UNIT 5:PREVENTION OF DISEASES IN CHILDREN
Key unit competence: Provide disease prevention services to children.
Introductory activity 5
Observe the following images illustrating different measures used to preventdiseases in children.
From the pictures shown above,
a) What do you think that the associate nurse from image A is doing
to the child?
b) What have you observed from the image B?
c) What do you think that the child from image C is doing?
d) What do you think to be the use of image D?
e) What do you think as the advantages of performing that activity
from image E?
f) What do you think that the children from image F are doing?
g) What have you observed from the image G?
h) What do you observe from the image H?
i) What do you oberved from image I ?j) What have you observed from image J?
5.1 Preventive measures for common childhood illnesses
Learning activity 5.1
A years ago, X District was one of the first to implement vaccination program in
southern province, Rwanda. Health care providers, community health workers
were trained and followed up for proper program implementation and, during
follow-up visits, availability of vaccines and materials at the community level and
health facilities were improved. But during monthly report from health facilities,
they noticed increased cases of pneumonia and diarrhoea among children
between 2 months -9months however no actions was taken on tracing dropouts
for vaccination due to lack of clear guidelines. During the review meeting a
month ago, the in charge of health canter reported that there is reduction in
number of children attending vaccination service. Then, recommendations were
made to start implementing the tracing of dropouts whenever possible in order to
increase the impact of the strategy and decrease the incidence of the diseases.
Some health facilities set up advanced strategy of vaccination to facilitate those
who are far from health centres. District health management team leader who
participated in the review meeting decided to start implementing tracing of
children immunization dropout by engaging CHWs.
Read the case scenario described above and think about answers to the following
questions:
a. What do you think can have been the cause of the incidence of increased
cases of pneumonia and diarrhoea among children as mentioned in the
scenario?
b. What intervention do you think that can be done to prevent the diseases
mentioned in scenario?
c. What do you think to be the cause of different childhood illnesses?
Learning activity 5.1
Globally, infectious diseases, including pneumonia, diarrhea, malaria
and sepsis remain the leading causes of death for children 1 month to 5 years of age.
Access to basic lifesaving interventions such as adequate nutrition, vaccinations,
and treatment for common childhood diseases can save many children’s lives.
Disease prevention is an important part of maintaining the child’s good health.
Disease prevention, understood as specific, population-based and individual
based interventions for prevention, aiming to minimize the burden of diseases and
associated risk factors. While different childhood illnesses are caused by a variety
of parasites, viruses, and bacteria, a lot of common childhood illnesses tend tospread.
It is the most cost-effective health intervention. A set of practice guidelines for
different service levels were created by the World Health Organization (WHO),which include vaccination.
Vaccination is the term used for getting a vaccine that is, actually getting the
injection or taking an oral vaccine dose. Immunization refers to the process of bothgetting the vaccine and becoming immune to the disease following vaccination.
Primary prevention refers to actions aimed at reducing the incidence of diseases
in children; these actions include the provision of information on behavioural and
medical health risks, nutritional and food supplementation; oral and dental hygieneeducation, clinical preventive services such as vaccination
Secondary prevention deals with early detection and treatment of diseases.
This comprises activities such as evidence-based screening programs for early
detection of diseases or for prevention of congenital malformations; preventivedrug therapies of proven effectiveness when administered.
Different measures used to prevent the childhood illnesses:
• Vaccinations: All recommended childhood vaccines are scientifically proven
to be safe and effective.
• Washing hands regularly: Getting children into the habit of washing their
hands is one of the most powerful ways to prevent illness. Encourage them to
wash their hands before and after eating, after using the washroom, and after
coming home from playing outside or in a public area.
• Covering mouth and noses when coughing and sneezing: Teach children
to help prevent the spread of illness by covering mouth and noses while
coughing and sneezing with a tissue or elbow. Tell them to remember to wash
hands after.
• Disinfection of toys, electronics, and communal objects: Bacteria and
parasites can survive on some surfaces for many days. Use alcohol wipes
or rubbing alcohol to clean favourite toys, tablets, phones, doorknobs, and
any other commonly touched household object. Wash bath towels and bed
sheets regularly.
• Eating healthy and exercise regularly: Following a healthy diet and
exercising are powerful ways to boost the immune system
• Starting good habits early: Explain early and often why good hygiene
matters. Integrate good hygiene habits into daily routines and don’t forget to
tell the children when they’ve done a good job.
Self-assessment 5.1
1. Define the term vaccination?
2. Differentiate the word vaccination and immunisation?
3. What are the actions aimed at minimising the incidence of the diseases
in children?5.2 Principles of early child hood development
Learning activity 5.2
Early Childhood development starts from conception until the age of 5 years which
means that it starts when a woman conceives and the foetus starts growing in the
womb. When the baby is born, there is specific needs for effective growth anddevelopment.
During this process a child progresses from dependency on their parents/guardians
to increasing independence. Child development is strongly influenced by genetic
factors (genes passed on from their parents) and events during prenatal life. It is
also influenced by environmental facts and the child’s learning capacity.
Child development can be actively enhanced through targeted therapeutic
intervention and the ‘just right’ home-based practice, recommended by OccupationalTherapists and Speech Therapists.
What does child development include?
Child development covers the full scope of skills that a child masters over their life
span including development in:
• Cognition: The ability to learn and problem solve
• Social interaction and emotional regulation: Interacting with others and
mastering self-control
• Speech and Language: Understanding and using language, reading and
communicating
• Physical skills: The fine motor (finger) skills and gross motor (whole body)
skills• Sensory awareness: The registration of sensory information for use
Why is child development important?
Observing and monitoring child development is an important tool to ensure that
children meet their ‘developmental milestones’. Developmental milestones (a
‘loose’ list of developmental skills that believed to be mastered at roughly the same
time for all children but that are far from exact) act as a useful guideline of ideal
development.
By checking a child’s developmental progress at particular age markers against
these arbitrary time frames, it allows a ‘check in’ to ensure that the child is roughly
‘on track’ for their age. If not, this checking of developmental milestones can be
helpful in the early detection of any hiccups in development. This ‘check’ is usually
carried out through child/mother services and Pediatricians as infants and toddlers,
and later through preschool and school term skills assessments.
The earliest possible detection (and early intervention treatment if appropriate)
of developmental challenges can be helpful in minimizing the impact these
developmental hiccups can have on a child’s skill development and subsequently
their confidence, or serve as an indicator of a possible future diagnosis.
Developmental milestone checklists or charts are used as a guide as to whatis ‘normal’ for a particular age range and can be used to highlight any areas in
which a child might be delayed. However, it is important to be aware that while
child development has a predictable sequence, all children are unique in their
developmental journey and the times frames that they meet the many developmental
milestonesProblems in Child Development:
Problems in child development can arise due to: genetics, prenatal circumstances,
the presence of a specific diagnosis or medical factors, and/or the lack of opportunity
or exposure to helpful stimuli. Specific assessment by the best fit professional (which
may initially be the general practitioner or Pediatrician, and then Occupational
Therapist, Speech Therapist, Psychologist and/or Physiotherapist) can provide
clarity about the developmental issues and extent of concern as well as can help to
formulate a plan to overcome the challenge(s). As the process of child development
involves multiple skills developing simultaneously, there may then be benefit in
consulting multiple professionals.
Overcoming the developmental challenges is crucial to maximizing the ease and
speed of development, minimizing the gap that occur between a child’s ability and
those of their same aged peers, the confidence of the child as well as the frustration
that can be encountered by the child’s parents and/or care-givers.
Principles of child development
1. Child growth and development are interrelated
In order to understand this principle, it is first necessary to distinguish
between “growth” and “development”. All organisms including the humans
increase in size as they grow older. Their responsive behaviors also increase in
number as time passes on and life situations vary. This is an index of quantitative
change and is called growth.
The term growth is used in purely physical sense. It generally refers to an increase
in size, length, height and weight. Changes in the quantitative aspects come into
the domain of growth.
Development implies improvement in functioning and behaviour and hence brings
qualitative changes which are difficult to be measured directly. It indicates changes
in the quality or character rather than in quantitative aspects. These qualitative
changes accumulate to form a noticeable change of behaviour pattern a qualitative
change from earlier to the present set of behaviour, which is termed development
a noticeable difference in the pattern of the same behaviour will be marked at this
stage.
The growth and developmental process starts at the prenatal stage when a single
celled organism at conception grows and develops to a highly complex bodystructure along with variety of functions. The process by which it takes place is
known as development. Growth continues after the baby is born up to maturational
limit while development continues throughout life.
Examples of quantitative change would be height, weight, or body temperature
(growth). For Qualitative change examples would be going from crawling to walking
stage or beginning to talk using words from a babbling stage(development).
Types of child growth:
• Physical growth (Height, Weight, head & chest circumference)
• Physiological growth (vital signs).
2. Child development proceeds from General to specific
As the child develops, his behaviour becomes more and more intricate and
complex leading towards specificity. In the beginning his behaviour remains mass
and undifferentiated a general response to all stimuli. But gradually they get
differentiated and specific response is elicited to specific stimulus.
For example, the child at birth expresses only three kinds of behaviour. They lie
and rest on the bed, they sleep and they cry when they are hungry. The baby again
cries when he is uncomfortable due to bed-wetting or something else disturbing
him. Gradually this crying response becomes time specific when he is hungry at
intervals. His crying responses due to uncomfortable feeling becomes different
from the earlier ones due to the presence of an unfamiliar face or remaining alone
in the bed and so on, thus indicating this awareness of making different responses
to different stimuli.
3. Child development proceeds directionally:
“The cephalo-caudal” principle refers to the fact that development (as well as growth)
always proceeds directionally from head to foot. This principle demonstrated in
physical growth simply by comparing the changes that take place in the comparative
sizes of different parts of the body.
At birth baby’s heads are large in comparison to the rest of their bodies. As children
grow older, the rate of growth increases in the lower extremities of the body. As this
occurs, the head gradually begins to look smaller in relation to the rest of the body.
4. Child development continues throughout life:
Development is more or less a continuous process with spurts at some stages. The
changes that are controlled by the developmental process are orderly and tend to
occur in an unvarying sequence. Therefore, the major changes are, more or less,
predictable. Everybody can be expected to sit before standing, to stand before
walking. Since development is continuous, what happens at one stage influences
all subsequent stages. People change as a result of maturation and experience.5. Child development is individualised: Each child is unique the most
important principles of development are individual differences. There is no
fixed rate of development. That all children will learn to walk is universal, butthe time at which each child takes his/ her first step may vary.
Self-assessment 5.2
1) Outline the principles of child development.
2) Outline types of growth3) Explain the term cephalo-caudal.
5.3 Types of child development
Learning activity 5.3
Read the case scenario below and answer questions below
Katia, a three-years-old little girl attends kindergarten where she has numerous
friends. She usually sings to her mum songs that are taught by her teacher. Her
weight is 17 kilograms. She is average size compared to the other children in
her class and has very good posture (physically fit) compared to her colleagues.
She is able to ride a bike with training wheels, loves jumping, likes playing with
her friends, love to help self-bath, feeds herself with a small spoon and fork.
She can zip, unzip and button her coat without assistance. She draws circle and
heart shapes. She is able to twist and partially braid her doll’s hair.
a. What do you think about Katia’s memory?
b. According to your understanding what do you think about her motor
skills?
c. What indicates Katia’s social emotional skill from the scenario?
As infants grow and reach early childhood, they become more aware of how
the world works and have a better understanding of what, where, how, and why
through the following types of development:
1. Cognitive and intellectual development in children: It is the development
of the skills and knowledge that help them understand their environment. It’s
the evolution of their thought process - how they process information, think,
determine right from wrong, make decisions, solve problems, learn new
things and how they perceive the world around them. Examples: thinking,
remembering, counting or identifying shapes.
Brain growth is part of cognitive development. The child’s brain develops in infancy
and early childhood so does their capacity to remember. The child memory plays a
huge significant role in a child’s socio-emotional and cognitive functioning.
The human brain is not fully developed at birth. That is the reason we can’t
remember being a baby, yet we can remember every line from our favourite teen
movie or song. It is due to the way brain develops, and more specifically, how
memory system develops from child hood, through adolescence and adulthood.
While the development of memory (short & long-term) is most evident in the first
2-5 years of a children’s life, their memory continues to develop well until adulthood.
Moreover, not all parts of the brain develop at the same time. In fact, the brain isn’t
fully developed until age of 25.
There are many ways to help promote children’s cognitive development. This can
literally start immediately after birth. The more engagement and interaction with
children, the more opportunities to them to develop the necessary cognitive skills
and abilities. As with adults, every child is different. For example, some will have
excellent memories; others may have weaker memory and skills but may showstrength in logic and reasoning instead.
2. Gross motor skills
Gross Motor skills refer to the physical skills needed to make large body movements
i.e. the large muscles, specifically the head, neck, arms, and legs. It’s themovement of arms, legs or torso in a coordinated and controlled way.
The first example of a child developing gross motor skills is at around 3-4 months
when he raises his head when pulled into a sitting position, followed by him rollingover. Examples are crawling, jumping or running.
Each stage of gross motor skill development leads to the next, as they strengthen
the necessary muscles and bones to help them progress from rolling over to sitting,
crawling, standing, walking, running, hopping, etc. Some gross motor skills also
require eye-hand coordination skills such as throwing, catching, kicking,riding a scooter or a bike
Children use our gross motor skills literally all the time, whether sitting down or
standing up or lying in bed, every time of moving or change positions, it’s by using
gross motor movements. Balance, body strength and body awareness are all part
of gross motor development. Here are a few other examples of everyday activitiesrequire gross motor skills
3. Fine motor skills
Fine motors refer to the physical skills needed to make small movements i.e.
the small muscles, specifically their hands and fingers. Fine motor skills startdeveloping almost at birth as they grasp reflexively, followed a few months later
when they place their fingers in their mouth, and by 6 months old, when they begin
to grasp at objects.
Fine motor skills involve more precision to perform than gross motor skills
and requires a number of independent skills (like hand-eye coordination, hand
control, body awareness, and patience) to work together to perform the task at
hand do things like play with toys, dress themselves, feed themselves, draw
and write are examples of fine motor skills.
Young children need time to practice their fine motor movement every day. Whether
they’re picking up something to eat or trying to pull up the zipper on their jacket,
it might be tempting (and far quicker) to take over and do it ourselves, especially
when we’re in a rush, but we must remember that these are all essential activitiesfor fine motor development.
Fine motor skill development is an originator to developing good handwriting
skills. The more opportunities a child has to pick up small objects (pincer grip),
and manipulate and exercise the small muscles in the palm of his hand, the better
control and strength he’ll have later on, when colouring, cutting and forming letters.
4. Speech and language
The development of speech and language refers to the skills children use to
understand and communicate with others. Language development helps a child to
communicate what they want and how they feel. It is also crucial to their thought
process; problem-solving, and forming relationships with others.
It is a critical part of child development and most of the foundations speech refers to
the making of sounds that become words. At around 2 months, babies first start
fussing, and at 6 months they generally start babbling - this is them learning
how to make the sounds which will eventually form words. It’s the physical act of
talking, even if we don’t understand what they’re saying.
Language, on the other hand, is the use of words (spoken or written), gestures
to communicate and understand others. Language refers to any form of
communication, be it verbal or nonverbal. Young children might not be forming
full sentences yet, or even speaking coherently, but don’t overlook their ability to
communicate. They can communicate their emotions and feelings through sound,
facial expressions, gestures and actions. Smiling, crying, shouting, laughing,
throwing things, pointing, and even throwing bad temper are just a few ways they
are attempting to communicate with you.
Language development is located down in the first 12 months of baby’s life and
develops at a rapid rate, especially between the ages of 2-5. Most children will havelearned the basics by age 6.
5. Social and emotional skills
These refer to a child’s ability to interact with others, to understand and
manage feelings and emotions. Examples of socioemotional skills are empathy,
sympathy, recognizing and expressing feelings, and the ability to relate toothers.
These skills begin in early childhood – from birth, as they interact with their
caregivers and form emotional attachments - and will continue growing throughout
adulthood. Babies show signs of socioemotional growth by smiling when he/she
sees you, waving goodbye when someone leaves, sharing his toys with his sibling,
even showing anxiety around strangers (around 7-9 months) or tantrums (around
age 2). The positive and negative reactions are all a normal part of their emotional
growth.
Healthy socioemotional skills will help the child to form and maintain positive
relationships, self-confidence, develop self-awareness and awareness of othersand their feelings, manage stress and anxiety.
Self-assessment 5.3
1. Outline types of child development.
2. Explain cognitive and intellectual development in children.3. Explain by giving examples on social and emotional skills.
5.4 Factors influencing the child development
Learning activity 5.4
Read the case scenario and answer questions below
Kaliza is 4years old firstborn of her family living in village. Her mother is a
housewife and her father is a farmer where they live in small house with 2 goats
and 2 rabbits. The child Kaliza did not start the nursery school yet because she
doesn’t speak well, is not able to feed herself, and cannot dress or undress
herself. She is fairly walking but can’t run, she is physically unstable when
looking at her. Her mother reported that community health worker measured her
and said that the child is not growing well. She also says that Kaliza is just lazy
as she is a girl. she added that her baby delayed even to sit and crawling just
like her younger sister. She claimed that her child does not like eating vegetables
and fruits. She does not like to play with other children (neighbours of her age)
because they live far from them.
a. What do you think about Kaliza’s condition?
b. What do you think that can cause the child in scenario delayedspeaking, walking?
Child development refers to the sequence of physical, language, thought and
emotional changes that occur in a child from birth to the beginning of adulthood.
During this process a child progresses from dependency on their parents/guardians
to increasing independence.
Child development is strongly influenced by a wide variety of factors throughout his/
her life. These factors influence a child both in positive ways that can enhance their
development and in negative ways that can compromise the child’s developmentaloutcomes.
These factors include:
Genetics: children inherit much genetically aside from physical appearance, like
eye and hair colour, skin tone, nose shape, as well as height and body build. Theyalso inherit things like attitude an extent, inherit traits like intelligence, abilities, and
attitude. While all kids are special and have amazing potential, some children are
also more naturally gifted or excel more than others at certain things. Whether it be
at sports or academics, some kids pick things up much faster or more easily than
others. Not everyone is destined to be a pro tennis player (in fact, few are). Not
every child learns at the same pace or has the same capability to acquire or retainor understand information.
Health & nutrition: Health attributes are passed through the genes, some viruses,
diseases, and disabilities can be developed as a result of external factors including
(but not limited to) our environment. Good health can include access to quality
healthcare, vaccinations, medicines, a toxin-free environment, clean water and air.
Nutrition (balanced diet) plays a significant part in children’s growth and development
as it affects not just their health but also strength, growth, and energy levels, which
can adversely affect learning. Providing children with a balanced diet from birth is
essential for their growth and development. When children face with health and
nutrition issues can lead them to developmental delay. Developmental delays
can reduce a child’s ability to communicate, learn, be mobile, live independently,make decisions and care for themselves
Gender: A side from the biological differences between boys and girls, gender
expectations and social norms can also influence a child’s development. More
often, without realizing it, the perceived gender roles can influence the way in
which parenting children can have profound effects on their children’s thoughts,
behaviours, and actions.
Parents unwittingly expose their children to different environments or opportunities.
For example, being roughhouse with boys, but be gentler with girls, and therefore
potentially exposing boys more to the use of gross motor skills at an earlier age.
Environment: children’s living physical and social environment also plays a big
role in influencing their development positively or negatively. Access to suitable
housing, health care, education and recreation facilities, clean air and water can
influence a child directly through their own health well-being and opportunities
afforded to them, as well as indirectly by affecting their caregivers’ emotional and
physical well-being.
It’s important for the child to have access to and live in a stress-free environment.
Children plays, toys, and interaction with others help stimulating both mental
and physical aspects. The social relationships that children have can be hugely
impactful. The quality of their interactions with others determines their intellectual,
social, and emotional development.
Family: Family is almost certainly the most important factor in child development. In
early childhood especially, parents are the ones who spend the most time with their
children and sometimes influence the way they act, think and behave. Children’s
social, emotional, and even physical development are very dependent on familial
related opportunities including the strength of familial bond.
The interaction with children (how often) can be hugely significant. Parents are
important people in their little lives, and children depend on them for everything
(nourishment, security, warmth, comfort, attention, stimulation, and, most importantly,
love and affection). If children feel safe, they can take risks, ask questions, makemistakes, and learn to trust, share their feelings, and grow well.
Self-assessment 5.4
1. Explain how can genetic influence child’s development?2. List factors influencing child development, it can be positively or negatively.
5.5 Promotion of child health
Learning activity 5.5
Observe the images below and reflect to them.
a. How do you understand health promotion?
b. What do you think about image C and D?c. What do you think about images A?
The World Health Organization defines health promotion as the process of enabling
people to increase control over, and to improve, their health. Health promotion
moves beyond a focus on individual behaviour towards a wide range of social and
environmental interventions. Health promotion’s purpose is to positively influence
the healthy behaviour of people and societies as well as the living and working
conditions that impact their health.
Health promotion focuses on improving and protecting the health of different
populations and communities, including children and their families. Health promotion
programs aim to reduce health disparities and improve health outcomes. Programs
that focus on improving the health and well-being of children in early childhood may
be implemented in homes, childcare settings, and other community-based settings.
Health in childhood determines health throughout life and into the next generation.
“Ill health or harmful lifestyle choices in childhood can lead to ill health throughout
life, which creates health, financial and social burdens for countries today and
tomorrow”
The above quote illustrates just how important the promotion of children’s health
is. Child health promotion focuses upon the enhancement of children and young
people’s overall health and well-being.
Child health promotion tips
The child health promotion activities include but not limited to the following activities:
• Growth monitoring
• Immunization program.
• Promotion of access to and participation in school feeding (healthy foods and
drinks at schools)
• Controlling food quantity and quality (foods and drinks) outside school feeding
• Offering leisure’s and sport activities to children (celebrations and events).
• Providing and ensuring access to safe water.
• Education on nutrition in classes, school day, and in after-school programs for
example, through school gardens and farm-to-school activities.
The center for disease control notes that programs that focus on influencing and
modifying certain health behaviors and outcomes from an early age can greatly
impact health outcomes later in life. Some of these programs include a focus on:
• Childhood obesity, especially programs in early childhood education settings
• Healthy food options and nutrition
• Physical activity like exercises
• Chronic disease in childhood prevention
Oral health
• Healthy sleep habits
• Prevention of drug use among children
• Access to age-appropriate screening tests for development, hearing, and
vision
• Childhood trauma and adverse childhood experiences (ACEs) prevention
Typical activities for health promotion, disease prevention, and wellnessprograms include:
Communication: Raising awareness about healthy behaviours for the general
public. Examples of communication strategies include public service announcements,
health fairs, mass media campaigns, and newsletters.
Education: Empowering behaviour change educations, communications and
actions through increased knowledge. Examples of health education strategies
include courses, trainings, and support groups.
Policies, systems and environment improvement: Making systematic changes
– through improved laws, rules, and regulations (policy), functional organizational
components (systems), and economic, social, or physical environment to encourage,
make available, and enable healthy choices
Nursing roles in child health promotion
The backbone of the nursing profession has always been recognized as that of a
caring profession and one that excels in disease prevention and health promotion.
Nurses are strong advocates for patients because they direct the health care
system.
The nursing roles in child health promotion and disease prevention are:
Health educator: Nurses spend the most time with the patients and provide
anticipatory guidance about immunizations, nutrition, dietary, medications, and
safety.
Nurses are consistently working to prevent illnesses such as heart disease, stroke,
diabetes, and obstructive pulmonary disease; they do this through a variation of
tactics that include education, risk factor prevention, and the monitoring of safety
hazards either in the workplace, community, or home. Helping patients to potentially
receive preventative services such as counselling, screenings, and precautionary
procedures or medications. Nurses can impassion those to engage in healthy
lifestyles through education, mentorship, and leadership.
Nurses are able to perform health promotion tasks by enhancing the quality of life
for all people through assessment of individual and community needs, education,identification of resources, evaluation and implementation of programs to help
reduce premature deaths.
Nurses provide the practical guidance on everyday health issues such as preventing
obesity, dental health, skin care and prevention of diseases and infections.
Nurses explore the best practice for nursing children with chronic illnesses such
as asthma, cancer, diabetes and disabilities, and gives guidance on promoting the
health of adolescents looking at issues of sexual health, smoking, drugs and alcohol.
Each chapter discusses key health promotion messages, relevant governmentpolicy and health promotion
Self-assessment 5.5
1. Briefly explain nursing roles in child health promotion.
2. Centre for disease control notes that programs that focus on influencing
and modifying certain health behaviours among children for better health,list at least 5 programs.
5.6 Developmental monitoring and screening
Learning activity 5.6
During community outreach, an associate nurse student found in one of the
visited families, a child called Cyiza who was dirty and lying in his bed. The
neighbour told that his parents do not care for him because he is still lying down
while other children of 3years of the same age can run and go to school. Cyiza
cannot get up and just know to say da and articulate other strange sounds.
a) What do you think about the situation of Iriza?
b) What do you think about parents attitudes towards this child ?
c) What should the associate nurse and parents do to help their child?
d) According to the age of the child in wich category can you classify the childCyiza?
Overview of child health development
Child health and development depends closely to experiences rooted from early
years of child’s life. Children including those with special health care needs, grow
healthy when all skills are timely acquired and grow up where their social, emotional
and educational needs are met. Positive parenting practices play an important role
in child’s healthy development. Therefore, parents should help their child stay
healthy, be safe, and be successful in many areas such as emotional, behavioral,
cognitive, and social by responding to children in a predictable way, showing
warmth and sensitivity, having routines and household rules, sharing books and
talking with children, supporting health and safety, using appropriate discipline
without harshness. Proper nutrition, exercise, and sleep have valuable impact on
child development.
Monitoring of development is critical for two reasons: First, new circumstances
(e.g., medical illness, family or environmental disruption, or injuries) may interfere
with development. Second, as children develop, they gain new categories of skills
that are difficult to assess at earlier stages (e.g., one cannot usually detect isolated
language delays in children younger than 18 to 24 months, the period at which
children begin to develop language skills). In 2006, the American Academy of
Pediatrics (AAP) published guidelines recommending developmental surveillance
at every child visit, as well as additional periodic developmental screening using astandardized test at the 9, 18, and 30 months old.
Stages of child development
a. New-born refers to the stage immediately after birth until 1 month.
b. Infant is a child in the period from 1 month until 12 months.
c. Toddler stage is from 12 months until approximately 3 years.
d. Early childhood or Pre-schooler are children in 3- to 6-year-olds.
e. School-age children are 6 to 12 years old.f. Adolescence begins around 12 or 13 to adulthood
Self-assessment 5.6
1. When can you argue that a child is growing or developing well?
2. What should do parents to help their child stay healthy, safe, and be
successful in many areas regarding?
3. Monitoring of development is critical for two reasons. Why?5.7. Developmental monitoring
Learning activity 1.4
These pictures are showing developmental monitoring of a child
a. Which domain do you think it explicates the A.
b. Which domain do you think it explicates the B.c. Which domain do you think it explicates the C.
Developmental monitoring is checking whether a child reaches the skills and
behaviours that are expected by his or her age or those of likelihood. It is something
parents and other caregivers can do, on a regular and ongoing basis. Developmental
monitoring provides important information about a child’s developmental health.
Using CDC’s developmental milestone checklists makes the monitoring easy. The
associate nurse, nurse and other child caretakers play a vital role in identifying
children at risk for developmental disabilities and in referring them for appropriate
early intervention services.
Physical developmental delays
Physical developmental delay is when a child is not able to do activities or basic
movements such as rolling over, sitting without support, or walking that other
children of their age are doing. Developmental delay can be a sign of a serious
health condition and it’s important to seek early care for adequate and timely
interventions. Parents and other caregivers are the most important to identifying
any deviation from normal basing on specific behavioral and skills features andtermed as developmental milestones.
Figure 5.3: a child with getting up problems ring the History Taking of a Child wit
All young children need both developmental monitoring and developmental
screening to help parents and child’s health care providers, teachers, and other
care takers know if child’s development is on normal progress.
Developmental monitoring involves using information obtained from the history
taking, physical examination, and developmental screening tests to assessdevelopment on an ongoing basis.
History Taking
The following information should be elicited:
Parental concerns regarding the child’s development.
Parental concerns regarding the child’s language development, articulation,
fine motor skills, or global development are likely to be associated with true
developmental delays.
Parental concerns about behavior or personal–social skills are associated withdevelopmental delays in some cases.
• Risk factors for developmental disabilitiesPrenatal
Maternal illness, infection, or malnutrition, maternal exposure to toxins, teratogens,
alcohol, illicit drugs, anticonvulsants, antineoplastic, or anticoagulants drugs,
decreased fetal movements, intrauterine growth retardation, family history ofdeafness, blindness, or mental retardation, chromosomal abnormalities
Perinatal: Asphyxia: Apgar scores of 0–3 at 5 min, prematurity, low birth weight,
abnormal presentation.
Postnatal: Meningitis, encephalitis, seizure disorder, hyperbilirubinemia: bilirubin
>25 mg/dl in full-term infant, severe chronic illness, central nervous system trauma,
child abuse. and neglect
Family history
Consanguinity may cause chronic condition of the kidney may be associated with
Attainment of developmental milestones
Developmental milestones (how a child plays, learns, speaks, acts, or moves)
are behaviours or skills most children can do by a certain age. All young children
need both developmental monitoring and developmental screening to help parents,
child’s health care provider, teachers, and other providers to know if the child’sdevelopment is on track
At 2 months
Social/emotional milestones
When spoken to or picked up, the child calms down and responds by looking at the
face of the instructor, demonstrating happiness to someone who walk up to her orsmile at her/him.
Language/communication milestones: Regarding this milestone, the infant only
makes sounds other than crying or reacts to loud sounds
Cognitive milestones (learning, thinking, problem-solving: At 2 months, the
child watches the movement of the person who is coming or going as and can
observe a toy for several seconds.
Movement/physical development milestones: At this age the infant holds head
up when on tummy, moves both arms and both legs and opens hands brieflyAt 4months
Social/emotional milestones: At this age the child smiles on his own to get
someone’s attention or chuckles (not yet a full laugh) when you try to make her
laugh; looks at you, moves, or makes sounds to get or keep your attention. Knows
familiar people; likes to look at self in a mirror and laughs.
Language/communication milestones: Regarding language or communication,
a 4months child makes sounds like “oooo”, “aahh” (cooing). Makes sounds back
to respond and turns the head towards the sound of a voice. Takes turns making
sounds with you. Blows “raspberries” (sticks tongue out and blows) and makessquealing noises.
Cognitive milestones (learning, thinking, problem-solving: Learning, thinking
and problem solving are observed when the child is hungry specific cues such as
opening mouth when she sees breast or bottle. Also he or she looks at his hands
attentively. Puts things in her mouth to explore them. Reaches to grab a toy he
wants and Closes lips to show she doesn’t want more food
Movement/physical development milestones: At this age, the child is able to
hold his head steady without support. He can hold a toy put in his hand and uses
arm to swing at toys. Brings hands to mouth and when lied in prone position, he /
she is able to push up onto elbows/forearms. Rolls from tummy to back. Leans on
hands to support himself when sitting
At 6 months
Social/emotional milestones: Social or emotional milestones are important cues
that display the child development; an infant at this age will be able to recognize
familiar people; Likes to look at self in a mirror and laughs
Language/communication milestones: Takes turns making sounds with you.
Blows “raspberries” (sticks tongue out and blows) Makes squealing noises.
Cognitive milestones (learning, thinking, problem-solving: The child explores
objects by his or her mouth. Reaches to grab a toy he wants and closes lips to show
she or his no longer hungry or does not want
Movement/physical development milestones: Physical development by 6
months is characterized by active movement of the limb where the enfant rolls from
the abdomen to back. Leans on hands to support himself when sitting
By 9 months
Social/emotional milestone: By this age most of babies are shy, clingy, or fearful
around strangers; Recognize their name when called. They are able to express
their emotions by facial expression (happy or unhappy)
Language/communication milestones: Child at 9 months’ lifts arms up to show
that she/he want to be picked up by a loved one and makes a lot of different sounds
like “mamamama” and “bababababa
Cognitive milestones (learning, thinking, problem-solving): The child shows
learning process by trying to identify objects when dropped out of sight (like his
spoon or toy). Bangs two things together
Movement/physical development milestones: The physical development occurs
progressively; thus the baby first tries to get to a sitting position by herself and end
by sitting without any support. This movement progress involves also the use of
upper and lower limbs. Thus the child will move things from one hand to her otherhand or uses fingers to “rake” food towards himself
By one year
Social/emotional milestones: The young infant has observed adult person doing
and in the future he will try to help in adult activity (washing clothes and other
activities)
Language/communication milestones: Communication skills are acquired
progressively; from sounds other than crying observed early, the one-year-old
baby can understand adult orders and respond accordingly. The infant will know
to say good bye, should call a parent “mama” or “dada” or another special name,
distinguish an order from adult person and responds accordingly ex: a no and the
child ceases what he or she was doing!
Cognitive milestones (learning, thinking, problem-solving): The learning
process is present at each state of child growing, we observed at the previous
state from where the child tried to identify objects when dropped out of sight (like
his spoon or toy) and bangs two things together thus by one year, the baby knows
to put something in a container, like a bean in a cup. Looks for things he sees you
hide, like a toy under a blanket
Movement/physical development milestones: Physical development involves
also limbs and the baby manage to stand; walking, holding on to furniture drinks
from a cup without a lid, as you hold it. For further progress, by one year the baby
picks things up between thumb and pointer finger, like small bits of food.
BY 15 months
Social/emotional milestones: By 15 months the baby copies other children while
playing, like taking toys out of a container when another child does, identify and
shows her / his objet of choice. He/she is also able to express their emotion by
clapping hand or he/she cuddles you.
Language/communication milestones: Language progresses as the baby grows
up; two words besides “mama” or “dada,” are acquired like “ba” for ball or “da” for
dog. Recognize a familiar object when you name it; Follows directions given with
both a gesture and words. For example, he/she gives you a toy when you hold out
your hand and say, “Give me the toy.” Points to ask for something or to get help
Cognitive milestones (learning, thinking, problem-solving): Learning at
this stage is characterized by baby’s progress in identifying objects and tries its
appropriate use. Phone to hear, cup put towards the mouth. Stacks at least two
small objects, like blocks
Movement/physical development milestones: By this age the infant takes a few
steps on his own and for taking some food the enfant feels easy to use fingers tofeed herself
By 18 months
Social/emotional milestones: By 18 months walks away by his or her own but
the immature child invents opportunities that make him closer to someone who
should help in need by: a. Showing something interesting, b. Putting hands out to
be washed, c. Reading with an adult, d. Helping in dressing him by pushing arm
through sleeve or lifting up foot
Language/communication milestones: By 18 years the communication skills
improve and besides “mama “or dada” three or more words are added. Responds
appropriately when asked to give something”
Cognitive milestones (learning, thinking, problem-solving): Learning process
at this age is characterized by baby’s imitation adult activities. She/he wants to
sweep and perform activity in in a simple and appropriate way or plays with toys,
like pushing a toy car in a simple direction.
Movement/physical development milestones: The child gets to a sitting position
by herself and without support. Upper limbs also progress and the infant is able
to change objects from one hand to her other hand or use fingers to “rake” food
towards himself
2 years
Social/emotional milestones: At 2 years the emotion of the child is characterized
by a bit of empathy towards others. The baby identifies negative emotions from
others. Such as when you are hurt or upset or pausing or looking sad when
someone is crying. Looks at your face to see how to react in a new situation
Language/Communication milestones: Communication at this age improves
and the baby is able to identify things in a book when you ask, like “where is the
chair? Language also progresses and at least two words together, like “More milk”
can be spelled. Some parts of the body are known and the infant can show at least
two body parts. Uses more gestures than just waving and pointing, like blowing a
kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving): The process of
learning is multi steps; by 2 years the baby holds something in one hand while
using the other hand; for example, holding a container and taking the lid off, tries to
use switches, knobs, or buttons on a toy, plays with more than one toy at the same
time, like putting toy food on a toy plate.
Movement/Physical development milestones: By 2 years limbs structures have
progressively developed, the child exhibits some advanced and strong movements
such as kicking a ball, running after it and he or she is able to walk up a few stairswith or without help. Eats with a spoon
By 30 months
Social/emotional milestones: At this age, the child shows some cues of socialism
and he/ she is interested by playing in group with other children. Wants his/her
progress to be noticed by others by saying “Look at me!
Language/communication milestones: Language progress increases gradually
and the child is now able to articulate about 50 words; says two or more words
together, with one action word; knows to pick an object from a book when it is asked
to show it or to name the object. Says words like “I,” “me,” or “we”
Cognitive milestones (learning, thinking, problem-solving): The infant has
learned from his/ her caregivers and at this age he shows his maturity or problem
solving by playing in nurturing his doll. When an object is left at a high level he will
try to reach it by climbing or standing on a stool. Follows two-step instructions like
“Put the toy down and close the door.” He is able to identify or pick a desired color
at least one.
Movement/physical development milestones: Physical development increases
with the age but also with a certain degree of maturity. Thus the child opens things
by twisting them or turning doorknobs to open it or unscrewing lids. Can undress off
alone, Jumps off with both feet. Open and turns off a book.
By 3 years
Social/emotional milestones: The child has familiarized with people around him
and does not like to be left alone or with strange ones. Within ten minutes after you
leave her, he has forgotten and will join others to play with.
Language/communication milestones: By 3 years, conversation is eased
using at least two back-and-forth exchanges. Use why questions to discover an
environment or a cibled one by asking “who,” “what,” “where,” or “why” questions,
like “Where is mommy/daddy?”. The infant is able to interpret an action on a picture
cg:” drawing”, “smiling.” Says first name, when asked. Wants other to appreciate
him or her by good spelling of words
Cognitive milestones (learning, thinking, problem-solving): Learning by 3
years old is marked by correct imitation or strong compliance to adult orders or
advices. Thus a 3 years old child is able imitate a work showed by a caretaker. Ex:
Draws a circle, when you show him how. Fear of hot objects as told.
Movement/physical development mile stones: A 3 years old infant is able to tie
thinks together and has acquired some self-care abilities such as dressing skills oreating by himself using appropriate kitchen utensils.
4 years
Social/emotional milestones: By 4 years old the child plays simulations that
imitate a desired profession, playing as a teacher or barking like a dog to provoke
fear in likelihood. However, he likes to be a helper comforting or protecting those
in danger. The child identifies respectful areas for applicable behavior! (church, vs
market)
Language/communication milestones: At this age the child is able to articulate
sentences with four or more words from a song or a story. Talks about at least one
thing that happened during his day, like “I played soccer.” And Answers simple
questions like “What is a coat for?” or “What is a crayon for?”
Cognitive milestones (learning, thinking, problem-solving): The child knows to
draw a person and can name at least 3 parts. He /She is able to identify few colors.
At this age he can tell a story in appropriate order.
Movement/physical development milestones: A 4 years old child catches a
large ball most of the time or holds crayon or pencil between fingers and thumb
(not a fist). Can unbutton some button. Finally serves food or pours water by him or
herself. Unbuttons some buttons
5years
Social/Emotional Milestones: The child does continue adapting to the social
environment; respects pre-established rules and can even take a role within a play.
Sings, dances, or acts for you. Does simple chores at home, like matching socks or
clearing the table after eating
Language/Communication Milestones: Development involve improved
communication where the infant is able to tell a story she heard or made up with at
least two events. For example, a cat was stuck in a tree and a firefighter saved it
• Answers simple questions about a book or story after you read or tell it to him
• Keeps a conversation going with more than three back-and-forth exchanges
• Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive milestones (learning, thinking, problem-solving): Counts to 10,
Names some numbers between 1 and 5 when you point to them, uses words about
time, like “yesterday,” “tomorrow,” “morning,” or “night”, Pays attention for 5 to 10
minutes during activities. For example, during story time or making arts and crafts
(screen time does not count), Writes some letters in her name, names some letters
when you point to them.
Movement/Physical Development Milestones: Buttons some buttons, Hops onone foot.
Physical examination
Head Circumference: A small head circumference may indicate abnormalities in
brain growth that place a child at risk for developmental disabilities. A large head
circumference may be a sign of hydrocephalus, a genetic syndrome, or a metabolic
storage disease. However, before assuming pathology in a child, one should
measure the head sizes of parents as a small or large head circumference may be
a family trait.
Congenital anomalies or dysmorphic features: Congenital anomalies or
dysmorphic features are associated with many genetic syndromes that may cause
mental retardation or learning disabilities.
Dermal lesions of neuro-cutaneous Syndromes
Approximately 50% of patients with dermal lesions have mental retardation or are
at risk for hearing loss and learning disabilities.
Muscle tone: Hypertonia may be a sign of cerebral palsy (CP), but in the first
year of their life, children with isolated increases in muscle tone should not be
diagnosed with CP as they may outgrow the problem. Hypertonia occurs in infants
with neuromuscular disorders or injury to the brain or spinal cord. Rarely, hypertonia
is the only sign of a metabolic disorder (e.g., peroxisomal disorders, acid maltase
deficiency). Hypotonia also occurs in some chromosomal disorders, such as Down
syndrome, so obtaining a karyotype should be considered if the child is dysmorphic
and hypotonic
• Primitive Reflexes
Asymmetries of primitive reflexes may help identify hemiplegia or other nerve
injuries. Persistence of primitive reflexes beyond the time of usual disappearanceor an obligate response may be signs of CP.
Self-assessment 5.7
a. What does mean developmental monitoring?
b. What elements do help in developmental monitoring?c. What does mean developmental milestones?
5.8 Developmental screening
Learning activity 5.8
Developmental screening refers to assessing the child development through exams
and with using appropriate tools. For developmental and behavioral screening, it
is done using formal questionnaires or checklists asking questions about a child’s
development, including language, movement, thinking, behavior, and emotions.
Developmental screening can be done by skilled care providers such as a doctor
or nurse, but also by other professionals in healthcare, early childhood education,
community, or school settings. This screening is more formal than developmental
monitoring but it is most of the time done only when there is a concern from parent
or health care provider. According to AAP, periodic developmental screening should
be a part of routine visits for all children even if there is not a known concern.
Importance of developmental screening
The first step to connecting young children with early intervention services is
effective, periodic developmental screening. Children with special health care
needs are more likely to have developmental delays and disabilities than their
peers, therefore the child should be early assessed for developmental issues in
order to provide timely and adequate intervention services. Appropriate and early
interventions to infants and toddlers with developmental delays and disabilities
must include their families for positive and sustainable results.
Screening includes also the use of parent reports and screening tools. Parental
concerns are highly accurate in identifying developmental problems. In somestudies, up to 80% of parental concerns have been found as accurate.
Signs of developmental delay
Table 5.1: Signs of developmental delays
At every visit the following elements must be considered:
• Eliciting and addressing parents’ concerns at each visit
• Viewing milestones at each visit
• Identifying and addressing psychosocial risk and resilience factors
• Using a general screen that is validated and accurate at 9, 18, 24 – 30 monthsand at each subsequent visit
Hearing assessment screening: Universal hearing screening during the newborn
period is recommended because screening limited to infants with risk factors for
hearing identifies only half of infants with significant hearing impairment.
Risk factors for hearing impairment: Family history of deafness, congenital
TORCH infections: toxoplasmosis, other infections, rubella, cytomegalovirus,
and herpes simplex, Congenital malformation of the head and neck, Prematurity
(< 1,500 g at birth), Extended stay in neonatal intensive care unit (>48 hrs.),
Hyperbilirubinemia requiring exchange transfusion, Meningitis or encephalitis,
anoxia.
Vision assessment: The detection of amblyopia is the most important reason for
early vision screening as early detection can prevent vision loss in the “neglected”
eye. Newborns should be able to fixate on a face; by 1 to 2 months of age, infants
should be able to follow an object horizontally across their visual field.
Development screening tests
General Development
Ages 0–5 Years: Ages and Stages Questionnaires: The Ages and Stages
Questionnaires is a series of parent-completed questionnaires that assess the
domains of communication, gross motor, fine motor, problem solving and personal
adaptive skills.
Ages 0–8 Years: Parents’ Evaluation of Developmental Status (PEDS):
This parent-completed questionnaire elicits parental concerns about aspects of
the child’s development and behavior. Based on the response of the parents to
questions, an algorithm guides the clinician in determining whether the child needs
referral, additional screening, or continued surveillance. Additional information on
this test is available at www.pedstest.com
Autism spectrum disorder (ASD) : The AAP(American association of paediatrician)
recommends that all children should be screened for autism spectrum disorder
(ASD) during regular well-child visits at 18 months, 24 months. Autism, or autism
spectrum disorder (ASD), refers to a broad range of conditions characterized
by challenges with social skills, repetitive behaviours, speech and nonverbal
communication.
Common signs of autism: Avoiding eye contact. Delayed speech and
communication skills. Reliance on rules and routines. Being upset by relatively
minor changes. Unexpected reactions to sounds, tastes, sights, touch and smells.Difficulty understanding other people’s emotions.
Self-assessment 5.8
1. State signs of developmental delay at 18 months.
2. Briefly explain autism3. list signs of autism
5.9 Immunisation according to expanded program of
immunisation
Learning activity 5.9
Today every country in the world has a national immunization programme.
Vaccines are viewed as one of the safest, most cost-effective, successful public
health interventions to prevent deaths and improve lives.
a. How do you understand by term immunization?
b. When a vaccine introduced into the body, it produces protection from
a specific disease, according to your understanding what is the name
for that protection?
c. Every country has immunization programme, what do you think aboutits aim?
Vaccination is the intervention used to prevent or eradicate childhood diseases. It is
the most cost-effective health intervention. A set of practice guidelines for different
service levels were created by the World Health Organization (WHO), which
include vaccine monitoring, immunization techniques, cold chain management and
reporting systems.
EPI (Expanded Program on Immunization) covers vaccination services implemented
in order to ensure the immunization of all vulnerable age groups by preventively
reaching out to them before they contract and develop infectious diseases. This
program aims to control, and eventually eradicate these infections with a special
focus on decreasing the incidence of these infectious diseases and its associated
deaths.
Immunization activities are fully integrated into routine health services within each
health Facilities. These are key terms that explains interchangeable words used in
immunization activity.
Immunity: Protection from an infectious disease. If you are immune to a disease,
you can be exposed to it without becoming infected.Vaccine: A preparation that is used to stimulate the body’s immune response
against diseases. Vaccines are usually administered through needle injections, but
some can be administered by mouth or sprayed into the nose.
Vaccination: The act of introducing a vaccine into the body to produce protection
from a specific disease.
Immunization: A process by which a person becomes protected against a disease
through vaccination.
There are two types of immunity: active and passive.
Active Immunity results when exposure to a disease organism triggers the immune
system to produce antibodies to that disease. Active immunity can be acquired
through natural immunity or vaccine-induced immunity.
Natural immunity: acquired from exposure to the disease organism through
infection with the actual disease.
Vaccine-induced immunity: acquired through the introduction of a killed or
weakened form of the disease organism through vaccination. if an immune person
comes into contact with that disease in the future, their immune system will recognize
it and immediately produce the antibodies needed to fight it. Active immunity is
long-lasting, and sometimes life-long.
Passive immunity is provided when a person is given antibodies to a disease rather
than producing them through his or her own immune system.
Vaccines types and mechanism of action
They exist live-attenuated vaccines, inactivated vaccines, subunit, recombinant,
conjugate, and polysaccharide vaccines, toxoid vaccines, mRNA vaccines and
Viral vector vaccines
Live-attenuated vaccines: Live-attenuated vaccines inject a live version of the
germ or virus that causes a disease into the body. Although the germ is a live
specimen, it is a weakened version that does not cause any symptoms of infection
as it is unable to reproduce once it is in the body. The types of diseases that liveattenuated
vaccines are used for include: Measles and rubella (MR combined
vaccine) and rotavirus
Inactivated vaccines: An inactivated vaccine uses a strain of a bacteria or virus
that has been killed with heat or chemicals. This dead version of the virus or bacteria
is then injected into the body. Inactivated vaccines are the earliest type of vaccine
to be produced, and they do not trigger an immune response that is as strong as
that triggered by live-attenuated vaccines. The types of diseases that inactivatedvaccines are used for include: Hepatitis A and Polio
Subunit, recombinant, conjugate, and polysaccharide vaccines: Subunit,
recombinant, conjugate, and polysaccharide vaccines use particular parts of
the germ or virus. They can trigger very strong immune responses in the body
because they use a specific part of the germ. These types of vaccines are used to
create immunity against the following diseases: Hib (Hemophilus influenza type b),
Hepatitis B, Human papillomavirus (HPV), cough, pneumococcal disease.
Toxoid vaccines: Toxoid vaccines use toxins created by the bacteria or virus to
create immunity to the specific parts of the bacteria or virus that cause disease, and
not the entire bacteria or virus. The immune response is focused on this specific
toxin. Toxoid vaccines do not offer lifelong immunity and need to be topped up over
time. Toxoid vaccines are used to create immunity against diphtheria and tetanus.
Viral vector vaccines: Viral vector vaccines modify another virus and use it as a
vector to deliver protection from the intended virus. Some of the viruses used as
vectors include adenovirus, influenza, measles virus and vesicular stomatitis virus
(VSV).
The Expanded Program on Immunization (EPI) plans to vaccinate children aged
0 to 15months, against: Tuberculosis, polio, diphtheria, Tetanus, Pertussis/
whooping cough, Hepatitis B, infections with haemophilus influenza type B,
pneumonia, measles, rubella and rotavirus infections.
The booster of measles vaccine is given at 15 months, but also 12-year-old
adolescent girls receive vaccine against human papillomavirus and tetanus vaccine
for pregnant women or women of childbearing age and the child also receives themosquito net impregnated during vaccination of MR at the age of 9 months.
Self-assessment 5.9
1. Explain types of immunity?
2. At what age of vaccination among children is extended?3. What are the vaccinated diseases among children in Rwanda?
5.10 National expanded program of immunisation vaccine
Learning activity 5.10
The overall goal of the national EPI is to contribute to the improved well-being of
the Rwandan people through reduction of child morbidity and mortality through
vaccination of preventable diseases. Vaccination program to children in Rwanda
is comprised of three principal components: routine vaccination, supplementalimmunization activities, and surveillance for target diseases.
Table 5.2; Immunization schedule
NB: - It is necessary to respect the minimum interval of 28 days between 2 doses
of vaccines with multiples doses (DTP-HepB-Hib, OPV, Pneumo and Vaccine
Rotavirus).
It is strictly forbidden to administer another multi-dose vaccine before 28 days even
if the vaccination date coincides with weekends or public holidays.
For the HPV vaccine, 12-year-old adolescent girls should not receive the second
dose before 6 months from the first dose.
In Rwanda, the school approach has been chosen as the basic approach for
administering this vaccine, but 12-year-old girls who are out of school and those
who have not been privileged enough to receive the vaccine should benefit from itat the health facility.
Vaccination for special cases: child who has never been in contact with thevaccination service
Table 5.3: immunization schedule for special cases
NB: Systematically check the BCG scar in the child who presents for vaccination at
14 weeks, if no scar revaccinate.
For the premature baby, it is necessary to start the vaccination calendar right out ofthe neonatology service.
Self-assessment 5.10
1. State the vaccines given at 6weeks
2. Explain how to administer BCG?3. Explain how to administer MR vaccine at 9months and 15 months.
5.11 Behaviour change communication and socialmobilization
Learning activity 5.11
Communication of the key messages about immunization to a group
The community has a big role to play in making the decision to vaccinate the target
population.
An example of messages to pass on to parents during an immunization
session:
Every child needs to be protected against some vaccine-preventable diseases. Here
are the diseases that can be prevented by vaccination: Tuberculosis, Diphtheria,
Tetanus, Pertussis, Poliomyelitis, Measles, Rubella, Hepatitis B, a large proportion
of pneumonia, meningitis, severe diarrhoea with dehydration caused by rotavirus,etc
The tetanus toxoid vaccine (VAT) for the pregnant woman protects the unborn baby.
Her mother needs two doses in the first pregnancy within 28 days, 6 months later
a third dose (VAT3), a year later a fourth dose (VAT4) and finally a year later a fifth
dose (VAT5). A mother, who has already received 5 doses of TT with the minimum
required interval between doses, is protected against tetanus for the rest of her
reproductive life and, as a result, will protect all the children who will be born from
her during the first month of their life against tetanus.
The immunization card is a very important tool for monitoring the health of the
child; it must be kept carefully and always present whenever the child reports to the
health worker.
4. Choose a method of communication that attracts the interest of the group:
storytelling, sketch, riddle, song, questions / answers, demonstration
5. Involve the group and Encourage parents to ask questions
• Against which disease is the child being vaccinated today?
• What are the possible side effects and how to do if they occur?
• What is the date of the next appointment?
• The need for the mother to keep the vaccination card
• Need to complete vaccination series
• How old is the child? (Check the date of birth of the child to determine if
the child is eligible for the rotavirus vaccine)
• I am giving your child vaccines: (quote them)
• They will help your child stay healthy
• The child may have fever and pain at the injection site. If the fever exceeds
two days, bring the child back to the nearest community health worker or
health facility.
• For measles, fever with a slight popular rash may appear within 6 to 12
days.
• For BCG, a small ulceration may develop followed by a scar and this in 1
to 2 months. If no scar within 3 months, bring the child back to revaccinate.
• Small health problems related to vaccination are much less serious than
if your child did not receive these vaccines.
• Bring your child back at 15 months old for reminder of measles vaccine.
• The need for the mother to keep the vaccination card.
1. Social mobilization
Social mobilization is the process of bringing together all possible inter-sectoral
partners and allies to participate in development programmes. It builds on the
contribution of technical experts, and emphasizes the capabilities and roles ofsocial allies and partners including community members. Social mobilisation aims
at empowering individuals and communities to identify their needs, their rights,
and their responsibilities, change their ideas and beliefs and organize the human,
material, financial and other resources required for socioeconomic development.
To lead a good social mobilization, the following factors are decisive:
• Obtain in due time a commitment from the politico-administrative
authorities (Cell and sector managers, mayors, ...)
• Solicit the participation of religious and community leaders (eg health
leaders, local elected officials ...). They usually know where, when, and
how to reach the population.
• Consider associations (Umugoroba w’ababyeyi, umuganda, Amarerero
(ECD), different clubs, etc.). They constitute a considerable resource on
knowledge of the local situation, and other diverse skills.
• Involve CHWs in the transmission of immunization messages at the
monthly meeting with CHWs and home visits.
• Make sure there is consistency in the contents of the messages.
Strategies to trace dropouts:
• Identify drop-outs and localise them in folders or vaccination register.
• Communicate the names of identified children to the community health worker
within their radius of action
• The community health worker, during home visits, retrieves these children
and brings them to the health center for immunization
• During the same visit, the community health worker registers newborns and
educates their mothers about their vaccination
• When monitoring children’s growth at the community level, the ASC should
check the immunization status of children and remind parents to respect
future appointments.
• Apply the vaccination policy to any contact : In case the mother brings her
child to the health center, ask him for a vaccination form, if the card is missing,
his mother receives an individual educational talk and vaccinate the child if
necessary or fix an appointement.
Preparation of the equipment for vaccination
i) Injection equipment and vaccines
• 5 ml syringes and needles to reconstitute RR vaccines
• 2 ml syringes and needles to reconstitute BCG.
• 0.5 ml auto-disable syringes for administration of DTP-HepB / Hib, RR,
vaccines, Pneumococcal-vaccine (PCV-13), Inactivated Polio Vaccine
(IPV), HPV and VAT vaccines• 0.05ml BCG syringes
• The droppers for the polio vaccine and the rotarix vaccine if the dropper is
not incorporated in the bottle)
• Safety boxes (receptacles) and trash
• Cotton or gauze
• Prepare vaccines according to the expected target per session
• Clean water to clean the vaccine injection site (Never use alcohol or
disinfectants)
• Ice packs
• Vaccine carrier
• Freeze -Tags for monitoring the quality of vaccines
ii) Management tools and IEC materials
• Vaccination card (children, teenage girls aged 12 and pregnant women)
• Immunization registry for immunization of children, teenage girls aged 12
and pregnant women
• Calendar to determine dates of appointments (RDV)
• Scorecards for vaccination
• IEC message books
• Posters and brochures
iii)Other materials
• Tables, Chairs, Benches, Baby Scales, Panties, Height, MUAC, Scissors,
Kidney Basins, Pens, DVD and Television.
Stapes of a vaccination session
• Home
• Registration and Sorting
• Growth monitoring
• Group IEC
• Vaccination
To maintain the required temperature during the immunisation session :
• Open the vaccine carrier and place the vaccines on the clean table Vaccine
vials should never be placed on frozen ice packs during the immunization
session because some non-freezable vaccines may be frozen;
• Frozen accumulators must be thawed (packaged) before putting them in
vaccine carriers for vaccine transport
• Avoid taking the ice packs out of the vaccine carrier during the immunization
session; this may increase the temperature inside the vaccine carrier and
thus expose the vaccines to temperatures above + 8 ° C.• Always keep the vaccine carrier in the shade and closed
Recommendations:
• When DTP-HepB-Hib, PCV-13, Rotarix and tetanus (VAT) vaccines are
kept at too low temperatures (ie below 0 ° C where they freeze), they can
no longer be considered as effective. They are damaged and must be
thrown away.
• Do not place hot accumulators next to the vaccines.
• Do not load multiple syringes with vaccines in advance before
administration.Self-assessment 5.11
1. State at least four strategies to trace dropout
2. List materials needed during vaccination session
3. When DTP-HepB-Hib, PCV-13, Rotarix and tetanus (VAT) vaccines are
kept at too low temperatures (below 0 ° C where they freeze), what will
happen and what to do?
5.12 Vaccination cold chain
Learning activity 5.12Observe the images below and reflect on it.
Cold chain is system for storing and transporting vaccines in a potent state (within
an acceptable temperature range) from the manufacturer to users.
The cold chain is the system used for keeping and distributing vaccines in good
conditions. It takes a chain of precisely coordinated events in temperature-controlled
environments to store, manage and transport these life-saving products.
Vaccines must be continuously stored in a limited temperature range from the
time they are manufactured until the moment of vaccination. This is because
temperatures that are too high or too low can cause the vaccine to lose its potency
(its ability to protect against disease). Once a vaccine loses its potency, it cannot
be regained or restored.
The cold chain guidelines recommend the following: the vaccine storage
should be maintained in the temperature range of 2–8°C, the use of
minimum/maximum thermometers, temperature charts, and the shake test.
The cold chain consists of a series of storage and transport links, all designed to
keep vaccines within an acceptable range until it reaches the user.Vaccines are sensitive to heat and freezing and must be kept at the correct
temperature from the time they are manufactured until they are used.
The cold chain equipment
Different levels within the health care system need different equipment for
transporting and storing vaccines and diluents at the correct temperature.
• Primary vaccine stores: need cold or freezers rooms, freezers, refrigerators,
cold boxes and sometimes refrigerator trucks for transportation.
• Intermediate vaccine stores: depending on their size and capacity need cold
and freezer rooms, and/or freezers, refrigerators and cold boxes.
• Health facilities: need refrigerators with freezing compartments, cold boxes
and vaccine carriers.
Cold chain monitoring equipment
The purpose of cold chain monitoring equipment is to keep track of the temperature
to which vaccines and diluents are exposed during transportation and storage
The different monitors are: Vaccine vial monitors, Vaccine cold chain monitor
card, Thermometers and Freeze indicator
Vaccine Cold Chain Monitor Card
A vaccine cold chain monitor is a card with an indicator strip that changes the
colour when the vaccines are exposed to temperatures too high. The vaccine cold
chain card is used to estimate the length of time that vaccine has been exposed
to high temperatures. Manufacturers pack these monitors with vaccines supplied
by WHO and UNICEF.Usually used for large shipments of vaccines. Same card
should remain with same batch.
Maintaining cold boxes and vaccine carriers
Must be dried after their use. If left wet with closed lids, they become moldy and the
seal will be affected. Store them with the lid open when not used, if possible. Don’t
store them outside under the sunlight, it can cause cracks and reduce the efficiency
of the cold box.
WARNING:
• Never shake the bulbs (not to heat them),
• Never exceed the amount of solvent recommended for dilution of the vaccine
• Regularly use solvents from vaccines of the same manufacturer and same
period
• Avoid freezing vaccine diluents At the service delivery level, diluents should
be kept in refrigerators
• The dilution syringe and the dropper must be used for each vial.
• Use clean water when cleaning the vaccine injection site.
• Do not use the cold accumulators on the table during the immunization
session; they stay at the vaccine doors to keep the correct temperature.
• Read the expiry date of the vaccine on the vial.
• If the date is exceeded, discard the bottle. Similarly, if the label has fallen and
is not found, discard the bottle;
• For liquid vaccines: OPV, IPV, VAT, DTP-HepB-Hib, Pneumo, Rotavirus
Vaccine and HPV; It must be reassured that vaccines are not frozen beforeadministering them.
Administration of the vaccine:
To avoid suffocation, do not direct the vaccine to the bottom of the mouth (to the
throat); rather direct the vaccine to the cheeks (lateral of the mouth).This vaccine
should be administered orally to children aged 6-14 weeks for the 1st dose and
children 24 weeks or less for the remaining two doses with a minimum interval of 4
weeks between doses.
Caution: If, for some reason, an incomplete dose is administered (for example, the
child has spat or regurgitated part of the vaccine), replacement of the dose is not
indicated. The childSelf-assessment 5.12
1. List the different monitors used in cold chain monitoring
2. Use true or false
If, for some reason an incomplete dose is administered
(for example, the child has spat or regurgitated part of the vaccine).
a) Replacement of the dose is indicated.
b) replacement of the dose is not indicated.
c) Replace the dose next month.
d) Replace the dose after 1week.
3. The child who comes for vaccination suffering from …. Does not receive
oral vaccines.
a) Malaria
b) Headache
c) Diarrhoea
d) cough
who comes to the session suffering from diarrhea does not receive oral vaccines.End Unit assessment 5
Multiple choice questions
1. Which statement defines Primary prevention?
a. Refers to the actions aimed for early detection and treatment of the
disease.
b. Refers to actions aimed at reducing the incidence of diseases in children
c. Simply means immunisation.
d. Refers to the actions aimed at sensitisation.
2. Which of the following statements that define (s) the immunization circle?
a. Refers to the process of becoming immune to the disease.
b. Refers to the process of getting vaccination.
c. Refers to the process of both getting the vaccine and becoming immune to
the disease following vaccination.
d. Refers to the action of vaccinating the population.
3. The increase in size, length, height and weight refers to one of the
following term.
a. Development
b. Growth
c. Cognitive milestone
d. Communication milestone
4. The improvement in the body functioning and behaviour refers also to one
of the following elements.
a. Development
b. Growth
c. Cognitive milestone
d. Communication milestone
5. One of the following principle refers to the fact that development (as well
as growth) always proceeds direc¬tionally from head to foot.
a. Integration
b. Individual difference
c. Interrelationd. Cephalo-caudal
6. Choose the correct features that are associated with many genetic
syndromes that may cause mental retardation or learning disabilities. a)
Congenital anomalies
a. Congenital anomalies
b. Head circumference
c. Dermal Lesions of neuro-cutaneous Syndromes
d. Muscle tone problems
7. The Expanded Program on immunization (EPI) plans to vaccinate children
aged 0 to 15 months, against the following diseases except:
a. Tuberculosis
b. Polio,
c. Diabetes mellitus
d. Tetanus
8. One of these types of immunity results when exposure to a disease
organism triggers the immune system to produce antibodies to that
disease and this can be acquired through natural immunity or vaccineinduced immunity.
a. Passive immunity
b. Active Immunity
c. Innate immunity
d. Immunodeficiency
9. One of these types of immunity is provided when a person is given
antibodies to a disease rather than producing them through his or her
own immune system.
a. Passive immunity
b. Active Immunity
c. Innate immunity
d. Immunodeficiency
10. These are the preventive measures used to prevent the childhood
illnesses except:
a. Getting the vaccinations
b. Washing the hands regularly
c. Eat healthy and exercise regularly
d. Receiving the medication due to the disease that the child is suffering from.SECTION B: SHORT ANSWER QUESTIONS AND TRUE OR FALSE
11. The combined vaccine against diphtheria, tetanus and pertussis
(whooping cough) and the vaccine against poliomyelitis cause sudden
infant death syndrome.
12. Vaccines have several damaging and long-term side-effects that are yet
unknown. Vaccination can even be fatal.
13. Better hygiene and sanitation will make diseases disappear and vaccines
are not necessary.
14. It is better to be immunized through disease than through vaccines.
15. It is necessary to take children for vaccination as it is the most useful way
of preventing childhood illnesses.
SHORT ANSWER QUESTIONS
16. Explain how do vaccines work?
17. State at list 5 activities to trace dropout of immunisation.
GROWTH MONITORING CHART BY WHO
