COMMUNITY

HEALTH II

Dr. Abdullahi Abdi Yusuf

2/26/2022
 Dr. Abdalle

UNIT ONE
ADDRESSING THE NEEDS OF THE FAMILY
Introduction
Many different definitions exist, but most family theorists agree that a family consists of one or
more individuals who share a residence or live near one another, possess some common
emotional bond and engage in inter-related social positions, roles and tasks.
Universal Characteristics of Families
Every family shares some universal characteristics with every other family. These universal
characteristics provide an important key to understanding each family’s uniqueness.
Five universal family characteristics are:
Every family is a small – social system
a) A families are interdependent; each member’s actions affect others members
b) Families maintain boundaries;
- family closeness
- links family members together in bond
- greater concentration with in the family
c) Family exchange energy:
- exchange materials, information
- need, take, health care, education, employment…..
- Contribute to the community by working, consuming goods services….
d). Families are adaptive behavior:
- equilibrium seeking behavior
- shift and change in response to internal and external forces.
Some times, if the internal /external forces (stress) beyond its limit, the family members leave
and become dysfunctional, at this time the family need help / interventions to restore
equilibrium.
e). Families are goal directed:
- exist for purpose, for example to
- establish and promote the development of their members, to provide love security, assistance
etc… to their family members.
Every family has its own cultural values and rules.
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o Shared values and effects

o Certain roles are presented and defined for family members
Every family has structures
Traditional family:
- Nuclear family (husband, wife, and children live in common house)
- Nuclear –dyad (husband, wife, with no children or grow children out side home
- single parent (one adult male/female living alone
- multigenerational (several age group live together. E.g., widowed women live with divorced
daughter with grand children’s)
Non traditional family structure
ex-Un married single parent (single women live with children
- co-habituating couple (two adults, just friends group marriage (several adults who share
common household and consider that all are married, share every thing including sex, child
rearing etc.)
Every family has certain basic function
a) affection
– give love and emotional support to the members
- sharing of gifts during holiday
- -love for sick family members
b) provide security and acceptance
- meet there members physical need (food, shelter, clothing
- acceptance of individual members
c) affiliation & companion companionship
- development of communication pattern
- Establishment of durable bond not broken by distance, time… ex. gathering during holiday,
weeding…even when scattered.
d) socialization
- Internalization of value
- Guidance for internal and external relation ship
e) control – maintenance of social control (ex. appropriate dressing
- division of labor
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- allocate various tasks, responsibilities …..

Every family moves through stages in its life cycle two broad stages
- period of expanding 􀃆when the family add new member/roles
- period of contracting 􀃆when members leave or dead.
Characteristics of healthy families
Healthy interaction among members
- Discuss problems
- Confront each other
- Share ideas and concern ….etc

Enhancement of individual development

- Promote each members growth
Effective structuring of relation ship
- Structure their role relationship to meet changing family needs over time. (flexibility of role)
Active coping effort
- Actively attempt to over come life’s problems and issues
Healthy environment and life-style
-create safe and hygienic living conditions for their members.
Regular links with the broader community
- Maintain dynamic ties the broader community
- Participate regularly in external groups and activities
Application of nursing process on promoting FH
Family health Assessment- provides information’s on the measuring a current health situation
of family member and emotional support that can be expected to be offered to an individual from
the family.
Main areas of assessment includes:
• Family demography (age, sex, education, occupation, etc….)
• Physical environment (housing space, climate, dietary pattern…)
• Psychological and spiritual environment (mutual respect, support,
• Family structure and role (division of labor, socialization process allocation and use of
power…)
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• Family function (ability to carry out appropriate developmental tasks….

• .Family value and belief
• .Family communication pattern (frequency and quality of communication with in the family,
b/w the family and its environment)
• Family decision making pattern (how, by whom, when decision is made)
• Family problem solving pattern (how a family handles its problem
• Family coping pattern (how a family handles conflicts and life change, family perception and
response to stressors)
• Family health behavior (family health history, current health status, health belief, use of health
resource...)
Family Nursing Diagnosis- example:
- Potential for enhanced parenting
- Potential for role conflict related to prolonged separation
- Altered family process related to emergency hospital admission of chilled
- Altered family process related to unplanned pregnancy.
Planning – depend on the type of diagnosis established and the goal to be achieved
-must be appropriate and desired by family members.
Implementation- A plan can be easily implemented if a family members have agreed on it and
support one another.
Evaluation - include not only the goals was achieved, but also that the family feels more
cohesive after working together toward the goal.
 Dr. Abdalle

UNIT TWO
PROMOTING AND PROTECTING THE HEALTH OF THE OLDER ADULT
POPULATION
12.1. Introduction
Peoples are living longer as a result of improved health care, eradication and control of
communicable disease, use of antibiotic and other medicines and accessibility to a better quality
of life for residents.
The older population does, however, have higher percentage (80%) of chronic conditions, some
of which may limit activities.
These chronic illnesses include arthritis, heart diseases, high BP, DM, visual and hearing
impairments.
Good health in elderly means maintaining the maximum degree possible of physical, mental, and
social rigor. It means being able to adapt, to continue to handle stress, and to be active and
involved in life and living. In short, healthy aging means being able to function, even when
disabled, with a minimum of ordinary help from others.
Wellness among the older population varies considerably. It is influenced by many factors
including personality traits, life experiences, current physical health and current societal support
some elderly people demonstrate maximum adaptability, resourcefulness, optimism, and activity,
however, misconception often arises from negative personal experience, myths shared
throughout the ages, and a general lack of information on older people. Some of these
misconception and stereotypes of older people includes
- Most older adults can’t live independently
- Chronological age determines oldness
- Most old people have diminished intellectual capacity/are senile
- All older people content and serene
- Older adults can/t be productive or active
- All older adults are resistant to change.

12.2. Health problems of elderly people

12.2.1. Problems associated with aging process
- Cataract
- Glaucoma
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- Deafness
- Reduced vision
- Immobility (due to changes in joints and bones)
12.2.2. Chronic disease
- Arthrititides
- heart disease
- Peripheral vascular disease
- Hypertension
- Cancer
- Diabetes mellitus
- Emphysema, Chronic Obstructive Pulmonary Diseases (COPD)
12.2.3. Psychological problem
-Dementia
-Depression
-Rigidity of out look
-Social and emotional withdrawal
-Suicide

12. 2.4. Sexual problems diminished sexual activity, this leads to physical and emotional
disturbance
12.3. Health maintenance program for older people
- communication service ( phones, emergency access to health care)
- dental care service
- dietary guidance and food services
- escort and protective services
- exercise and fitness program
- financial aid and companions
- health education
- hearing aid and hearing-aid assistance
- home health service
- legal aid and counseling
- library service
 Dr. Abdalle

- medical supplies /equipment

- medication supervision
- recreational and educational program
- safe, affordable, and ability appropriate housing
- social assistance service offered in conjunction with the health maintenance
 Dr. Abdalle

UNIT THREE
HOME VISITING AND HOME HEALTH SERVICES
Definition
Home visiting / home health service is that components of a continuum of a comprehensive
health care in which health services are provided to individuals, and families in their place of
residence for the purpose of promoting maintaining or restoring health or of maximizing the
level of independence while minimizing the effect of disability and illness, including terminal
illness.
Home health service refers to all the services and products provided to clients in their home, to
maintain, restore, or promote their physical, mental, & emotional health.
Purposes of home health services
• To prevent institutionalization (primary goal)
• To maximize clients level of independence
• To maximize the effects of existing disabilities through non-institutional services.
Factor influencing the growing of home health services
1. Increasing elderly population: because chronic illness is more common in elderly & need help
& assistance
2. Growing of HIV/AIDS populations: for better understanding of client need at home.
3. Advanced technology: technology allows all the services at home level.
4. raising the cost of health care
5. Demands for consumer satisfaction.
Home visiting
Purpose:
• Afford the opportunity to gain more accurate assessment of the family structure and behavior in
the natural environment.
• Provide opportunity to make observations of the home environment and to identify both
barriers and supports for reaching family health promotion work
• Meeting the family on their home ground may also contribute to family’s sense of control and
active participation in meeting their health needs.
Advantage
 Dr. Abdalle

1. the family is seen in a familiar atmosphere which is were relaxed and makes communication
easier than at hospital or clinic
2. All family members can be seen & assessed by one person at one visit
3. The health workers, who know the neighborhood, are aware of local problems, priorities,
customs, difficulties, & resources.]
4. High risk families can be identified & visited as a priority
5. The health workers, can observe, assess, & act up on obvious and latent health problems.
Health workers can follow these problems, Health workers can follow these problems at
subsequent visit.’
6. Much can be assessed at one time. Ex personal hygiene, water supply, sanitation, waste
disposed, food storage ……
7. More accurate assessment is done
8. Better understanding & good relationship is established with the family members.
9. Advice will be practical and suited to the family’s needs.
Limitations
1. time consuming
2. limited equipment can only be carried to home
3. appointment might be not kept
4. destruction in the home makes construction difficult
5. certain homes may be geographical not reachable
Objectives of Home Visiting
- To create close relation ship with communities and families
- To discover the condition in which the family lives & to identify how these conditions affect
their health.
- To promote family health by providing family members with health education adapted to their
levels of growth and development
- To monitor the use of skill learned in health education
- To demonstrate to the family how to administer health care needed by others family members.
- To refer to appropriate specialized services.

Kinds of Home Care

 Dr. Abdalle

Home for the aged. This is a kind of home health care provided for the elder greater than 65
years of age, who need a minimum care which is often characterized as “supervised living or
residential care.”
Basic home. It is a home for those individuals who need assistance in activity of daily living
(ADL), such as eating, breathing or routine nursing care including administration of medication.
Skilled home. It is a home for those individuals with serious health problems who need 24 hours
nursing care or supervision.
Principles of home visiting
1. Family members should be included in all phases of the care process
2. The health workers (teams) are guests in the clients home there fore only make these
interventions that the clients agrees with
3. Mutual health team – client goal and intervention may require long periods to achieve,
therefore, patience is necessary
4. Home visiting can be done by health professionals employed in various ways.
5. The health team function autonomously in the family health care provision. The family and
the team develop a positively interpersonal relation ship as they work to achieve the goal
6. The health team is a visitor at a client therefore; the
team must not wait to be motivated.
Phases and activities of home visiting
Phase 1. Initiation phase – clarify purpose of home visiting
-share information to family member
Phase 2. Pre-visit phase – initiate contact with family
-determine family willingness
-schedule home visiting
-review records
Phase 3. On home phase – introduction him/her self
-warm greeting
-social interaction (to develop trusting r/s
-implement nursing process.
Phase 4. Termination phase – review visit with family
- plan for future visit
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Phase 5. Post – visit phase – Record visit

- plan for next visit

Areas (points) to be assessed during Home visiting

1. General cleanliness
2. Solid waste disposal
3. latrine
4. personal hygiene
5. vaccination of <1yr infants
6. vaccination of women
7. ANC
8. Feeding of children <2 yrs
9. FP
10. Presense of insects / rodents in the house
11. Presence of sick person in the house and action taken.
Community Health Nursing Bag
Definition: A specially prepared bag for carrying supplies to the field a clean and orderly way.
Purpose
• Helps the nurse to give service effectively in homes
• Reduces the danger of spreading infections
• Provides the necessary items needed in the field
• Identifies the nurse in the field because a home visiting bag is a part of the uniform
Contents of the Bags
A. General supplies
B. Equipment
C. Others
A General supplies
Soap and soap dish
Plastic apron
Plastic square to put the bag on
Aluminum cup for water
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One or two small towels to dry the hand

Instrument
• Thermometer
• Fetoscope
• Scissors
• Artery forceps
• Tape measure
• Plaster
• Cotton
• Gauze
• Applicator
• Bandage
• Antiseptic solution
• Syringe and needle
• GV. Tetracycline eye ointment
• Kidney dish

• Vaseline
• Tongue depressor,
• Disposable gloves
• Cord tie
• Anti pain
• Ergometrine tablets
• Ferrous sulphate
• Vitamin, A
• Test tube
• Baby scale
• Chloroquine
• Mebendazile
• BBL
• Pocket
• Small towel
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• Soap and soap dish

• Plastic square
• News paper for placement of the gag
• Match
Care of the bag
Change inner lining as needed.
Label bottles
Refill supplies as needed

Do not put bag on the beds

Do not put your properties on the bag
Do not put on the floor
Basic principles of using the bag
• Select safe area to place it
• Place on the plastic square
• Wash your hands before you do anything
• All wastes should be covered in newspaper and burned
Responsibilities of nurses
Use the bag correctly
Keep the bag clean and orderly
Pay attention for broken equipment
Report all broken equipment
Do not miss equipment
Go through nursing process and form family focused nursing
 Dr. Abdalle

UNIT FOUR

COMMUNITY HEALTH PROBLEMS

Major Community Health Problems

The major health problems in communities are infections and parasitic diseases. These include:
• malaria
• measles
• cough (whooping cough)
• Tuberculosis
• Upper respiration tract Infection
• Diarrhea/Dysentery and diarrhea disease
• Malnutrition
• Skin problems
• Cerebra spinal meningitis
• Yellow fever
• Complications of pregnancy and child birth
• Neonatal tetanus
• HIV/AIDS
Leading Causes of Death and Morbidity

1. Most common causes of death in Hospitals in Nigeria are: a) Infective and parasitic disease. b)
Diseases of the respiratory system. c) Accidents, poisons and violence.

d) Diseases of the circulatory system. e) Diseases of digestive system.

2. Common causes of death among children: a) Malaria b) Diarrheal diseases. c) Acute

respiratory infections (Upper and Lower) respiratory tract Infections e.g. pneumonia. d) Vaccine
preventive diseases e.g. diphtheria, pertussis (whooping Cough) tetanus, poliomyelitis, measles
and tuberculosis. e) Malnutrition f) HIV/AIDS- High prevalence rate about 300,000 people have
died of AIDS. (UNAIDS, 2005).

Factors Responsible for the Health Problems of the Community

These can be identified in the various facets of Community life.
 Dr. Abdalle

1. Nutritional Status of the Population - Malnutrition is a common phenomenon in the

community. - Half of the world population is caught in the vicious cycle of ignorance, Poverty,
malnutrition (under nutrition) diseases and early death. - Malnutrition is an underlying factor in
more than 50o/o of childhood mortality - The number of undernourished people old and young in
the developing Countries are very high (450 million).
Population at risk in malnutrition:
• Children- Premature babies are easily susceptible to diseases e.g. malaria, diarrhea, twins or
multiple babies.
• Elderly persons.
• Adolescents who eat food in erratic fashion e.g. pregnant adolescents.
• Patients with chronic diseases.

2. Vectors Vectors are arthropods or similar invertebrates which transmit diseases to man either
directly or indirectly. Examples are: 1) Mosquito which causes malaria, filarial and yellow fever.
2) Housefly which causes typhoid, cholera and gastroenteritis. 3) Tsetse fly causes sleeping
sickness. 4) Rat flea causing plagues.

3. Environmental Factors
These include physical environment, topography, neighborhood and Industrial conditions. They
may have direct and indirect effect on community health.
a) Physical environment- reflection of level of health, orderliness, Cleanliness of a community
is usually useful index of health Consciousness and community development of health - related
matters.
b) Topography and climatic variations Factors within these domains include: vegetation,
temperature variations, types of soil and mineral deposits.
c) Neighborhood: - cohesion among neighbors and established traditions and culture d)
Industrial climate of the Community e) Atmosphere of place of work crease differences in
experiences of health.
4. Behavioural Factors
All socio-cultural practices exhibited in:
- Habits and culture passed down to the children help in formation of healthful habits
(Socialization Process).
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- Gender inequality
- Beliefs
- Attitudes
5. Factors at Home
- Attitude and behavior of parent to parent, child to parent, and within siblings.
- Family budget
- Educational status of parent
- General sanitation of the home and its environment
6. Tradition and Prejudices
- Health bias - Religious bias - Religion and cultural behavior of a community will affect health
of its members. - Taboos in foods - May affect type of services sought for and received from
medical, nursing and auxiliary personnel.

7. Socio-Economic Status

- High/low income families - Poverty - Economic policies e.g. privatization, deregulation and
massive retrenchment of employees in public service - Income inequality - stress

8. Political Factor

- Willingness and unwillingness of people in government to give priority to health matters

(significant influence the health status of people in the community). - Political and social crises -
Corruption, crime and insecurity

9. Organizational Factors

- Overlap in functions may affect coordination and integration of services. - Bureaucracy.

Impact/Significance of the problems to the health of the Community

These include:

1. High morbidity among, children and adult.

2. High mortality

- Infant mortality
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- Childhood mortality\maternal mortality

3. Dependency ratio is increased

4. Low productivity leading to retrenchment
5. Decreased life span
6. Increased rate of handicapping conditions/disability
7. Drain on family/community resources
- Medical care costs
- Hospital costs
- Costs of drugs and appliance
8. Nutritional impact
a) Reduced food supply because of disability or death of food producers and disability or death
of food purchasers
b) Inadequate food preparation because of disorganization and result of ill health
9. Social impact
- Short term loss due to family and Community disruption caused by acute illnesses.
- Long-term loss due to chronic diseases or debilitating injury
- Loss of security )
10. Environmental impact Climatic influences:
- Relation of drought to nutritional diseases e.g. PCM (protein, calorie, malnutrition).
- Relation of flood conditions to diseases e.g. malaria.
11. Migration and urbanization
a) Relation to the social system of the community.
b) Effect of disruption of family system by occupational injuries and chronic illnesses.
12. Physical and biological impact such as water supply, housing, waster disposal, vector
infestation e.g. - Effect of overcrowding on communicable diseases - Relation of inadequate
water disposal on the impact of Bilharzias.
 Dr. Abdalle

UNIT FIVE
HIV/AIDS

Introduction
HIV and AIDS
Human Immunodeficiency Virus
Acquired Immune Deficiency Syndrome
The HIV infection continues to spread around the world. In a number of countries AIDS is the
leading cause of death in young people. Today there are over 42 millions people living with HIV
around the world. New HIV infections occur at a rate of about 16000 people a day, of whom
approximately 700 are children. At present HIV/AIDS is among the top ten causes of death
worldwide.
HIV/AIDS –The beginning
1981 CDC in the US reported unusual clusters of PCP and KS in gay men
1983 HIV first isolated in France
1984 test for detecting antibodies developed
1985 industrialised countries screen blood/ tissue donations
1985/6 Development of antiretroviral therapy (AZT)
1996 Combination Anti- retroviral therapy results in 67% fall in AIDS mortality (those with
access)
HIV/ AIDS- Global Epidemiology
In 1981 CDC reports unusual clusters of PCP and KS Twenty Years later HIV/AIDS has killed
estimated 21.8 million people and 42 million are living with HIV infection Over 90% of people
living with HIV Infection do not know they are infected Sexual transmission is the most
common mode of transmission
HIV is found
1. Blood
2. Vaginal and Cervical Secretions
3. Most body organs
4. Semen
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5. Skin
6. Cerebral and Spinal Fluid
7. Saliva
8. Breast Milk
9. Tears
Spread of HIV infection
HIV transmission involves complex cultural, behavioural and economic forces.
Poverty, illiteracy and violence often force people to engage in unsafe sexual practices. As well,
the “invisible” nature of HIV infection fuels the epidemic in that the carriers infect others
without realising that themselves are infected.
Routes of HIV transmission
1. Unprotected sex between homosexual men
2. Unprotected heterosexual
3. Intravenous drug use and sharing of needles
4. Blood transfusion
5. Mother –to-child
6. In rare circumstances, HIV infection can spread in health care settings to patients/clients
or health care providers, through needle stick or injury with other sharps (ICN, 1996).
The different stages of HIV Infection
1. Primary Infection
2. Clinically Asymptomatic Stage
3. Symptomatic HIV Infection
4. Progression from HIV to AIDS
Markers of Disease Progression
a. CD4 Cell Counts
b. Viral Load
WHO Case Definition for AIDS Surveillance Adults and Adolescents
WHO has recommended AIDS case definitions for use in adults and adolescents in countries
with limited clinical and laboratory diagnostic facilities. The recommended case definition
depends on whether. HIV lasting is available.
WHO case definition for AIDS surveillance where HIV testing is not available.
 Dr. Abdalle

The case definition for AIDS is fulfilled in the presence of at least 2 major signs and least I
minor sign.
Major signs
• Weight loss > 10% of body weight
• Chronic diarrhea for more than I month

• Prolonged fever for more than I month

Minor signs
• Persistent cough for more than I month
• Generalized pruritic dermatitis
• History of herpes zoster
• Oropharyngeal condidiasis
• Chronic progressive or disseminated herpes simplex infection
• Generalized lymphodenopothy
• For patients with tuberculosis, persistent cough for more than I month should not be considered
as a minor sign.

Opportunistic Infections
Diarrhoea
is a common symptom in patients with HIV occuring about 27% of symptomatic HIV infected
patients 40- 90% of patients with AIDS
Acute- Patients present almost immediately
Chronic- Symptoms present for a least a month and continue
Causes:
a. HIV affecting small bowel
b. Bacterial Infection- Salmonella/ campylobacter
c. Protozoal Infection- cryptosporidium
d. Fungal Infection- candida
Investigations:
a. Stool specimens
b. Sigmoidoscopy/ Colonoscopy
c. Biopsy
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Treatment:
a. Depends on severity and duration of treatment
b. Ensure hydration and adequate nutrition
c. Modify Diet
d. Treat underlying cause of diarrhea
e. Antidiarrhoeal treatment may be administered in some cases
Pnemocystis Carinii Pneumonia (PCP)
Commonest opportunistic infection occuring in 80% of all HIV positive patients.
Remains a primary presentation in the undiagnosed patient
Clinical Presentation
a. Severe Shortness of Breath
b. Dry cough
c. Unexplained Fever
d. Potentially very unwell
Diagnosis
a. Exercise Tolerance
b. Chest X- ray
c. Induced Sputum
d. Broncheolar Lavage
Treatment:
Depending on the severity of infection
Intravenous Co-trimoxazole (high toxicity- rash, nausea, bone marrow suppression)
Intravenous Pentamidine (toxicity, renal failure, low blood pressure, low blood sugar)
Dapsone/ Atovaqoune
Candida
Oral candida (thrush) is a common opportunistic infection occuring in more than 95% of HIV
positive patients.
Oesophageal candidiasis is an AIDS defining condition
Clinical Presentation
a. Creamy/ Whit plaques on the tongue, back of throat
b. Oral discomfort and pain
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c. Taste perversion
d. Discomfort on Swallowing
e. Nausea
f. Sensation of food sticking to gullet when swallowing

Antiretroviral Therapy
Goal of Antiretroviral Therapy
To increase the length and quality of life by improving immune function
How?
By reducing the amount of replicating virus to as low a level as possible, for as long as possible,
in all sites where HIV infected cells are present
Antiretroviral Drugs
1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
a) Abacavir
b) Didanosine (ddI)
c) Lamivudine (3TC)
d) Stavudine (d4T)
e) Zalcitabine (ddC)
f) Zidovudine (AZT)
2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
a) Efavirenz
b) Nevirapine
3. Protease Inhibitors (PIs)
a) Amprenavir
b) Indinavir
c) Lopinavir + Ritonavir
d) Nelfinavir
e) Ritonavir
f) Saquinavir

4. Nucleotide Reverse Transcriptase Inhibitors (NtRTI)

Tenofovir
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History of Antiretrovirals
1987 zidovudine (NRTI)
1993 Didanosine & zalcitabine (NRTI)
1996 Protease inhibitors
1998 Nevirapine (NNRTI)
2002 Tenofovir (NtRTI)
HAART - Highly Active Antiretroviral Therapy
a. 2 NRTIs + 1 NNRTI
b. 3 NRTIs
c. 2 NRTIs + 1 PI
d. 2 NRTIs + 2 PIs
When to start therapy
a. HIV status
b. CD4 count
c. viral load
d. assessment of compliance & risk of drug toxicities
Adverse Effects
Immediate / short term
- nausea, vomiting
- diarrhoea
- malaise, lethargy

- headache
Long term / emerging
- mitochondrial toxicity
- pancreatitis, peripheral neuropathy, lactic acidosis (NRTIs)
- lipodystrophy (PIs)
- lipoatrophy (NRTIs
Drug Specific
-Nevirapine - liver toxicity
-Efavirenz - vivid dreams, hallucinations
-Indinavir - renal stones
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-Abacavir - hypersensitivity reaction

Adherence
Adherence of 70 - 80% only 25% of patients maintained viral load suppression
Adherence of 95% then 81% maintained viral load suppression
Practical measures to aid adherence
a. Health care professional consultation
b. Medication record cards
c. Alarm watches, mobile phones, pagers
d. Daily/weekly pill boxes
e. Information phone lines
f. Information available in other languages

Antiretroviral Failure
􀃆 Main causes:
- lack of adherence
- intolerance
- resistance
Post Exposure Prophylaxis
􀃆 Risk of infection has been estimated at 0.3% (3 in 1000)
􀃆 Combination of three drugs is recommended for at least four weeks
􀃆 Drug choice depends on antiretroviral history of source patient, adverse effects,
contraindications, drug interactions
Primary prevention
􀃆 Voluntary counseling and testing (VCT)
􀃆 Preventing mother-to-child transmission
􀃆 STIs prevention and management
􀃆 Blood safety
􀃆 Sexual Behavioral changes
􀃆 Youth- based prevention
􀃆 Public-private partnerships
􀃆 Prevention among injecting drug users (IDU)
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􀃆 Faith-based interventions
Care support and treatment
􀃆 Expanding and strengthening TB prevention and care
􀃆 Prevention and treatment of HIV related opportunistic infections
􀃆 Enhancing palliative care
􀃆 Promoting appropriate and effective use of anti – retrovirals
Prevention of mother-to-child transmission of HIV
􀃆 Implementation of voluntary counseling in ANCs
􀃆 Implementation of zidovudine and nevirapine preventive therapy
􀃆 Interventions to prevent postnatal transmission:

• Exclusive breastfeeding associated with early weaning

• Replacement feeding
􀃆 Linking HIV prevention to care activities

NUTRATION AND HIV/AIDS

The aim of Nutrition therapy, and type of nutritional advice will differ according to the stages of
disease:
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Other Support Services

People who have AIDS or people who are in contact with someone with AIDS are often afraid
that the negative feelings towards PLWHAs will be too strong to bear. Those feelings cannot and
should not be avoided. They are normal reactions to crisis. Family, friends, neighbors,
community based healthworkers- anyone who cares-can help another person cope with these
feelings by listening and taking to the person about these feelings.
Support services are those given to PLWHAs to help meet social, spiritual, emotional, economic
and medical needs.
Support service help to:
• Assure quality of care
• Reduce anxiety
• Provide sense of belonging
• Improve relationships between PLWHAs and caregivers
• Meet material needs
 Dr. Abdalle

UNIT SIX

IMMUNIZATION

Definitions

Immunization

This is introduction of antigens into the body in order to produce and strengthen the body
defense system and to prevent infection. The prevention of diseases by immunization is the best
known practical, low cost and community based means of protecting children and adult against
the major Killer diseases.

Immunity

It is the resistance usually associated with possession of antibodies that has an inhibitory effect
on specific micro-organisms or its toxins that cause a particular infectious disease.

Factors Affecting Individual’s Resistance to Diseases

1) Nutrition
2) Age
3) Disease condition
4) Health Status
5) Stress
Four Ways by which Immunity is gained are
1. By having the disease
2. By having active immunization
3. By passive immunization
4. By receiving maternal antibodies
Types of Immunity
1. Passive Immunity (Temporary) This can be divided into
a) Natural Immunity- acquired either naturally by Maternal transfer and it is short lived e.g.
measles may not be contacted before four months of age.
 Dr. Abdalle

b) Artificial Immunity- Inoculation of specific protective antibodies, convalescence or immune

serum globulin containing antibodies e.g. ATS.

2. Active Immunity This lasts months or years. It can be divided into:

a) Natural Immunity- Through infection (clinical/sub-clinical infections).

b) Artificial Immunity- inoculation of products of infectious agent, the agent itself is killed or
in modified form (attenuated) or variant form, Killed. e.g. whooping cough, I.M polio, cholera
typhoid and influenza. Killed- attenuated e.g. measles, BCG, Oral polio, yellow fever, rubella,
Mumps, toxoid e.g. Tetanus (TT) and diphtheria.

3. Inherent Resistance
Ability to resist disease without action of antibodies or of specifically developed response.
Inherent resistance immunity rests in anatomic or physiologic characteristics of the host and can
be genetic or acquired, permanent or temporary.
Cold Chain System
System Used for Storing and Distributing Vaccines
It is a supply system which particularly critical because vaccines are easily destroyed by heat,
temperature that is hot or cold.
Components of Cold Chain System
- People
- Equipments e.g. refrigerators, stores, freezers, vehicles, vaccine, ice packs, thermometers,
sterilization and injection equipment. (must be adequate and in good condition).
Maintenance of Cold Chain System
In order to maintain the system, the following actions must be taken:
a) Obtain Vaccine
b) Maintain Equipments
c) Handle Vaccine properly

Expanded Program on Immunization

 Dr. Abdalle

It was initiated in 1979 by World Health Assembly which was later changed to National Program
on Immunization (NPI). The objective of EPI is to effectively control the occurrence of the
immedicable diseases through immunization and provision of Vaccines. These diseases are:
1. Tuberculosis
2. Poliomyelitis
3. Diphtheria
4. Whooping Cough
5. Neonatal Tetanus
6. Measles
7. Diseases of women of childbearing age,
Target Population for EPI delivery
1. All children aged 0-24 months initially, but after the first year, focus should be on 0-12
months of age.
2. Women of child bearing age.
Planning and Management of Expanded Programme on Immunization (EPI)
1. Situation analysis of: a) Total Population b) Health status related to the EPI diseases c) Health
resources
2. prioritizing (setting priority) a) Accessibility b) Population coverage c) Critical areas 3.
Encouraging participation of all sectors a) Non-governmental organizations (NGO) b)
Government organization
4. Revising plans and setting goals for full immunization coverage a) Vaccines b) syringes and
needles c) Cotton wool and alcohol d) Records/report forms e) Transportation for outreach
immunizations teams. f) Information, Education, Communication
Practice of Immunization and Role of Community Health Nurse
This includes:
1. Mobilizing the community so that everyone can transfer information on immunization.
2. Getting the health authority to ensure constant availability of vaccines.
3. Educating and convincing parents to immunize their children.
4. motivating mothers to t, go back respectfully until full dose is completed
Steps to take to ensure that Vaccines are properly Collected and Transferred
 Dr. Abdalle

a) Obtain the right amount of vaccine needed by preparing an inventory report and calculating
vaccines requirements for a specific period.
b) Make sure that there is enough storage facilities.
c) Check type, amount of vaccine diluents and ice packs.
d) Check expiry date of the vaccines.
e) Put fully frozen icepacks or cold packs around the sides and bottom of the transport box.
f) Take shortest route to your destination.
g) Transfer vaccines and diluents immediately to cold chain facilities (refrigerators, freezers,
cold room).
h) If there are no refrigerators, use transport box for temporary storage for not more than five
days.
i) Notify personnel receiving vaccine for date, time of arrival of vaccines, if vaccines are shipped
by air or sea.
Giving of Immunization
1. Explain to mother in the language she understands, the complete immunization course for her
child.
2. Obtain accurate immunization history in a newly registered child. This Includes: a) History of
immunization previously received with dates. b) history of infectious diseases which the child
has had, if any. c) history of allergies and reactions to immunization. d) Note vaccination scar if
present.
3. Assess the immunization of the child. This will be based on assessment of: a) history of
immunization. b) child’s health and nutrition. c) risk of exposure to particular disease. d) current
national immunization guidelines. e) contraindications.
4. Administer and supervise administration of immunization. This includes giving intradermal,
subcutaneous and intramuscular.
5. Record the immunization given on the child’s record.
6. Instruct the mother on the immunization given, expected reactions and appropriate follow-up.
7. Tell the mother when to bring the child back for the next immunization.