provide an ambiance room temperature)
skilled birth attendants composed of a licensed  Wash hands with clean water and soap
doctor, nurses and midwife who act as a team at the  Double glove just before delivery
primary level facilities such as rural health unit,
variety? clinic to comply the basic emergency care Within the 1st 30 seconds
both to the mother and the baby  CALL OUT THE TIME OF BIRTH

1. Administer parental antibiotics INTERVENTION: Dry and provide warmth (prevents

2. Administer parenteral oxytocic drugs hypothermia). So this particularly refers to the 1st
3. Administer parenteral anti convulsants for calls step which is the immediate thorough drying.
preeclampsia and eclampsia Immediate drying prevents hypothermia. Because
4. Perform manual removal of placenta the thermal regulations process on the newborn are
5. Perform removal of retained products not yet fully developed and can’t adapt yet to the
6. Perform assisted vaginal delivery external environment. It is important to maintain a
warmth environment.
ESSENTIAL INTAPARTAL NEWBORN Suggested actions is:
CARE (EINC)  Use a clean, dry cloth to thoroughly dry the
Definition of terms baby by wiping the eyes, face, head, front and
 Newborn- refers to a baby from birth to about back, arms and legs.
2 months of age  Remove the wet cloth.
 Intrapartum- Occurring during labor or  Do a quick check of newborn’s breathing while
delivery drying
 Labor- is a series of continuous , progressive
contractions of the uterus that help the cervix During the first 30 seconds, healthcare workers
dilate ( open) and efface(thin) this allows the should note the following conditions:
fetus to move through the birth canal  Do not ventilate unless the baby is floppy/limp
 HYPOTHERMIA- low body temperature and not breathing.
 Vernix- waxy white substance found coating the  Do not suction unless the mouth/nose are
skin of newborn huma babies blocked with secretions or other material.
 BREECH PRESENTATION- Occurs when the baby
bottocks or feet or both are in place to come If after 30 secs of thorough drying, newborn is not
out first during birth breathing or is gasping:
 EINC- It is a protocol that characterized by a Suggested actions is:
series o series of time bound, chronologically-  Call for help
ordered standard procedure that the baby  Clamp and cut the cord immediately
receives at birth . It is consist of suggested  Reposition the airway
actions and intervention to be done in  Transfer to a warm, firm surface
sequence for its specific time frame  Start resuscitation protocol
 Evidence based standard for safe- meaning  Suction airway if it us blocked
evidences are solid that this practices are for
the safety and quality care of birthing mothers
and their newborn within the 48 hours of
intrapartum period (labor and delivery) and a
week of life for the newborn
If after 30 secs of thorough drying, newborn is
4 time bound intervention that are being done breathing or crying:
chronologically INTERVENTION: Do skin-to-skin contact
FOUR CORE STEPS OF ESSENTIAL Suggested actions is:
NEWBORN CARE  Place the newborn prone on the mother’s
1. Immediate and through drying abdomen or chest skin-to-skin
2. Early skin to skin contact  Cover newborn’s back with a blanket and head
3. Properly time cord clamping with a bonnet (this prevents heat lost and it
4. Non- separation of the new born and the maintains warmth to the baby)
mother for early initiation of breastfeeding  Place identification band on ankle
Guidelines in giving immediate new born
This intervention of skin-to-skin contact, evidences
care
has shown its importance of a thermal regulation of
THE FIRST 90 MINUTES a newborn and the transfer of the normal skin flora
 It starts at the PERINEAL BULGING with the from the mother to infant as well as in establishing
presenting part visible which is the head of the breastfeeding practices.
baby normally this is refer to the 2nd stage of
While maintaining skin-to-skin contact, healthcare  Open tissue on head, abdomen or back
workers should note the following: If any:
 Cover any open tissue with sterile gauze before
 Do not separate the newborn from mother, as referral.
long as the newborn does not exhibit severe  Refer for special treatment and/or evaluation if
chest in drawing, grasping or apnea and the available.
mother does not need urgent medical
stabilization. Intervention rooming-in:
 Do not put the newborn on a cold wet surface  90mins-6hours of life, the intervention focus on
 Do not wipe off vernix if present, because rooming in. It is a practice where in the baby
studies suggest that vernix ahas a protective stay with the mother in the post labor recovery
effect on the baby’s skin room.
 Do not bathe the newborn earlier than 6 hours
of life (delaying bathing for at least 6 hours Millennium Development Goals:
after birth protects the skin of the baby from  Eradicate extreme poverty and hunger
the bacterial invasion. And also it keeps their  Achieve universal primary education
skin condition and keeps their blood sugar  Promote gender equality and empower women
stable, because often bathing causes  Reduce child mortality
hypoglycaemia)  Improve internal health
 If the newborn must be separated from his/her  Combat HIV/AIDS malaria and other disease
mother, put him/her on a warm surface, in a  Ensure environmental sustainability
safe place close to the mother  Develop a global partnership for development

Within 1-3 minutes:  The Philippines: One of the 42 countries

accounting for 90% of mortality rates in
INTERVENTION: Do appropriately timed cord children under 5 years old globally.
clamping or delayed cord clamping which is defined  Study have shown that 70% of newborn deaths
as prolonging the clamping of umbilical cord at least may be averted during labor.
1 minute after delivery
Suggested actions is: Delivery and immediately postpartum- it is a first
 Remove the first set of gloves immediately few seconds and minutes of life that every newborn
prior to cord clamping Filipino given a chance to survive and have a better
 Clamp and cut the cord after pulsations have life during the first few moment in the arm of the
stopped (typically at 1-3 minutes) mother, during the first embrace (saunang yakap)

How to do the cord clamping and cutting? Preparation:

 Apply a sterile plastic clamp or a cord clamp at  3 surgical gloves- which will be used
2cm from the umbilical base obstetrician and remaining pair for the
 Clamp again at 5cm from the umbilical base pediatrician.
 Cut the cord close to the first clamp (plastic  2 blankets
clamp) Then observed to Oz blood  1 Bonner
 Cord care set
Reminder during cutting the cored  Eye care
Note:  Vitamin K and hepatitis B shot
 Do not milk the cord towards the newborn. Procedure:
 Umbilical cord milking is a procedure in which  Wash hands 5 counts for each movement.
the clamp or the unclamp umbilical cord is  Put the gloves on- double gloving steps.
clasped and the blood is push 2 to 4 times
towards the newborn in a rapid time rate. In Within the first 3 mins:
the present guidelines, milking of the cords is  Once the baby is delivered, call out the time of
no longer practice, instead delayed cord cutting birth
is observed because study shows that delay  Towel dry the baby for at least 30 seconds to
cord clumping allows the newborn to continue stimulate the baby to breath
receiving the fetal blood from the placenta  Do not wash the baby within the first six hours
after delivery which can result in 60% more of of life
the red blood cells and 30% increase in blood  Washing may lead to hypothermia and
volume it increase hemoglobin concentration infection
reduce the range of having anemia, and include  Carry out a rapid assessment of the baby’s
the cardio pulmonary adaptation and better breathing as you dry the newborn
iron status and six months postpartum.  Remove the wet cloth
 Initiate skin-to-skin contact by placing the baby
 Do controlled cord traction with counter prone on the mother’s abdomen or between
traction and gentle urine massage. her breast
 After cord clamping, ensure 10 IU oxytocin is  Place the bonnet on the baby’s back and head
given to the mother intramuscularly.  Use second linen to cover the baby’s back to
keep infant warm
Look for malformations:  Removing the first pair/ first set of gloves prior
 Cleft palate or lip to handling the cord
 Club foot  Do not cut the cord immediately
 Odd looking, unusual appearance
 Allow the cord pulsations to stop without sustain new life for those first precious
milking the cord moments in the life of the newborn and the
 Clamp the cord at 2cm from the umbilicus base life-giving embrace of the mother “Unang
 Apply the second clamp at 5cm from the baby’s Yakap” “ Yakap ng Ina” “ Yakap ng Buhay”.
umbilicus  Unang Yakap is a campaign launched by the
 Cut the cord DOH with support from the WHO based on an
administrative order issued in December 2009
BENEFITS OF PROPER CORD CLAMPING on the Guidelines on Essential Newborn Care.
 Waiting for 1-3 mins or until cold pulsation  Unang yakap draws on the support of the
stops prevents anemia whole hierarchy of the DOH and its attached
 Lower rate of intraventricular hemorrhages agencies, other public and private providers of
 Promotes bonding between mother and child health care and development partners
 Increases the overall success of breastfeeding/ implementing the Maternal, Neonatal and Child
colostrum feeding Health and Nutrition (MNCHN) Strategy.
 Allows colonization of good bacteria
 Protects the baby from hypoglycemia
 Inject 10 IU of oxytocin into the mother’s arm
to prevent uterine _ _ _ _ _ ? EPI
 While maintaining skin to skin contact check on
the mother’s condition and deliver the placenta Immunization - process by which vaccines are
check how heavy her bleeding is and examine
introduced into the body to induce immunity.
her perineum, lower vagina, and vulva for _ _
_?
Vaccines- substance used to stimulate the
 Clean the mother and keep comfortable production of antibodies and provide immunity
 At about 30 mins to an hour after birth, the against one or several diseases, prepared from
baby will start licking, rooting, and toughing causative agent of a disease, its products, or a
movements that is ready to breastfeed synthetic substitute, treated to act as an
 Encourage the crawling reflex/ encourage the antigen w/o inducing the disease.
mother to nudge her newborn towards her
breast to seek out the nipple Cold chain- system of storing and transporting
 Council on positioning and attachment vaccines at recommended temperatures from
 After the baby completes his first breastfeed
the point of manufactures to the point of use.
and detaches from the breast while his with the
mother carry out the eyecare procedure and
administer vaccines\ Site- specific area in the body where the vaccine
 Keep the child in the mother’s arm as she is introduced.
recovers from giving birth Dosage- amount of vaccine in ml/drops to be
 The newborn stays with the mother as she is administered.
brought to her room or the ward
 The baby may be washed after atleast 6 hours Routes of vaccines administration:
Intradermal ID- vaccine is injected to the top
 Exclusive breastfeeding starts at birth with layers of the skin(dermis).
colostrum feeding and continues for six months
Subcutaneous- vaccine is injected to the fatty
 At 6 months, appropriate complementary solids
are started while breastfeeding continues until
tissue below the skin and above the muscle.
two years or beyond Intramuscular- vaccine is injected into the
muscle
SUMMARY OF STEP BY STEP METHODS Oral- vaccine is given by drops into the mouth.
OOUTLIUNED ESSENTIAL NEWBORN
CARE PROTOCOL Introduction:
1. Drying for atleast 30 sec with a rapid
The expanded program of immunization is a
assessment of breathing and tone
World Health organization Program with the
2. Early skin-to-skin contact
3. Properly timed cord clamping goal to make vaccines available to all children
throughout the world:
Non- separation for early breastfeeding Expanded means:
 Carry out eye care and immunization -expanding the number of diseases to be
procedures after completion of the first covered
breastfeed -expanding the number of children and
 Rooming-in population to be covered
 Exclusive breastfeeding for six months -expanding coverage to all corners of the
country and spreading services to reach the less
 As we adopt and embrace essential newborn
privileged sectors of the society.
care were closer to attaining the millennium
development goals of reducing child mortality
in the country as we health professionals and Background:
maternal and newborn care give each newborn • experienced with smallpox eradication
a better chance at health and survival and will program showed the world that immunization
remain to change on how we move forward it was the most powerful and cost effective
means doing things differently using a protocol weapon against vaccine preventable diseases.
that are evidence-based and timebound to
• In 1974, the WHO launched its "expanded 9. To reduce the incidence of bacterial
program of immunization" (EPI) against six most meningitis due to haemophelus influenza
common preventable diseases (diphtheria,
pertussis, tetanus, polio, tuberculosis and Contraindications of vaccines
measles). Note: vaccine cannot be given if the child is
immunocompromised
EXPANDED PROGRAM ON IMMUNIZATION
-established in 1976 General
-ensure that infants/children and mothers have • Any acute illness
access to routinely recommended infant/child • severe malnutrition
vaccines. • In known case of immune deficiency

RA No. 10152 RELATED TO GROUP OF VACCINES

''mandatory infants and children health • During pregnancy
immunization act of 2011" • during steroid therapy
President Benigno Aquino III • during radiation therapy
-july 26 2010 • during administration of anti metabolites
Basic immunization for children under 5
including other types that will be determined by INDIVIDUAL VACCINES
the secretary of Health'' • BCG- Extensive dermatitis
• Polio- diarrhea within 3 weeks of
Overall Goal tonsillectomy
To reduce the morbidity and mortality among • Pertussis- febrile illness convulsion
children against the most common vaccine- • measles- convulsion
preventable disease.
Morbidity-being ill SOME COMMON VACCINES
Mortality- death • BCG
• DPT
Strategies: • MEASLES
1. Conduct of routine immunization for • TETANUS
infants/children/women through the reaching • POLIO -IPV OPV
every brngy (REB) strategy. • MMR(MEASLES MUMPS RUBELLA
2. Supplemental Immunization Activity(SIA)
3. Strengthening vaccine-preventable diseases POLIO- short of poliomyelitis it is caused by
surveilance poliovirus.or as a carrier of virus without having
4. Procurement of adequate and potent the symptoms of disease it infects the persons
vaccines and needles and syringes to all health brain and spinal cord causing paralysis
facilities nationawide.
Poliomyelitis
10 diseases covered by EPI: OPV(ORAL POLIO VACCINATION )
Tuberculosis Is administered on the 6 or 14th week of life
Polio 2-3 drops orally
Measles The extent of protection against polio is
Diphtheria increased the earlier the OPV is given
Pertussis
Tetanus DIPHTHERIA- Is a bacterial infection that affects
Hepa B the nose and throat it causes breathing
Pneumococcal meningitis problems and swallowing problems.
Influenza
Diarrhea PERTUSSIS - is a whooping cough or also called
100 day cough it is highly contagious
Objectives of EPI: respiratory disease
1. To achieve 100% coverage for eligible
children by an ongoing integrated program NEONATAL TETANUS- Infection occurs at
2. Eradication of polio to maintain polio free unhealed umbilical stump ( non sterile
status equipment)
3. Elimination of measles
4. Elimination of Neonatal Tetanus DIPHTHERIA PERTUSSIS TETATNUS
5. Maintain zero level of diphtheria DPT
6. Reducing pertussis incidence to a minimum Is given at 6 weeks old having 3 doses (0.5ml)
level given in intramuscular on the upper portion of
7. Reducing childhood TB incidence the thigh
8. Reduce incidence of hepatitis B among under An early starr with DPT reduces the chance of
five children severe PERTUSSIS
14 weeks (DPT 3) Doses: 0.5 mL
The mothers receive the vaccine it provides
protection to the child born to her as well Vaccine: measles Mumps-Rubella vaccines
Minimum age: 12-15 months old
TETANUS TOXOID IMMUNIZATION Number of doses: 1 dose
*Neonatal Tetanus is one of the public health Doses: 0.5 mL
concerns that we we need to address among
newborns. To protect them from deadly The components of pentavalent vaccines are
disease, tetanus toxoid immunization is DPT, HEPATITIS B and HAEMOPHILUS
important from pregnant women and child INFLUENZA TYPE B vaccines
bearing age women
The pentavalent vaccine encompasses the DPT
Both mother and child are protected against which is given under 6,10 and 14 weeks of life if
tetanus and neonatal tetanus toxoid a series of pentavalent is available the DPT is no longer
2 doses of tetanus toxoid vaccination must be given
received by a women one month before
delivery to protect baby from neonatal tetanus Five-in-one Pentavalent
and the 3 booster dose shots to complete rhe 5 One vaccine against five diseases
doses following the recommended schedule -diphtheria
provides dull protection for both mother and -pertussis
chd the mother is then called as fully -tetanus
immunized mother -hepatitis b
-hip
TUBERCULOSIS- Affects the lungs this is a
airborne disease In 2012, Rotavirus and Pneumococcal vaccines
were introduced in the national immunization
BCG OR BACILLUS CALMI BUREN program
- Is given at birth or any time at birth at 0.05ml
intradermal at right delted region of the arms Rotavirus vaccines protects the variant children
- it is used because it is effective in reducing the from acute diarrhea
severity of tb meningitis and miliary TB
It is given at least 6 weeks of life with 3 doses
HEPATITIS B- Viral infection that attackd the One month interval between doses and 2 drops
liver this transmitted through blood or other orally
body fluids this given at birth 3 doses 4 weeks
interval Pneumococcal vaccine protects the young from
Intramuscular pneumonia - a bacterial infection in the lungs
Upper outer portions of the thigh starting from that is a common complication from the flu. In
left then right addition to a flu shot every fall, its a good idea
Prevents liver cirrhosis and liver cancer to get a once-in-a-lifetime pneumococcal
vaccine
EMEASLES is caused by a airborne virus that
infects the respiratory tract PCV is given 6 weeks of life at 3 doses with one
MCV ( MEASLES-CONTAINING VACCINE) month interval between doses of 0.5 mL that is
9 Months of life given IM deltoid area
2 dose( 0.05ml)
Subcutaneous This table summarize the vaccines discussed
Upper outer portions of the arms
At least 85% of measles can be prevented by Vaccine: BCG (bacillus calmette-guerin)
immunization at this age Minimum age at 1st dose: at birth or anytime
after birth
Administration of the 2 dose measles- Number of doses: 1
conataing vaccine was implemented in. 2009 Minimum interval between doses:
Reason: BCG protects the infant from possibility
MCV1(Monovalent measles) at 9-12 month old of TB meningitis and other TB infections
MV2 (MMR- MEASLES,MUMPS AND RUBELLA
GERMA MEASLES AT 12-15 MONTHS OLD Vaccine: Hepatitis B vaccine
Minimum age at 1st dose: at birth
This is the schedule of giving measles or MMR Number of doses: 1
vaccines Minimum interval between doses:
Reason: reduces the chance of being infected
Vaccine: measles vaccine and becoming a carrier of Hepatitis B
Minimum age: 9 months old
Number of doses: 1 dose Vaccine: Pentavalent Vaccine (DPT-HepB-Hib)
Minimum age at 1st dose: 6 weeks 1 dose BCG and Hepa B at birth
Number of doses: 3 3 doses of POV
Minimum interval between doses: 4 weeks / 1 3 doses of pentavalent vaccine
month 1 dose measles vaccine before the childs first
Reason: it is a protection against diphtheria, birthday (DOH, 2017)
tetanus, pertussis, hepatitis b and haemophilus
influenza type Every Wednesday is designated as
immunization day and is adopted in all parts of
Vaccine: Oral piolo vaccine (OPV) and the country. Immunization is done monthly in
Inactivated Polio Vaccine (IPV) barangay health stations, quarterly in remote
Minimum age at 1st dose: 6 weeks areas of the country
Number of doses: OPV - 3 doses, IPV - 1 dose
coexist with OPV 3 Care of the Vaccines
Minimum interval between doses: 4 weeks / 1 1. Storage and transport of vaccines from the
month primary vaccine store down to the end-user at
Reason: protection against polio diseases the health facility and further down at the
outreach sites
Vaccine: Rotavirus vaccine 2. A “first expiry and first out” (FEFO) vaccine
Minimum age at 1st dose: 6 weeks system. It is practiced that all vaccines are
Number of doses: 2 utilized for its expiry date, proper arrangement
Minimum interval between doses: 4 weeks / 1 of vaccines and or labeling of the expiry dates
month are done to identify those close to expiry
Reason: protect against diarrhea caused by 3. Vaccine temperature is monitored twice a
severe forms of rotavirus disease day (early in the morning and in the afternoon)
in all health facilities and plotted to monitor
Vaccine: measles break in cold chain
Minimum age at 1st dose: 9 months - cold chain is a system of transporting or
Number of doses: 1 storing vaccine within the sage temperature
Minimum interval between doses: range of 2 degrees celsius to 8 degrees celsius
Reason: prevents death, malnutrition and (strive for 5 degrees celsius - the midway out).
protection from measles The role of cold chain is to maintain the potency
of vaccines, called chain bridges must be
Vaccine: MMR (measles, mump, rubella) reported from the department as soon as
vaccine possible using the cold chain bridge report
Minimum age at 1st dose: 1 year and 1 month form. This form is also use to report light
Number of doses: 1 exposure bridges for light sensitive vaccines
Minimum interval between doses: Cold chain equipment
Reason: protection against measles, mump and -cold room
rubella virus -freezer
-refrigerator
-transport box
-vaccine carriers
-thermometers
-cold chain monitors
-ice packs
-temperature monitoring chart safety collector
boxes

WEEK 3 DAY 1
Breastfeeding

WHO guideline: “COMPLETE OR FULL “Breastfeeding is a mother’s gift to herself, her

IMMUNIZATION” coverage is defined as a child baby and the earth”- Pamela K. Wiggins
has received a BCG vaccination against
tuberculosis; three doses of DPT vaccine to Learning outcomes:
prevent diphtheria, pertussis and tetanus (DPT); 1. Clearly define what is breastfeeding
at least three doses pf polio vaccine and one 2. Review the anatomy and physiology of
does of measles vaccine (jul 30, 2015) Breast Milk Production
3. Recognize the Advantage of
This is the latest idea for Breastfeeding
A Fully Immunized Child: - For women
- For infant
 4. Enumerate the Preparation and Feeding colostrum which is a fluid that’s rich in
cues immune cells and antibodies but low in fat.
5. List the steps on latching on, different  Colostrum coats the baby’s gastrointestinal
breastfeeding positions and associated tract and has a laxative effect which helps
problems in breastfeeding and it’s the baby pass the first stool which is called
management meconium.
6. Identify and learn the different laws  Within a few days after delivery the breast
that protect infant and young child start producing milk which relative to
feeding colostrum has a much higher fat content.
In fact, the amount of fat in milk also varies
Breastfeeding during a feeding session. When milk is
The method of feeding an infant directly from sitting in the breast, fat globules stick to
the human breast the alveolar walls rather than moving into
the lactiferous ducts.
Anatomy and Physiology of Breast Milk  So when a baby begins feeding and drinks
Production the milk that was in the lactiferous ducts
first that milk has relatively low fat
 Breast tissues- develop during puberty and content. The process of feeding though
is made up of adipose or fat tissue as well increases the milk flow and those fat
as globules get swept into the lactiferous
 Glandular tissue- that makes the milk ducts causing the fat content of the milk
 Lactiferous ducts- which serves as steadily increase as the feeding session
passageways which guides the milk to the continues.
nipple. Zooming in on the glandular tissue  Breast milk also contains lactose, vitamins,
there is micronutrients and various proteins like
 Alveolus which is a modified sweat gland casein and maternal antibodies.
made up of alveolar cells which actually  Most importantly, it contains secretory IgA
make the breast milk. which supplements the baby’s
 Wrapping around the alveolus are special gastrointestinal immune system.
Myoepithelial cells that squeeze down and
push the milk out of the alveolus down to ADVANTAGES OF BREASTFEEDING (For
the lactiferous ducts and out of one the Women)
pores on the nipple. At which point it Woman gains several physiologic benefits from
enters the baby’s mouth. breastfeeding
 When the breast are full of milk, they can 1. The release of oxytocin from the
get heavy. And there are suspensory posterior pituitary gland aids in uterine
ligaments called Cooper’s ligaments which involution.
help hold them up against the chest wall. 2. Successful breastfeeding can have an
 During pregnancy, the placenta releases empowering effects because it is a skill
human placenta lactogen and only a woman can master.
progesterone. 3. Breastfeeding may serve a protective
 Anterior pituitary gland releases prolactin. function in preventing breast cancer
And all three of these hormones stimulate and possibly ovarian cancer.
the growth of more glandular tissue and 4. A woman may return to her pre-
prepare the alveolar cells to produce milk. pregnant weight sooner and if
 Prolactin also stimulates milk let down. But menstruation is delayed this may serve
progesterone prevents that from as temporary family planning method
happening. So by mid pregnancy, the 5. Long term effect may include a
breast are capable of making milk but don’t decrease risk of hip fractures and
release it. Except for some occasional osteoporosis in post-menopausal
leakages from the nipples. The breast period for the women.
enlarge. 6. Breastfeeding provides an excellent
 The area around the nipple called the opportunity to enhance a true
areola begins to darken and the areola symbiotic bond between mother and
glands also called child
 Montgomery glands which look like bumps 7. Breastfeeding reduces the cost of
on the areola start to produce lipoid fluid feeding and preparation time for infant
which moisturizes the nipple. feeding.
 Once the baby’s delivered though, the
placenta or afterbirth is also delivered. So ADVANTAGES OF BREASTFEEDING (For Infants)
placenta progesterone disappears and milk
begins to flow. Initially though, the breast 1. Breast milk contains secretory
don’t actually make milk, they make immunoglobulin A or the IgA which binds
large molecules of foreign proteins
 including viruses and bacteria. Thus keeping  Restlessness or crying
them from being absorbed from the  Tense body posture
gastrointestinal tract. So this strengthens 3. Assess the nipples if the nipples is normal,
immune system. flat or inverted
2. Breast milk contains more linolic acid an  Nipple shield is a helpful breastfeeding
essential fatty acid for skin integrity and less device made of rubber silicone or synthetic
sodium, potassium, calcium and materials that is worn over the nipples and
phosphorus than do many formula. Breast areola in while the infant is sucking.
milk also has a better balance of trace  Another way of correcting an inverted
elements such as zinc. So this provides nipple is through the Hoffman Technique
complete nutritional food.  Place both bottom on opposite side of the
3. Breast milk contains the ideal electrolyte nipple at the based gently pull the thumbs
and mineral composition for human infant of a from each other hand in opposite
growth. So this safely rehydrates. direction. Work both up and down and
4. A great deal of discussion about the sideways. Start with two repetitions per
benefits of breastfeeding has centered on day, gradually building up to five. This
the effects of breastfeeding on the technique is thought to break down the
formation of the dental arc. Because babies adhesion at the base of the nipples that
suck differently from a breast than from a keep it inverted.
bottle. That may make breastfeeding the
best preparation for forming common Step in Latching on
speech sounds. 1. Hold your baby towards your body and her
5. Breastfeeding may also help prevent nose close to your nipple
excessive weight gain in infants. It has 2. Move your baby back an inch or two. Her
been shown that exclusive breastfeeding head should tilt back, and her mouth will be
into the infant’s fourth month of life can open. It's important for your baby's mouth
decrease obesity as adolescents. to be open wide.
6. Less incident of gi, respiratory, ear 3. If she doesn't open her mouth you can
infection. Lastly breast milk has lactoferrin touch your nipples to her lips to get her to
is an iron binding protein in breast milk that open up.
interferes with the growth of pathogenic 4. When she opens her mouth wide, move it
bacteria. The enzyme, lysozyme in onto the nipple by pulling her towards you.
breastmilk apparently actively destroys the This is called "latching on"
bacteria by lysine or dissolving the cell 5. Gets as much of your arriola into the baby's
membranes. Possibly increasing the mouth as possible. For the large breasts
effectiveness of the antibodies. Leukocytes compressed it with your fingers not to know
in breastmilk provide protein against cover the nose, to prevent obstruction of
common respiratory infections invaders. babies breathing.
Macrophages is responsible for producing 6. Observed if your baby is sucking and
interferon a protein that protect against swallowing easily.
viruses it helps interfere for virus growth. 7. Listen for sounds of a happy feeding baby
Bifidus factor is a specific growth promoting
factor for the beneficial bacteria the
lactobacillus bifudus be produced the Holding the breast to help baby to latch on
present of lactobacillus bifudus in
breastmilk interferes the colonization of 1. Is the C- hold this is done by placing the
pathogenic bacteria in the gastrointestinal thumb above the nipple at the 12 o'clock
tract that reducing the incidence of diarrhea position and the remaining fingers below
this less of incidence of … the nipple at the 6 o'clock position.
2. U- hold thumb on the areola on one the
Preparing for breastfeeding side at the 9 o'clock position and remaining
fingers at 3 o'clock position.
1. Instruct the mother of the importance of 3. V-hold place the thumb and index finger
hygiene, it is very important to Clean the above the nipple at the to 12 o'clock
breast daily without using soap or no position and the middle finger below the
application of alcohol, it is important also nipple at the 6 o'clock position.
to do hand washing before and after
breastfeeding because this prevent the Sign of Effective Suckling
spreading of possible infection.
2. The mother should observe the feeding  Slow deep sucks and swallowing sound
cues  Cheeks full and not drawn in Baby feeds
 Sucking of fingers calmly
 Tongue thrusting  Baby finished feed by him or herself and
 Lip smacking seems satisfied
 Mother feels no pain 5 minutes first day, per breast
7-8 minutes second day, per breast
(VIDEO)…. 10 minutes third day, per breast
Build up to 20 minutes, per breast
Step 1: If the baby falls asleep after 10 minutes
 Know when to burp your baby, in nursing when milk comes in, cut back to 5 minutes per
burp her when you’re switching one breast breast
to the other. If you’re bottle feeding burp If the baby is still hungry, may go back
her every time (….) in the both cases you to first breast feed for another 5 minutes.
should burp her at the end of every meal. Nurse both breasts at each feeding.
 If the baby is crying or uncomfortable Start with breast ended with at the last feeding.
between feeding, try burping her. It maybe Air dry nipples after each feeding; apply
random gas. eucerin cream around areola (brown area) nut
Step 2: not on tip of the nipple
 Sit the baby upright in your lap. Facing you
but angle slightly in one side and leaning 4 MOST RECOMMEDED BREASTFEEDING
slightly forward with the chest against your POSITIONS
hand, put the chin in between the index 1. CRADLE POSITION- the moms arm
finger and thumb in that hand. The other supports the baby at the breast. The baby’s
hand firmly rub tap her back or rub your head is cradled near her elbow, and her arm
palm or fingertips and do a circular motion supports the infant along the back and neck.
simply put a pressure to help push out the The mother and baby should be chest to chest
air. 2. CROSS- CRADLE POSITION- uses the
 Put a bib on your baby and slip your hand opposite arm ( to the cradle position) to
under it in case she spits up. support the infants, with the back of the baby’s
Step 3: head and neck being held in the mother’s hand.
 Place a burp cloth on your thigh and lay 3. FOOTBALL HOLD POSITION- also known
the baby across to your la, let his tummy to as the CLUTCH HOLD. This position is especially
rest in your other thigh gently put a useful if the mother:
pressure to her belly to push out the gas as • Had a C-section and wants to avoid her
you rub or pat her. baby against her abdomen
Step 4: • Large breast
 Drape the burp cloth over your shoulder • Premature baby
and hold the baby against it. Be sure to • Twin
support her head and neck in one hand. 4. SIDE LYING POITION- this position is a
And the other, rub or pat her back good choice when breastfeeding in the middle
of the night. When using this position, there
Step 5: should be no excess bedding around the infant
 Resounding belch, any minutes if she that could pose a suffocation hazard.
doesn’t burp it okay too. Another position is KARANGAROO MOTHER
 Babies usually spit up just about a CARE- the baby is place in an upright position
teaspoon of milk. between mother’s breast, chest t chest.
Position the baby’s hips in a frog-leg
Signs that a baby is not sucking effectively or position with the arms also flex
unsatisfied. Secure the baby in this position with the
Rapid, shallow sucks and smacking or support binder
clicking sounds. Turn the baby’s head to one side
Cheeks drawn in slightly extended
Baby is restless and body posture is Tie the cloth firmly around the mother’s
tense baby
Baby feeds very frequently, for a very
long time, but does not release breast and ASSOCUATED PROBLEMS IN BREASTFEEDING:
seems unsatisfied 1. BREAST ENGORGEMENT-
Mother feels pain Breast becomes full, tense and hot with
throbbing pain due to the increase lymphatic
Nursing should not hurt! and venous circulation.
Cause of Pain: improper latching on. Expected to occur the 3rd postpartum
If the baby is sucking only in the nipple, day accompanied by fever (milk fever), lasts for
break the suction by placing pinky finger gently 24hrs.
into the corner of her mouth.
Take her off the nipple, and latch her NURSING CARE TO MOTHER EXPERINCE BREAST
onto the areola as much as possible ENDORGEMENT
• Encourage breastfeeding or pumping
BREASTFEEDING TIMING • Advice use firm-supportive brassiere
• Warm packs (if not going to breastfeed- - Exclusive breastfeeding from 0 to 6
apply cold compress; no massage; no breast months
pump; apply breast binder). - Appropriate and safe complementary
feeding to start from 6 months onwards
ASSOCIATED PROBLEMS IN BREASTFEEDING - Breastfeeding is still appropriate for
children up to 2 years of age and beyond
Nursing Care - Other related products such as teats,
● Encourage breastfeeding or pumping feeding bottles, and artificial feeding
● Advise use of firm-supportive brassiere paraphernalia are prohibited in health
● Warm packs (if not going to breastfeed- facilities
apply cold compress; no compress; no - Infants or milk formula may be harmful
breast pump; apply breast binder) to a child’s health and may damage a
2. Sore Nipples child’s formative development
- Improper positioning
- Forcefully pulling an infant from the VIOLATIONS:
breast 5. Giving of samples
- Allowing to suck too long at a breast 6. Assistance, logistics, or training, financial
after it is emptied or material incentives, or gifts of any sort
- Permitting a nipple to remain wet from from milk companies to health workers
leaking milk 7. Information that implies or creates a
Nursing Care belief that bottle-feeding is equivalent
- Encourage to continue breastfeeding or superior to breastfeeding
expose nipples to air for 10-15 minutes
after feeding Rooming-in and Breastfeeding Act of 1992 (RA
- Exposure to watt bulb placed 12-18 7600)
inches away to promote vasodilation - Provides incentives to government and
- Advise not to use plastic liners that come private institutions with rooming-in and
with nursing bras breastfeeding practices
- Use nipple shield Declaration of Policy
- Apply lanolin to the nipples after air
exposure - The states adopt rooming-in as a
national policy to encourage, protect
3. Mastitis and support the practice of
- Inflammation of the breast breastfeedi9ng. It shall create an
- Signs and symptoms: pain, swelling, environment where the basic physical,
redness, lumps in the breast, milk emotional, and psychological needs of
becomes scanty mothers and infants are fulfilled through
Nursing care the practice of rooming-in and
- Supportive brassiere, empty breast with breastfeeding
a pump Provision of Facilities for Breastmilk Collection
- Continue breastfeeding and Storage
- Apply a warm compress to increase
drainage - The health institution adopting rooming-
- Ice compress to minimize the pain in and breastfeeding shall provide
sensation equipment, facilities, and supplies for
- Administer antibiotics as prescribed breastmilk collection, storage and
varying the feeding position to increase utilization, the standards of which shall
breast drainage be defined by the Department of Health

LAWS THAT PROTECT INFANTS AND YOUNG Expanded Breastfeeding Act of 2009 (RA 10028)
CHILD FEEDING Declaration of Policy

Milk Code (E.0 51) - The state adopts rooming-in as a

- Ensures safe and adequate nutrition for national policy to encourage, protect
infants through the promotion of and support the practice of
breastfeeding and regulation breastfeeding
promotion, distribution, selling, Provision of Facilities for Breastmilk Collection
advertising, product public relations, and Storage for Health Institutions
and information services for artificial
milk formulas and other covered - The health institution adopting rooming-
products in and breastfeeding shall provide
- Ensures safe and adequate nutrition for equipment, facilities, and supplies for
infants breastmilk collection, storage and
Policies: utilization. Health institutions are
 likewise encouraged to set up milk banks event or circumstances which may be
for the storage of breastmilk donated by conducive to the same
mothers and which have undergone
pasteurization. The stored breastmilk Lactation Periods
will primarily be given to children in the - Nursing employees shall be granted
neonatal intensive care unit whose own break intervals in addition to the regular
mothers are seriously ill time-off for meals to breastfeed or
Kalusugan at Nutrisyon ng Mag-Nanay Act (RA express milk. These intervals, which shall
No. 11148) include the time it takes an employee to
*first 1000 days get to and from the workplace lactation
● Was enacted into law last 29 November station, shall be counted as
2018 as “An Act Scaling Up the National compensable hours worked. The
and Local Health and Nutrition Programs Department of Labor and Employment
Through A Strengthened Integrated (DOLE) may adjust the same: Provided,
Strategy for Maternal, Neonatal, Child that such intervals shall not be less than
Health and Nutrition in the First Oner a total of forty (40) minutes for every
Thousand (1000) Days of Life eight (8)- hours working period
- Adequate nutrition of pregnant and
lactating women Creating Breastfeeding success in Health Care
- Exclusive breastfeeding in the first 6 Facilities
months with initiation within the first - Educate about the benefits and
hour of birth management
- Continued breastfeeding up to 2 years - Initiate within half an hour after birth
and beyond - Maintain lactation even if mothers
should be separated from their infant
Integration of Breastfeeding Education in - Exclusive for the first 6 months of life
Curricula - Not giving pacifiers
- Integrate in the relevant subjects in the - Practice rooming-in 24 hours a day
elementary, high school, and college - Encourage breastfeeding on demand
levels, especially in the medical and - Establish support groups and referral
nursing education, the importance, system
benefits, methods or techniques of
breastfeeding, and change of societal
attitudes towards breastfeeding

Breastfeeding Awareness Month

- To raise awareness on the importance of
and to further promote breastfeeding,
the month of August in each and every
year throughout the Philippines shall be
known as “Breastfeeding Awareness
Month”
- On February 23, 2011, the Department
Of Health (DOH) launched the exclusive
breastfeeding campaign dubbed as
“BREASTFEEDING TSEK”: (Tama, Sapat,
Eksklusibo).” The primary target of this
campaign is the new and expectant
mothers in urban areas

Establishment of Lactation Stations

5. All health and non-health facilities,
establishments, or institutions shall
establish lactation stations. The
lactation stations shall be adequately
provided with the necessary equipment
and facilities
6. In addition, all health and non-health
facilities, establishments or institutions
shall take strict measures to prevent any
direct or indirect form of promotion,
marketing, and/or sales of infant
formula and/or breastmilk substitutes
within the lactation stations, or in any