Midwife Licensure Exam The Midwife's Public Health Service Delivery — Immunization / EPI Delivery by the MidwifeConcept Map

EPI Delivery by the Midwife - Complete Concept Hierarchy

Comprehensive mind map showing the entire hierarchy of EPI concepts at the BHS level. Organized around six major branches: cold chain management (storage, VVM, heat/freeze sensitivity), routine schedule (birth through 12 months), vaccine administration (routes, sites, dosing), contraindications (true vs false), and record-keeping systems. This map reflects the midwife's core responsibilities in delivering immunization services safely and effectively.

EPI Vaccine Storage and Quality Control Decision Tree

Decision tree for vaccine storage quality control at the BHS. Shows the critical checkpoints the midwife performs: expiry and VVM verification, classification by heat/freeze sensitivity, proper shelf placement based on vaccine characteristics, and twice-daily temperature monitoring. This flowchart emphasizes the cold-chain safety gates that prevent wastage and ensure vaccine potency.

Immunization Administration and Documentation Workflow

Workflow for vaccine administration and documentation by the midwife at the BHS. Starts with child registration and TCL verification, proceeds through contraindication screening (with emphasis that mild illness is NOT a barrier), then vaccine preparation, administration at correct sites/routes, and dual recording in both the immunization card and facility systems. Highlights the importance of completing all due vaccines in one visit to reduce return trips.

Defaulter Tracking and Catch-up Immunization Process

Systematic process for identifying, tracking, and bringing back defaulted children. Emphasizes the midwife and BHW collaboration using the TCL as the key tool. Critical points: home visits address barriers, the series is CONTINUED (never restarted) from the last dose given, and tracking culminates in FIC/CIC classification depending on whether immunization was completed before or after the first birthday. This reflects the DOH's target-driven approach to coverage.

Reconstituted Vaccine Use Time Limits and Waste Management

Critical safety protocol for reconstituted vaccines. BCG has a 4-hour window and measles/MMR a 6-hour window after mixing. Any remainder must be discarded and never stored or used in subsequent sessions. The flowchart emphasizes that wastage, while unfortunate, is preferable to using a compromised vaccine. Tracking wastage helps identify systemic problems (over-preparation, equipment issues) that can be corrected to improve efficiency.

Child Immunization Status Life Cycle from Birth to Evaluation

State diagram showing the immunization journey of a child from birth through completion. Illustrates the critical on-time pathway (leading to FIC) versus the delayed pathway (CIC). Shows how defaulters are intercepted via tracking, resume their series from the last dose given (not restarted), and eventually reach the FIC or CIC endpoint. This visualization emphasizes that while FIC (completion before 12 months) is the program goal, catch-up and CIC completion still protects the child.

Heat and Freeze Sensitivity Classification of EPI Vaccines

Distribution of EPI vaccines by their temperature sensitivity profile. Heat-sensitive vaccines (OPV, BCG, measles) require top-shelf placement near the cold source. Freeze-sensitive vaccines (Hepatitis B, Pentavalent, PCV, IPV, TT/Td) must be stored away from the freezer and never frozen—these represent the largest group and are the most common cause of cold-chain errors. This pie chart reinforces the need for differentiated shelf placement and handling protocols.