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

Concept

Cold Chain Management

Sub Concepts

• Storage temperature +2°C to +8°C
• Vaccine Vial Monitor (VVM) reading
• Shake test for freeze-damaged vaccines
• Twice-daily temperature monitoring
• Heat-sensitive vs freeze-sensitive vaccines
• FEFO principle
• Refrigerator maintenance and placement

Relationship To Central

Critical infrastructure ensuring vaccine potency and safety

Concept

Routine EPI Schedule

Sub Concepts

• Birth doses: BCG and Hepatitis B
• 6-week schedule: Pentavalent 1, OPV 1, PCV 1
• 10-week schedule: Pentavalent 2, OPV 2, PCV 2
• 14-week schedule: Pentavalent 3, OPV 3, PCV 3, IPV 1
• 9-month schedule: MCV1, IPV 2
• 12-month schedule: MCV2
• Age-based contact points

Relationship To Central

Core immunization timeline for protection against vaccine-preventable diseases

Concept

Vaccine Administration

Sub Concepts

• BCG: 0.05 mL intradermal, right upper arm
• Hepatitis B: 0.5 mL IM, anterolateral thigh
• Pentavalent: 0.5 mL IM, anterolateral thigh
• PCV: 0.5 mL IM, anterolateral thigh
• IPV: 0.5 mL IM, anterolateral thigh
• OPV: 2 drops oral
• MCV/MMR: 0.5 mL subcutaneous, upper arm
• Auto-disable syringe use
• Site selection and needle safety

Relationship To Central

Proper technique ensures effective immunization and safety

Concept

Contraindications and Safe Practice

Sub Concepts

• True contraindications: anaphylaxis, severe prior reactions
• BCG contraindication in clinical AIDS
• FALSE contraindications: mild illness, fever, malnutrition
• Breastfeeding is NOT a contraindication
• Prematurity and low birth weight protocols
• Missed opportunity prevention

Relationship To Central

Ensures immunization safety while avoiding missed opportunities

Concept

Record Keeping and Defaulter Tracking

Sub Concepts

• Immunization card (mother-held)
• Target Client List (TCL)
• Field Health Services Information System (FHSIS)
• Fully Immunized Child (FIC) indicator
• Completely Immunized Child (CIC) indicator
• Home visit follow-up
• Series continuation, never restart policy

Relationship To Central

Ensures complete immunization coverage and program monitoring

Concept

Vaccine-Specific Considerations

Sub Concepts

• BCG: live-attenuated, heat-sensitive, 4-hour use limit
• Hepatitis B: freeze-sensitive, birth dose critical
• Pentavalent: freeze-sensitive, combines 5 antigens
• PCV: freeze-sensitive, pneumococcal protection
• OPV: oral live-attenuated, most heat-sensitive
• IPV: inactivated, part of polio eradication
• MCV/MMR: heat-sensitive live-attenuated, 6-hour use limit

Relationship To Central

Each vaccine has unique storage, handling, and protection profile requirements

To

Vaccine Administration

From

Cold Chain Management

Strength

strong

Relationship

Only potent vaccines (maintained through proper cold chain) can provide effective immunization when administered

To

Record Keeping and Defaulter Tracking

From

Routine EPI Schedule

Strength

strong

Relationship

TCL and immunization cards track adherence to the schedule; defaulter tracking ensures children follow the timed schedule

To

Contraindications and Safe Practice

From

Vaccine Administration

Strength

strong

Relationship

Safe administration includes screening for true contraindications and recognizing false ones to prevent missed opportunities

To

Cold Chain Management

From

Vaccine-Specific Considerations

Strength

strong

Relationship

Each vaccine's heat/freeze sensitivity determines its placement in the refrigerator and handling protocol

To

Vaccine-Specific Considerations

From

Routine EPI Schedule

Strength

strong

Relationship

Schedule specifies which vaccines are given at each age; each vaccine has unique properties affecting storage and administration

To

Routine EPI Schedule

From

Record Keeping and Defaulter Tracking

Strength

moderate

Relationship

Records track progress against schedule; TCL identifies which vaccines are due for which children

To

Record Keeping and Defaulter Tracking

From

Contraindications and Safe Practice

Strength

moderate

Relationship

False contraindications (mild illness) must not prevent vaccination; records show reason for deferral if true contraindication exists

To

Vaccine-Specific Considerations

From

Cold Chain Management

Strength

moderate

Relationship

VVM, shake test, and temperature monitoring apply to all vaccines but decisions depend on vaccine-specific sensitivity profiles

To

Record Keeping and Defaulter Tracking

From

Vaccine Administration

Strength

strong

Relationship

Every dose administered is documented immediately in the card and TCL; records enable tracking of coverage and FIC/CIC status

To

Contraindications and Safe Practice

From

Routine EPI Schedule

Strength

moderate

Relationship

Schedule defines when vaccines are due; contraindication assessment determines if those doses should be given at that visit