Self-Assessment Questions (SAQs) for Study Session 2

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. 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 2.1 (tests Learning Outcomes 2.1, 2.2 and 2.3)

Which of the following statements is false? In each case, say what is incorrect.

  • A  All the antibacterial vaccines in the EPI in Ethiopia are injected intramuscularly in the outer upper arm.
  • B  All of the antibacterial EPI vaccines will lose their effectiveness if they become frozen.
  • C  If five doses of TT vaccine are given to a woman of childbearing age at the correct intervals, she will receive the fifth dose at least 2 years and 7 months after the first dose.
  • D  Most infants who are immunized with three doses of pentavalent vaccine at the correct intervals will be protected against diphtheria, pertussis and tetanus.
  • E  BCG vaccine is supplied as a powder which has to be mixed with a special diluent to activate the vaccine before use.
  • F  If a vial of pentavalent vaccine has a deposit like fine sand at the bottom, you should throw it away.

Answer

  • A is false. BCG is injected intradermally (into the top layer of the skin). The other antibacterial vaccines in the EPI are injected intramuscularly, but only BCG and TT vaccine are injected in the upper arm. Pentavalent vaccine and PCV10 are injected in the upper outer thigh.
  • B is false. BCG vaccine is a powder which can be frozen before it is reconstituted with diluent. The BCG diluent and all the other antibacterial EPI vaccines will not be effective if they become frozen.
  • C is true. If five doses of TT vaccine are given to a woman of childbearing age at the correct intervals, she will receive the fifth dose at least 2 years and 7 months after the first dose. The intervals are TT1, then at least 4 weeks to TT2, then at least 6 months to TT3, then at least 1 year to TT4, and then at least one more year to TT5.
  • D is true. Between 78% and 95% of infants who are immunized with three doses of pentavalent vaccine at the correct intervals will be protected against pertussis, diphtheria and tetanus. (They will also be protected against hepatitis B and Hib diseases.)
  • E is true. BCG vaccine is supplied as a powder which has to be mixed with a special diluent to activate the vaccine before use.
  • F is false. If a vial of pentavalent vaccine has a deposit like fine sand at the bottom, it does not need to be thrown away; you should shake the vial to mix the vaccine with the liquid before use.

SAQ 2.2 (tests Learning Outcomes 2.2 and 2.3)

Read Case Study 2.1 and then answer the question that follows it.

Case Study 2.1  Birke’s story

Birke is two months’ pregnant with her first baby. She is at the antenatal clinic and hears Nurse Ayele telling a group of women about neonatal tetanus, a disease that causes death in newborn babies. Nurse Ayele talks about the injection that women can get to protect themselves and their babies. Birke asks for the injection.

‘I am sorry,’ says Nurse Ayele, ‘I can’t give you tetanus toxoid now. It’s too early in your pregnancy and it might harm the baby.’

Birke is surprised. She says: ‘My friend told me that the health workers in Dembi Health Post give these injections to every woman the first time she goes to the antenatal care clinic, even if she is only one month pregnant. They say it is not dangerous.’

  • Who is following the correct procedure: Nurse Ayele or the health workers in Dembi Health Post?

Answer

The health workers in Dembi Health Post are correct. TT vaccine should be given to all pregnant women during their first contact with a health facility, regardless of the gestational age of their pregnancy. So Nurse Ayele should give Birke the TT immunization.

SAQ 2.3 (tests Learning Outcomes 2.4 and 2.5)

Complete Table 2.9 by filling in the management of the adverse events listed.

Table 2.9  Adverse events following immunization with antibacterial vaccines and their management at Health Post level.

Adverse eventManagment
Low-grade fever
Soreness at the injection site
Abscess at the injection site
Swollen lymph glands
Severe allergic reaction (rash, breathing difficulty, rapid pulse, dizziness or fainting)
Coma and/or convulsions

Answer

The completed version of Table 2.9 appears below.

Table 2.9  Adverse events following immunization with antibacterial vaccines and their management at Health Post level.

Adverse eventManagement
Low-grade feverParacetamol syrup, 5 ml as required, up to a maximum of four doses
Soreness at the injection siteParacetamol (as above); warm compress applied to the affected area
Abscess at the injection siteAmoxicillin syrup orally three times daily and urgent referral to a health centre
Swollen lymph glandsRefer the child to a health centre
Severe allergic reaction (rash, breathing difficulty, rapid pulse, dizziness or fainting)Do not give another dose of this vaccine; refer the child to a health centre immediately
Coma and/or convulsionsDo not give another dose of this vaccine; refer the child to a health centre immediately

SAQ 2.4 (tests Learning Outcomes 2.2 and 2.4)

The mother of a 10-day-old infant visited your Health Post. She told you that her baby has a small sore on her right upper arm following a vaccination given immediately after the birth. What would you tell the mother?

Answer

You should tell the mother that the sore is a result of BCG vaccination, which will protect her baby from tuberculosis. Reassure her that this is a normal reaction to the vaccine and that the small sore is a good sign that the vaccine is working effectively. Tell her the sore will heal in about two weeks and leave a small scar, which is harmless.

SAQ 2.5 (tests Learning Outcomes 2.1 and 2.5)

What should you do if an infant is brought to you for routine EPI immunization at 14 weeks and you find that he or she has a temperature of 39oC? Is this a contraindication for vaccination?

Answer

This child has a high-grade fever. Give paracetamol syrup (5 ml) and refer the child to a health centre; do not vaccinate until the child recovers.

Summary of Study Session 2