Self-Assessment Questions (SAQs) for Study Session 4

Now that you have completed Study Session 4, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Some questions test your understanding of some Learning Outcomes for previous study sessions, as well as those in this one. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

SAQ 4.1 (tests Learning Outcomes 4.1, 4.3 and 4.4)

Place a cross in the appropriate boxes in Table 4.2 to indicate the correct route of administration for each vaccine, and whether it is supplied as a liquid or if it has to be reconstituted with diluent before use.

Table 4.2  Vaccine administration and reconstitution summary.

Route of administrationReconstitution?
Polio (OPV)
Pneumococcal (PCV10)
Rotavirus (RotarixTM)
TT (in women)


Table 4.2  Completed vaccine administration and reconstitution summary.

Route of administrationReconstitution?
Polio (OPV)XX
Pneumococcal (PCV10)XX
Rotavirus (RotarixTM)XX
TT (in women)XX

SAQ 4.2 (tests Learning Outcomes 2.4, 3.4 and 4.2)

Read Case Study 4.1 and then answer the questions that follow it.

Case Study 4.1  Bekelech’s immunization clinic

Three worried mothers have brought their sick babies to the Health Post one week after the babies received their scheduled EPI vaccines at six weeks of age. When Bekelech, the Health Extension Practitioner, checks the babies, she finds that they each have red and painful swellings on the left upper thigh and moderate fever. When they were immunized at the Health Post a week previously it had been a very busy day. Over 25 parents brought their children for immunizations, five pregnant women needed TT vaccine, and several people arrived with other health problems. Bekelech remembered that things kept going wrong that day and she had to rush to finish immunizing all the clients before nightfall.

  • a.What is the swelling in the thighs of the three sick babies, and what could have caused it?
  • b.What should Bekelech do about this problem?


(a)  The red and tender swelling on the babies’ left thighs is likely to be an abscess at the site where they received the pentavalent vaccine by intramuscular injection the previous week. An abscess at an injection site is usually caused by a contaminated needle or syringe, or incorrect vaccine preparation, or incorrect injection technique. The fact that Bekelech was so busy that day last week may have resulted in poor adherence to standard procedures when she immunized the babies. For example, she may have:

  • used the same needle and syringe for more than one injection
  • touched the needle with unclean hands before giving the injection
  • placed the needle and syringe on a table top or other unclean surface
  • failed to keep the vaccine cold during the long immunization session.

(b)  Bekelech should:

  • Treat the abscesses by giving the babies amoxicillin syrup three times daily and placing clean, warm compresses on the affected area. She should ensure that the mothers take their babies to a health centre urgently for further assessment.
  • Take care in future to ensure that standard procedures are followed when giving immunizations.

SAQ 4.3 (tests Learning Outcomes 4.1, 4.2, 4.3 and 4.4)

Read Case Study 4.2 and then answer the question that follows it.

Case Study 4.2  Fatuma’s immunization clinic

Fatuma is preparing to give BCG vaccinations to a number of babies. Before giving the vaccination, she washes her hands, checks that the expiry date on the vaccine ampoule has not passed, she taps the ampoule to make sure all the vaccine powder is at the bottom, and opens the ampoule. She inspects the diluent and uses it to reconstitute the vaccine. She places the reconstituted vaccine on a foam pad placed on top of conditioned ice-packs in a vaccine carrier, and administers it intradermally to each baby in the upper right arm.

  • What two things has Fatuma forgotten to do? In each case, explain why this is important and what could happen as a result of it being forgotten.


Fatuma forgot to check the VVM on the vaccine ampoule. She checked the expiry date of the vaccine, but this will not tell her if the vaccine has been exposed to heat and lost its potency. She should check the VVM and if it has passed the discard point she should discard it.

Fatuma also forgot to clean the injection site. She should clean the skin with antiseptic solution and leave it to dry before giving the vaccination. Pushing a needle through dirty skin could introduce an infection into the baby’s body.

SAQ 4.4 (tests Learning Outcome 4.5)

What is incorrect in the following statement?

  • OPV is given to babies by first withdrawing the liquid vaccine into a sterile syringe, and then pushing the plunger just enough to let 2 drops of vaccine drip from the syringe into the baby’s mouth.


OPV is never given to babies using a syringe as a substitute for the glass dropper supplied with the vaccine or the dropper incorporated into the vaccine vial. Using the correct dropper ensures that the correct dose of OPV is given in two drops of vaccine.

Summary of Study Session 4