Expanded Program on Immunization

Goal of EPI

• Morbidity and mortality reduction of immunizable disease

Types and Schedule of Vaccines

Side effects: BCG

2-3 weeks abscess will ulcerate then heals leaving a scar (approx. 12 weeks from vaccination)
 Koch’s Phenomenon
-inflammation on site after 2-4 days
 Deep Abscess at site
-incision and drainage; powdered INH
 Indolent Ulceration
-(ulcer after 12 weeks) INH powder
 Glandular Enlargement
-treat as abscess

Side Effects: DPT

• Fever for a day

• Soreness at site within 3-4 days
• Abscess after a week or more
– incision and drainage
• Convulsions

Side effects: Measles

• Fever after 5-7 days usually 1-3 days

• Mild rashes
 Cold Chain

• Vaccines destroyed by heat

• BCG, DPT, OPV, TT, MEASLES, HEP B
• Most sensitive to heat
• OPV, MEASLES (-15 to -25oC, freezer)
• Destroyed by freezing
• DPT, TT, HEP B (2-8OC, body of ref)
EPI Vaccines are multi-dose (i.e. 1 vial can be used for multiple patients) and thus in practice, wastage of doses per
vials of vaccines are observed regularly.

 The wastage factor is used to compute annual vaccine requirement in a target population
 It is a number based on approximated wastage if all recommendations of EPI guidelines are met
 It is constant for a specific vaccine
DPT
 number of doses per patient: 3
 Wastage allowance: 40%
 wastage factor: 1.67
 Number of doses per vial/amp: 20 or 10

OPV
 number of doses per patient: 3
 Wastage allowance: 40%
 wastage factor: 1.67
 Number of doses per vial/amp: 20

Measles
 number of doses per patient: 1
 Wastage allowance: 50%
 wastage factor: 2.00
 Number of doses per vial/amp: 10

BCG
 number of doses per patient: 1
 Wastage allowance: 60%
 wastage factor: 2.50
 Number of doses per vial/amp: 10
Hepatitis B
 number of doses per patient: 3
 Wastage allowance: 10%
 wastage factor: 1.10
 Number of doses per vial/amp: 1 or 10

Tetanus Toxoid
 number of doses per patient: 2
 Wastage allowance: 40%
 wastage factor: 1.67
 Number of doses per vial/amp: 20 or 10

Nutrition
Goal of Nutrition Program
• Reduce morbidity and mortality related to nutritional deficiencies:
1. protein-energy malnutrition
2. Vitamin A deficiency
3. Iron-deficiency anemia
4. Iodine-deficiency disorder

Marasmus

• Deficiency in protein and energy that can occur even if the child is less than one year old.
• Signs:
- Very thin (no fat, muscle wasting)
- Very poor weight gain
- Old man’s face
- Enlarged abdomen
- Prominent ribs
- Loose and wrinkled skin
- Anxious, always hungry

Kwashiorkor
 • Disease of the older child when the next baby is born usually when the child one to three
years old
• Signs:
- Very thin, fails to grow
- Light colored weak hair
- Moon-shaped unhappy face
- Muscle wasting
- Edematous extremities
- Skin sores and peeling
- Apathetic, does not want to eat

Treatment:

• Food is the only cure!

- Increase protein and energy concentration of food prepared
- Increase frequency of feeding
- Increase variety of food offered

Family planning – Fertility Regulation

Goal of Family Planning Program

Maternal and child health through

 Proper timing of pregnancy
 Proper interval of pregnancy
 Proper number of pregnancy

Major Program Policies

 Improvement of family welfare with main focus on women’s health, safe motherhood and
child survival
 Freedom of choice
 Promotion of family solidarity and responsible parenthood

Family Planning Methods

1. Spacing methods
 Hormones (pills, injectibles)
 Intrauterine Device
 Condoms (male, female), cervical cap; diaphragm; sponge; spermicides
  Natural (Cervical Mucus, Basal Body Temp., Sympto-thermal, Lactational Amenorrhea
Method)
2. Permanent Methods
 Tubal Ligation
 Vasectomy

Control of Diarrheal Diseases

Control of Dehydration

Classification of Dehydration

• Mild
– Sunken fontanels and eyeballs
– dry lips, child is irritable but conscious
– (-) skin fold test
• Moderate
– Lethargic, normal blood pressure
– (+) skin fold test
• Severe
– Comatose, almost (-) unrine output
– Dry tear ducts
– (++) skin fold test

Treatment of Diarrhea

• Mild Dehydration:
- Give ORS for 4 – 6 hours treatment
- Reassess after 4 – 6 hours
• Moderate and Severe Dehydration:
Control of Acute Respiratory Infection = (CARI)
Goal of CARI

• Morbidity and mortality reduction of pneumonia

• Identify and treat pneumonia

Assessment

• History
- Age
- Cough and duration
- Able to drink or has stop feeding
- Fever and duration
- Convulsions

Assessment

• Physical Examination
- Respiratory rate
Fast Breathing:
> less than 2 months : 60 min
> 2 months – year : 50 min
> 1 – 5 years : 40 min
- Chest in-drawing
- Stridor during inhalation
- Wheeze during exhalation
- Level of consciousness
- Fever
- Malnutrition

Classification of Illness:
For 2 months to 5 years
1. Very severe disease
- not able to drink
- convulsions
- sleepy
- stridor
- severe malnutrition

2. Pneumonia

a. Severe pneumonia
- chest in-drawing
- nasal flaring, grunting
- cyanosis

Treatment:

• First dose of anti-biotic/anti-malarial

• Refer urgently to hospital
• Treat fever and wheeze

b. Not severe pneumonia

- no chest in-drawing
- fast breathing

Treatment:
• Home Care
• Antibiotic
• Follow-up visit after 2 days

After 2 days:
- Same: change antibiotic
- Worse: refer
- Improving: consume antibiotic

3. No pneumonia
- no chest in-drawing
- no fast breathing

Treatment:
• If chronic, refer
 • Treat ear discharge and sore throat
• Provide home care
• Assess for other problems

Classification of Illness:
For infants less than 2 months

1. Very severe disease

- stopped feeding well
- convulsions
- abnormally sleepy
- stridor
- wheeze
- severe malnutrition
- fever (38C) or hypothermia
(below 35.5C)

Treatment:
1. Provide first dose of antibiotic
2. Keep warm
3. Refer urgently to hospital

2. Pneumonia

- severe chest in-drawing

or fast-breathing

3. No pneumonia