Que. 1. How many under five deaths can be prevented by the exclusive breast feeding up to 6 months?

Ans. 1. 13% of the estimated under five deaths.

Que. 2. How many under five deaths can be prevented by the appropriate complementary feeding?

Ans. 2. 6% of the estimated under five deaths. 

Que. 3. What are the key reasons for undernutrition in early life?

Ans. 3. The Key reasons for undernutrition in early life are as follows – 

1)     Faulty and suboptimal infant and young child feeding problems

2)     Low birth weight

3)     Repeated episodes of diarrhea and ARI

Que. 4. Enumerate long term effects of stunting.

Ans. 4. Stunting is irreversible and it may leave residual long term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes.

Que. 5. At what age, does infant smile after looking at mother?

Ans. 5. 6-8 weeks.

Que. 6. At what age, does infant sit without support?

Ans. 6. 6-8 months. 

Que. 7. Which are the type of actions required for strengthening of Infant & Young Child Feeding (IYCF) interventions?

Ans. 7. The strengthening of IYCF interventions requires the following areas of action – 

1)     By ensuring implementation of IMS Act i.e. Infant Milk Substitutes, feeding bottles & Infant foods (Regulation of production, supply & distribution) Act 1992, and amendment Act 2003.

2)     By providing accurate information & skilled counselling to all women, family & community members.

3)     By providing support measures for sustained appropriate feeding through maternity protection.

Que. 8. What are the levels on that actions to promote infants and young child feeding have been grouped?

Ans. 8. Actions to promote infant and young child feeding have been grouped at the following three levels – 

1)     At health facilities

2)     During community outreach activities and

3)     During community and home based care

Que. 9. What is the package of services for IYCF counseling center?

Ans. 9. Package of services include – 

1)     Growth monitoring

2)     Communication and counselling on IYCF

3)     Information about services available through community outreach (e.g. Immunization)

4)     Provision of Vitamin A & IFA supplements for children older than 6 months, if not received in the outreach.

5)     In case child is born prematurely or LBW, one to one counseling session should be conducted with the mother/ care givers and request for follow up visits to the center. 

Que. 10. Where should ideally IYCF counseling centers be located?

Ans. 10. In the outpatient area in high case load facilities (DH/CHC).

Que. 11. Which are the MCH contact opportunities during community outreach?

Ans. 11. MCH contact opportunities during community outreach are as follows – 

1)     VHNDs

2)     RI sessions

3)     Biannual rounds

4)     IMNCI/Sick children consultation at community level

5)     Special campaigns (e.g. Breast feeding week)

6)     Any state specific initiative

Que. 12. How will you identify severe acute malnutrition (SAM)?

Ans. 12. SAM is identified by very low weight for height (below – 3Z scores of the median WHO growth standards), by mid upper arm circumference (MUAC) less than 11.5 cm or by the presence of bilateral pitting edema in children 6 to 59 months of age.

Que. 13. Who had developed Ready to Use Therapeutic Foods (RUTF)?

Ans. 13. Andre Briend & Nutriset (a private company) in 1990s.

Que. 14. What is the ready to use therapeutic foods (RUTF)?

Ans. 14. RUTF is a highly fortified oil-based paste made of peanuts, milk powder, oil, sugar and vitamin/mineral powder. It is equivalent in formulation to F-100 (Milk Formula recommended by WHO for the important treatment of SAM).

Que. 15. What do you mean by moderate acute malnutrition (MAM)?

Ans. 15. MAM is defined in children 6-59 months old as weight for height Z score < – 2 and > or equal to – 3 standard deviations of the WHO standards and/or MUAC < 12.5 cm & > or equal to 11.5 cm.

Que. 16. What do you mean by Chronic Malnutrition or Stunting?

Ans. 16. Chronic malnutrition, also known as stunting, is a form of growth failure which develops over a long period of time. Inadequate nutrition over long period of time (including poor maternal nutrition and poor infant and young child feeding practices) and/ or repeated infections can lead to stunting. In children, it can be identified using height for age nutritional index.

Que. 17. What do you mean by term acute malnutrition or wasting?

Ans. 17. Acute Malnutrition, also known as wasting, is characterized by rapid deterioration in nutritional status over a short period of time. In children, it can be identified by weight for height nutritional index or with mid upper arm circumference or by presence of bilateral pitting edema.

Que. 18. What is undernutrition?

Ans. 18. The outcome of insufficient food intake and/or inadequate absorption of nutrients, inadequate feeding and care and infectious diseases.

Que. 19. What do you mean by term underweight?

Ans. 19. A composite form of undernutrition that includes elements of both wasting and stunting or a combination of both. In children, it can be identified using the weight for age nutritional index.

Que. 20. What do you mean by Community based management of acute malnutrition (CMAM)?

Ans. 20. An approach that includes community engagement and mobilization for early detection and referral of cases of acute malnutrition: outpatient management of SAM for children 6-59 months without medical complications; inpatient management of SAM for children 6-59 months with medical complications and in some cases management of MAM for children 6-59 months.

Que. 21. What is REACH initiative?

Ans. 21. Renewed Efforts against Child Hunger and Undernutrition (REACH) initiative is a country led approach to scaled up effective interventions through coordinated action of UN agencies, civil society, donors and the private sector, under the leadership of national governments.

Que. 22. What do you mean by term prevalence of SAM?

Ans. 22. It is proportion of children 6 – 59 months with SAM in a population at a given point in time.

Que. 23. What is the integrated management of SAM?

Ans. 23. Integrated management of SAM is – 

1)     One of the basic health services to which a child has assess.

2)     Embedded into a broader set of nutrition activities (IYCF, micronutrient supplementation etc.)

3)     Integrated within a multi-sectoral approach to tackling the determinants of undernutrition. 

Que. 24. What do you mean by term incidence of SAM?

Ans. 24. It is the occurrence of new cases of children 6-59 months with SAM in a population over a specified time period.

Que. 25. What is the burden of SAM?

Ans. 25. It is the number of children 6-59 months with SAM present in a population at a certain time or over a period of time, based on prevalence and incidence.

Que. 26. What do you mean by the target of the SAM?

Ans. 26. It is the number of the children 6-59 months with SAM that a program expects to treat based on potential case load and a coverage objective (geographical & treatment).

Que. 27. How will you calculate national burden of the SAM?

Ans. 27. National burden = Sum of regional (provincial) burdens.

Que. 28. How will you estimate the target of SAM children in a given area?

Ans. 28. Target = Population 6-59 months in geographical Area* Prevalence* 2.6* Treatment Coverage (%)

Que. 29. What do you mean by geographical coverage in SAM management program?

Ans. 29. Geographical Coverage = Health facilities delivering CMAM services / Total health facilities.

Que. 30. What do you mean by Treatment Coverage in SAM programming?

Ans. 30. Treatment Coverage = Cases admitted within a given period / Burden for the same period.

Que. 31. How will you calculate National treatment coverage in SAM programming?

Ans. 31. National treatment coverage = New admissions/ National burden.

Que. 32. How will you assess Program Implementation Progress in SAM programming?

Ans. 32. Program implementation progress = Admissions/ Target case load.

Que. 33. What is Semi – quantitative evaluation of access & Coverage (SQUEAC)?

Ans. 33. SQUEAC is a semi-quantitative method that provides in depth analysis of barriers and boosters to coverage.

Que. 34. What is the target of Poshan Abhiyaan regarding stunting & undernutrition in the 0-6 years’ age children?

Ans. 34. To prevent and reduce stunting and undernutrition by 2% per year amongst 0-6 years’ age children.

Que. 35. What is the target of Poshan Abhiyaan regarding anemia reduction in young children (6-59 months)?

Ans. 35. To reduce the prevalence of anemia by 3% per year.  

Que. 36. What are the other effects of undernutrition on children apart from mortality susceptibility?

Ans. 36. The other effects of undernutrition in children are as follows – 

1)     Irreversible hindrance to children’s cognitive development and physical growth.

2)     Increased susceptibility to childhood infections 

Que. 37. At what age, does child speak short sentences?

Ans. 37. 24 months. 

Que. 38. How will you define adequate diet in a 6-24-month child?

Ans. 38. It is defined as a child fed either breastmilk or source of dairy; and age-appropriate number of food groups and age appropriate number of meals per day.

Que. 39. Which are the barriers observed in practice of IYCF?

Ans. 39. The barriers observed are as follows – 

1)     Poor awareness on feeding practices

2)     Inadequate knowledge on timing and quality of complementary feeding.

Que. 40. What is the median duration of exclusive breastfeeding in boys and girls?

Ans. 40. For boys – 3 months; for girls – 2.8 months. 

Que. 41. Which is the important risk factor for undernutrition & sickness during first 2 years of child’s life?

Ans. 41. Lack of breastfeeding or faltering of exclusive breastfeeding from age of 3 months onwards.

Que. 42. What is the utility of growth charts?

Ans. 42. Based on growth charts, underweight children will be identified and taken up for further management.

Que. 43. What do you mean by growth chart?

Ans. 43. The growth chart is a visible display of the child’s physical growth & development.

Que. 44. What are the important child health problems?

Ans. 44. Important child health problems are as follows – 

1)     Low birth Weight/ Pre maturity

2)     Malnutrition

3)     Infections & Parasitosis

4)     Accidents & poisoning

5)     Behavioral problems  

Que. 45. How will you assess behavioral development of a child?

Ans. 45. It can be assessed by – 

1)     Motor development

2)     Personal-social development

3)     Adaptive development

4)     Language development.

Que. 46. Which period in child’s life is critical & regarded as a window of opportunity for survival & development?

Ans. 46. First 1000 days of child’s life.

Que. 47. What should be the characteristics of optimal complementary feeding?

Ans. 47. Should be timely, appropriate, adequate & safe.

Que. 48. Which is the most important cause of under-5 mortality?

Ans. 48. Undernutrition.

Que. 49. What are the general danger signs for children 2 months to 5 years?

Ans. 49.  The general danger signs for children 2 months to 5 years are given below – 

1)     The child is not able to drink or breastfeed

2)     The child vomits every thing 

3)     The child has had convulsions

4)     The child is lethargic or unconscious

Que. 50. Which are the two most common bacteria causing pneumonia in children?

Ans. 50. Streptococcus pneumoniae & Haemophilus influenza.

Que. 51. On which grounds, a child with cough or difficult breathing is assessed?

Ans. 51. A child with cough or difficult breathing is assessed for – 

1)     How long the child has had cough or difficult breathing.

2)     Fast breathing

3)     Chest in drawing

4)     Stridor in a calm child

5)     Spo2

Que. 52. When will you say that child has fast breathing?

Ans. 52. If on breath count,

In a child 2 months – 1 year —– 50 breaths/minute or more

In a child > 1 year – 5 years —— 40 breaths/minute or more

Que. 53. What is a stridor and what does cause it?

Ans. 53. Stridor is a harsh noise heard when the child breaths in. Stridor occurs when there is a swelling of the larynx, trachea or epiglottis. This swelling interferes with air entering the lungs.

Que. 54. Which are the three possible classifications for a child with cough or difficult breathing?

Ans. 54. The three possible classifications are as follows – 

1)     Severe pneumonia or very severe disease

2)     Pneumonia

3)     No pneumonia: Cough or cold

Que. 55. What are the signs of severe pneumonia?

Ans. 55. The signs of severe pneumonia are as follows – 

1)     Any general danger sign or

2)     Stridor in calm child or

3)     Spo2 < 90%

Que. 56. Enumerate most important sign of pneumonia.

Ans. 56. Fast Breathing or chest indrawing.

Que. 57. What is the prescribed treatment of severe pneumonia in children under IMNCI?

Ans. 57. The prescribed treatment for field workers is – 

1)     Give first dose of injectable ampicillin & gentamycin

2)     Urgently refer to hospital near by

3)     Provide oxygen to all children on the way to hospital

4)     If wheezing, give an inhaled bronchodilator before transfer.

Que. 58. What is the treatment of pneumonia in children under IMNCI?

Ans. 58. The treatment of pneumonia is – 

1)     Give Amoxycillin for 5 days.

2)     If wheezing, give an inhaled bronchodilator for 5 days

3)     Soothe the throat & relieve the cough with safe remedy if child is 6 month or older.

4)     Follow up after 2 days.

Que. 59. What do you mean by Diarrhoea?

Ans. 59. Diarrhoea is passage of frequent loose or watery stool. It is defined as passage of 3 or more loose or watery stools in a 24 hours period.

Que. 60. What are the types of diarrhoea?

Ans. 60. Types of diarrhoea are as follows – 

1)     ACUTE DIARRHOEA – If an episode of diarrhoea lasts less than 14 days.

2)     PERSISTANT DIARRHOEA – If the diarrhoea lasts 14 days or more.

3)     DYSENTERY – Diarrhoea with blood in stool, with or without mucus.

Que. 61. On what parameters, a child with diarrhoea is assessed for?

Ans. 61. A child with diarrhoea is assessed for – 

1)     How long the child has had diarrhoea.

2)     Blood in the stool to determine if the child has dysentery and

3)     Signs of dehydration

Que. 62. Which are the possible classifications of dehydration in a child with diarrhoea?

Ans. 62. The possible classifications of dehydration are as follows – 

1)     Severe Dehydration

2)     Some Dehydration

3)     No Dehydration

Que. 63. Which are the clinical features suggesting severe dehydration in a child with diarrhoea?

Ans. 63. If two of the following signs are present, a child can be classified having severe dehydration – 

1)     Lethargic or unconscious

2)     Sunken eyes 

3)     Not able to drink or drinking poorly

4)     Skin pinch goes back very slowly.

Que. 64. Which are the clinical features suggesting some dehydration in a child with diarrhoea?

Ans. 64. If two of the following signs are present, a child can be classified having some dehydration – 

1)     Restless or irritable

2)     Sunken eyes

3)     Drinks eagerly, thirsty

4)     Skin pinch goes back slowly

Que. 65. What is the treatment of children with some dehydration?

Ans. 65. The treatment of children with some dehydration – 

1)     ORS solution

2)     Fluid and food

3)     Daily dose of zinc supplement for 14 days

4)     Follow up after 5 days if not improving

Que. 66. What are the treatment options for children with no dehydration?

Ans. 66. A child who has no dehydration needs home treatment. The golden rules of home treatment are as follows – 

1)     Give extra fluids

2)     Continue feeding

3)     Give zinc supplement daily for 14 days

4)     Tell when to return

Que. 67. How will you classify persistent diarrhoea in a child?

Ans. 67. The persistent diarrhoea in a child can be classified as follows – 

1)     Severe persistent Diarrhoea – Dehydration present

2)     Persistent Diarrhoea – No Dehydration

Que. 68. What is the recommended treatment for persistent diarrhoea?

Ans. 68. The recommended treatment for persistent diarrhoea are as follows – 

1)     Advise the mother on feeding a child who has persistent diarrhea

2)     Give single dose of Vitamin A

3)     Give Zinc sulfate daily for 14 days

4)     Give multivitamins.

5)     Follow up in 5 days

Que. 69. What is the recommended treatment of dysentery in a child?

Ans. 69. The recommended treatment of dysentery in a child are as follows – 

1)     Treat the child’s dehydration

2)     Give cefixime for 5 days

3)     Give Zinc sulfate daily for 14 days

4)     Follow up in 2 days

Que. 70. At what age, does infant stand with support?

Ans. 70. 10-11 months.

Que. 71. At what age does child walk wide base?

Ans. 71. 12-14 months.

Que. 72. What kind of home-based fluids has to be given to a child during episodes of diarrhea?

Ans. 72. Home based fluids to be given to a child during diarrhea includes – 

1)     Rice water

2)     ORS

3)     Lassi

4)     Soup

5)     Daal water

6)     Nimbu pani

7)     Tea

8)     Water

9)     Curd

Que. 73. What are the steps of the ORS preparation?

Ans. 73. The steps of ORS preparation are given below – 

1)     Wash your hands with Soap & water

2)     Take a liter of clean drinking water in a clean container

3)     Take a packet of ORS and add all its contents in water

4)     Stir thoroughly so that powder is completely mixed

5)     Cover the vessel

Que. 74. When will you advise parents of a child with diarrhoea to consult nearest health center?

Ans. 74. Parents of a child with diarrhoea will be advised to consult nearest health center in following conditions – 

1)     Increase in frequency of diarrhoea and vomiting

2)     Child not taking anything orally

3)     Child is not active

4)     Child is having features of dehydration 

Que. 75. How diarrhoea can cause under nutrition and worsen milder forms of malnutrition?

Ans. 75. Diarrhoea can cause under nutrition and worsen milder forms of malnutrition as follows – 

1)     Impaired intestinal absorption causes loss of macro & micronutrients (e.g. Zinc) in diarrhea.

2)     Urinary loss of specific nutrients are increased e.g. Vitamin A

3)     There is increased catabolism due to infection

4)     Mothers often make a mistake of not feeding enough food to a child with diarrhea for some days after the child is better

5)     Doctors often do not give sufficient emphasis on the need for continued feeding during diarrhoea or to correct feeding practice when it was faulty prior to illness.

Que. 76. What is the dose of Zinc in treatment of diarrhoea?

Ans. 76. The dose of Zinc in treatment of diarrhoea is as follows – 

2 months to 6 months child ———– 10 mg/day of elemental zinc for 14 days

6 months & older child —————– 20 mg/day of elemental zinc for 14 days 

Que. 77. How much fluid (ORS & home based) should be given in addition to usual fluid intake in case of diarrhoea?

Ans. 77. Up to 2 years ———- 50-100 ml after each loose stool

               2 years or more ——- 100-200 ml after each loose stool 

Que. 78. At what age, does infant recognize mother?

Ans. 78. 4-5 months. 

Que. 79. At what age, is infant suspicious of strangers?

Ans. 79. 9-10 months. 

Que. 80. At what age, does infant speak his first word?

Ans. 80. 10-11 months.

Que. 81. What are the causes of high prevalence of Zinc deficiency?

Ans. 81. The causes of high prevalence of Zinc deficiency are as follows – 

1)     Poor intake of Zinc

2)     Poor absorption of zinc available in diet

3)     Excessive loss of zinc in stools in diarrhoea episodes

Que. 82. What are the benefits of Zinc in acute diarrhoea?

Ans. 82. Children who received zinc during acute diarrhoea had lower stool outputs, shorter duration of diarrhoea and fewer episodes of diarrhoea lasting more than seven days.

Que. 83. Why Zinc is to be given for a duration of 14 days?

Ans. 83. Because zinc not only treats diarrhoea episode but also helps to repair the damaged gut mucosa and enhance overall immune function and protects the child from developing pneumonia and diarrhoea in the next 2-3 months.

Que. 84. What are the effects of Zinc deficiency?

Ans. 84. The effects of Zinc deficiency are as follows –

1)     Growth slows down, child becomes malnourished.

2)     Increased risk of developing infections like diarrhoea & pneumonia

3)     Infections are likely to be more severe in children with Zinc deficiency

Que. 85. What are GOI (2007) guidelines for the management of diarrhoea?

Ans. 85. The GOI (2007) guidelines for the management of diarrhoea are as follows – 

1)     Treat dehydration with ORS or IV fluids

2)     Give Zinc tablets for 14 days

3)     Use antibiotics when appropriate (e.g. Cholera, Dysentery etc.)

4)     Do not give anti-diarrhoeal & other drugs

5)     Advise mother – 

1. a)     To give extra fluids to drink
2. b)     Continue feeding
3. c)     Recognition of danger signs to seek care immediately.

Que. 86. What is the cause of death in children with bacterial pneumonia?

Ans. 86. Hypoxia or sepsis.

Que. 87. Up to what percentage of episodes of diarrhoea become persistent in under 5 children?

Ans. 87. 20%.

Que. 88. Once ORS solution is prepared, how long it can be used?

Ans. 88. 24 hours.

Que. 89. What is the drawback of inadequately home prepared ORS?

Ans. 89. It may cause osmotic diarrhoea.

Que. 90. In India, which are the micro-organisms responsible for nearly half of the total diarrhoea episodes in children?

Ans. 90. Rotavirus & Enterotoxigenic E.coli.

Que. 91. What percentage of infants & children are admitted in the hospital due to rotavirus diarrhoea?

Ans. 91. 25%.

Que. 92. What is the advantage of intravenous ringer lactate with 5% dextrose in treatment of diarrhoea?

Ans. 92. In addition to dehydration, it corrects hypoglycemia.

Que. 93. What are the long-term effects of zinc supplementation for 14 days in children?

Ans. 93. 34% reduction in prevalence of diarrhoea & 26% reduction in prevalence of pneumonia.

Que. 94. Which are the independent domains converged and integrated across under Home Based care of Young child (HBYC)?

Ans. 94. The domains are – 

1)     Health

2)     Nutrition

3)     WASH

4)     Early Childhood development 

Que. 95. When does home visits by ASHA start under the Home Based Care of Young Child (HBYC)?

Ans. 95. Starts from 2-3 months of age of child and continuing in 2nd year till 15 months.  

Que. 96. What is the purpose of home visits by ASHA under HBYC?

Ans. 96. To plug the gap between health system contacts with family and provide platform to improve child nutrition, immunization, development, hygiene practices and reduce common childhood illnesses such as diarrhea and pneumonia.

Que. 97. What is the objective of HBYC?

Ans. 97. The objective of HBYC is to reduce child mortality and morbidity and improve nutrition status, growth and early childhood development of young child through structured, focused and effective home visits by ASHAs.  

Que. 98. What are the nutrition domain specific actions under HBYC?

Ans. 98. The nutrition domain specific actions are as follows – 

1)     Exclusive breastfeeding for 6 months

2)     Adequate complementary feeding from 6 months & continued breastfeeding up to 2 years of age

3)     Iron & Folic acid supplementation

4)     Promote use of fortified food.  

Que. 99. What are the health domain specific actions under HBYC?

Ans. 99. The health domain specific actions are as follows – 

1)     Full immunization for children 

2)     Regular growth monitoring

3)     Appropriate use of ORS during diarrhea episodes

4)     Early care seeking during sickness.  

Que. 100. What are other domain specific actions under HBYC other than health & nutrition?

Ans. 100. Other domain specific actions are as follows –

1)     Age-appropriate play & communication for children

2)     Appropriate Hand washing practices. 

Que. 101. What is the schedule of home visits by ASHA in coordination with AWW in HBYC?

Ans. 101. Starting from 3rd month and extending into 2nd year of life (Quarterly visits in 3,6,9,12 & 15 months).   

Que. 102. How much incentives will be paid to ASHA for 5 home visits to a child?

Ans. 102. Rs. 250/- for 5 visits is provisioned for ASHA.  

Que. 103. What are the functions of AWWs in HBYC?

Ans. 103. AWWs will continue to provide Take Home Ration and nutrition specific counseling to mothers. In addition, she will record weight of the young children and monitor growth & development using MCP cards as per guidelines.

Que. 104. What are the functions of ASHAs under HBYC?

Ans. 104. ASHAs will ensure exclusive & continued breastfeeding, adequate complementary feeding, age-appropriate immunization and early childhood developments.

Que. 105. How will the payment of ASHA be ensured?

Ans. 105. Payment to ASHA will be given after validating that age-appropriate vaccination is completed and recorded along with the weight in MCP cards.

It is also desirable that at least 10% home visits are duly verified by the ANM/ASHA facilitator after checking the record or documentation.

Que. 106. What do you mean by the term vaccines?

Ans. 106. Vaccines provide active immunity to the body by stimulating the immune system which produces antibodies against disease producing organisms.

Que. 107. When was the Universal Immunization Program (UIP) introduced in India?

Ans. 107. 1985.

Que. 108. When was Measles Vaccine added to National program on Immunization?

Ans. 108. 1985.

Que. 109. When was vitamin A supplementation introduced in India?

Ans. 109. 1990.

Que. 110. Why do we give BCG vaccine only on the left upper arm and measles-rubella vaccine only on right upper arm?

Ans. 110. BCG is given on the left upper arm and measles-rubella vaccine only on right upper arm to maintain uniformity and for helping surveyors in verifying the receipt of the vaccine. 

Que. 111. Why do we give 0.05ml dose of BCG to newborns (Below one month of age) instead of 0.1 ml?

Ans. 111. This is because the skin of the newborns is thin and an intradermal injection of 0.1 ml may break the skin or penetrate into the deeper tissues and cause abscess and enlarged axillary lymph nodes. 

Que. 112. What are the additional benefits of BCG Vaccine?

Ans. 112. BCG vaccine, apart from pulmonary tuberculosis, also protects the children against severe childhood TB e.g. TB meningitis & military TB. 

Que. 113. At what age does child run?

Ans. 113. 24 months. 

Que. 114. Till what age can a child be given JE vaccine?

Ans. 114. Till the age of 15 years. 

Que. 115. What should be the ideal interval between two prophylactic doses of vitamin A?

Ans. 115. 6 months.

Que. 116. How will you treat vitamin A deficiency in a child?

Ans. 116. By giving Vitamin A immediately 2 lakh IU on two successive days. Any child with corneal ulcer should receive this dose of vitamin A irrespective of vitamin A deficiency present or not.

Que. 117. What do you mean by Cold Chain?

Ans. 117. Cold Chain is a system of storing and transporting vaccines at recommended temperatures from the point of manufacture to the point of use. 

Que. 118. Within what period, reconstituted BCG & Measles-rubella vaccine should be used?

Ans. 118. Four hours. 

Que. 119. Within what period, reconstituted JE vaccine should be used?

Ans. 119. Two hours. Otherwise there is risk of contamination with Staphylococcus aureus leading to toxic shock syndrome. 

Que. 120. In BCG, Measles-rubella & JE vaccine, why there is risk of contamination with Staphylococcus aureus?

Ans. 120. Because these live vaccines do not contain preservatives.

Que. 121. What is a Vaccine Vial Monitor (VVM)?

Ans. 121. A vaccine vial monitor (VVM) is a label containing a heat sensitive material which is placed on a vaccine vial to register cumulative heat exposure over time. 

Que. 122. Name the vaccines who lose their potency if frozen.

Ans. 122. T series Vaccines (DPT, TT), Hepatitis B vaccines, PCV, Pentavalent & IPV.

Que. 123. How does freezing damage the vaccine?

Ans. 123. Freezing dissociates the antigen from the adjuvant alum thus interfering with the immunogenicity of the vaccine.

Que. 124. What are the cold chain equipment?

Ans. 124. Cold chain equipment, both electrical & non-electrical is used for storing vaccines and/or transporting them at appropriate temperatures.

Que. 125. What range of cabinet temperature is maintained by a deep freezer and an ice linked refrigerator (ILR)?

Ans. 125. Deep freezer ——– Cabinet temperature between – 15 degree to – 25 degree Celsius

                  ILR ——————— Cabinet temperature between + 2 degree to +8 degree Celsius.

Que. 126. What is the use of Ice linked Refrigerator at the PHC level?

Ans. 126. It is used to store all UIP vaccines at the PHC level.

Que. 127. How will you arrange vaccines top to bottom in an ILR?

Ans. 127. Top to bottom order is as follows – 

1)     Hepatitis B

2)     Pentavalent & PCV

3)     DPT, IPV

4)     TT

5)     Rotavirus vaccine

6)     BCG & JE

7)     Measles/MR

8)     OPV

Que. 128. What do you mean by Cold Boxes?

Ans. 128. Cold boxes are insulated boxes, used for transportation and emergency storage of vaccines & ice-packs.

Que. 129. What is the use of Vaccine Carriers in Immunization Programs?

Ans. 129. They are used for carrying vaccines (16-20 vials) & diluents from PHC to session sites.

Que. 130. How will you manage returned unused vaccines?

Ans. 130. Keep a box labeled RETURNED UNUSED in the ILR for all unused vaccines that can be used in subsequent sessions. Discard vaccines that have been returned unopened more than thrice. 

Que. 131. When will you call an ice-pack adequately conditioned?

Ans. 131. An ice pack is adequately conditioned as soon as beads of water cover its surface and the sound of water is heard on shaking it.

Que. 132. What do you mean by the Cold Chain sickness rate?

Ans. 132. Cold chain sickness rate is the proportion of cold chain equipment out of order at any point of time and should be kept to the minimum acceptable level of less than 2%. 

Que. 133. What do you mean by the downtime?

Ans. 133. Down time refers to the time between breakdown of equipment and its repair or the period for which an equipment remains out of service. 

Que. 134. What do you mean by response time?

Ans. 134. The response time is the period between sending information regarding breakdown to actual attending. 

Que. 135. At PHC, how many months stock of vaccine are stored?

Ans. 135. One month with 0.25 months buffer stock & 0.25 months lead time stock.  

Que. 136. At district level, how many months stock of vaccines are stored?

Ans. 136. Two months with 0.5 months buffer stock & 0.25 months lead time stock.  

Que. 137. What is buffer or safety stock?

Ans. 137. 25% of vaccines & 10% of syringes at PHC & district level.  

Que. 138. What is the purpose of keeping buffer stock?

Ans. 138. The buffer stock serves as a cushion or buffer against emergencies, major fluctuations in vaccine demands or unexpected transport delays.

Que. 139. How you can sort out the problems of stock out, inadequate or excess stock?

Ans. 139. By adopting minimum/maximum inventory control system.

Que. 140. What do you mean by term Lead Time?

Ans. 140. The lead time refers to the time between ordering of new stock and its receipt. 

Que. 141. What is the purpose of bundling?

Ans. 141. Bundling ensures that vaccines are always supplied with diluents, droppers, AD syringes and reconstitution syringes, in corresponding quantities, at each level of supply chain.

Que. 142. How will you calculate vaccine wastage rate?

Ans. 142. Vaccine wastage rate = 100 – Vaccine usage rate

                                                         = 100 – Doses administered/ doses issued * 100.

Que. 143. Mention FIVE RIGHTS to ensure quality vaccines and supplies.

Ans. 143. The FIVE RIGHTS are as follows – 

1)     The RIGHT goods

2)     In the Right quantities

3)     In the RIGHT quantities delivered

4)     To the RIGHT place

5)     At the RIGHT time

Que. 144. What do you mean by Pentavalent Vaccine?

Ans. 144. Pentavalent vaccine provides protection to a child against five life threatening diseases namely Diphtheria, Pertussis, Tetanus, Hepatitis B & Hemophilus influenza type b.

Que. 145. What are the risks related with unsafe injections?

Ans. 145. Blood borne diseases such as Hepatitis B, Hepatitis C & HIV/AIDS can be transmitted through unsafe injections practices and injection overuse.

Que. 146. Which was the first vaccine to be introduced in India?

Ans. 146. BCG vaccine in 1962.

Que. 147. When was Vaccine Vial Monitor (VVM) introduced on vaccines in UIP?

Ans. 147. 1997.

Que. 148. When was India & South East Asia region certified as polio free?

Ans. 148. 2014.

Que. 149. When was maternal & neonatal tetanus elimination achieved in India?

Ans. 149. 2015.

Que. 150. When was pentavalent vaccine expanded to all states in India?

Ans. 150. 2015.

Que. 151. When was rotavirus vaccine introduced in India?

Ans. 151. 2016.

Que. 152. When were MR & PCV vaccines introduced in India?

Ans. 152. 2017.

Que. 153. When was ANM authorized to use adrenaline in AEFI?

Ans. 153. 2017.

Que. 154. When was Mission Indradhanush was introduced by GoI?

Ans. 154. December 2014.

Que. 155. What is the purpose of Mission Indradhanush?

Ans. 155. The mission focuses on interventions to improve full immunization coverage for children in India from 65% in 2014 to at least 90% over the next 5 years through special catch up drive.

Que. 156. As per coverage evaluation survey (2009), what was the percentage of vaccination in India through public sector?

Ans. 156. 91%.

Que. 157. Which were the different sites in public sector responsible for vaccination of children?

Ans. 157. The different sites are as follows – 

1)     Fixed sites PHC/CHC/ Govt. Hospital ——— 37%

2)     Health Sub centers ——————————– 19%

3)     Outreach session held at AWC —————– 26%

4)     Outreach session at any place in village —— 9%   

Que. 158. Which are the objectives of UIP?

Ans. 158. The objectives of UIP are as follows – 

1)     Rapidly increase immunization coverage

2)     Improve the quality of services

3)     Establish a reliable cold chain system up to the health facility level

4)     Introduce a district wise system for monitoring of program

5)     Achieve self-sufficiency in vaccine production     

Que. 159. What do you mean by pipeline vaccines?

Ans. 159. Research on new vaccines continue across the world & these vaccines are called pipeline vaccines.

Que. 160. What is the goal of UIP?

Ans. 160. To provide every child and pregnant women protection from vaccine preventable diseases.

Que. 161. Which are the vaccines to be given to newborn at birth?

Ans. 161. OPV, Hepatitis B & BCG vaccines.

Que. 162. What do you mean by full immunization?

Ans. 162. Before age of 1 year, if a child has received 3 doses of OPV, 3 doses of rotavirus vaccine (Where applicable), 3 doses of pentavalent vaccine, 3 doses of fractional IPV, 3 doses of PCV (Where applicable), MR vaccine 1st dose, JE 1st dose (where applicable). 

Que. 163. What do you mean by complete immunization?

Ans. 163. Before age of 2 years, if a child has received full immunization at age 1 year plus MR vaccine 2nd dose, DPT booster, Polio booster & JE 2nd dose (where applicable). 

Que. 164. When should OPV1, OPV2 & OPV3 be given?

Ans. 164. At 6, 10 & 14 weeks.

Que. 165. When should rotavirus vaccine be given if applicable?

Ans. 165. 6, 10 & 14 weeks.

Que. 166. What is the dose of rotavirus vaccine?

Ans. 166. 5 drops orally/2.5 ml.

Que. 167. What is the schedule of administration of pneumococcal conjugate vaccine?

Ans. 167. At 6 & 14 weeks; booster at 9 completed months.

Que. 168. What is the dose of pneumococcal conjugate vaccine?

Ans. 168. 0.5 ml.

Que. 169. What is the route and site of administration of PCV?

Ans. 169. Intramuscular at antero-lateral aspect of right mid-thigh.

Que. 170. What is the site & route of administration of DPT boosters?

Ans. 170. DPT booster 1 —- Antero-lateral aspect of left mid-thigh, intramuscularly.

DPT booster 2 —————— Upper arm, intramuscularly

Que. 171. When should the OPV booster be given?

Ans. 171. 16-24 months of age.

Que. 172. What does the availability of updated and complete micro plan at a planning unit (Rural/Urban) signify?

Ans. 172. Preparedness of a unit and directly affects the quality of services provided.

Que. 173. What help does improving micro plan provide?

Ans. 173. The help provided by improving micro plan are as follows – 

1)     Define the area & population covered by each sub center

2)     Prevents/ reduces drop outs

3)     Prevents left outs

4)     Identifies a high risk area /high risk groups including nomadic population

5)     Increases the RI coverage

6)     Strengthen capacity to use data for action 

Que. 174. What are the key elements of the cold chain?

Ans. 174. The key elements of the cold chain are as follows – 

1)     Personnel – to manage vaccine storage and distribution (vaccine & cold chain handlers at each cold chain point)

2)     Equipment – to store and transport vaccine and monitor temperature

3)     Procedures – to ensure correct utilization of equipment and ensure vaccines are stored and transported safely.

Que. 175. What is the role of vaccine & cold chain handler?

Ans. 175. VCCH should be responsible for forecasting, indenting, receiving, storing & distribution of vaccines & logistics, maintain cold chain equipment and related records. 

Que. 176. What is the utility of large deep freezer (275-300 liters)?

Ans. 176. Preparation of ice packs & storage of IPV stock for 3 months.

Que. 177. What is the utility of small deep freezer (105-125 liters)?

Ans. 177. Preparation of ice packs.

Que. 178. What do you mean by hold over time?

Ans. 178. The time taken by the equipment to raise the inside cabinet temperature from its cut off temperature to maximum temperature limit of its recommended range e.g. in the case of ILR, if the temperature is 4-degree C, then the time taken to reach 8-degree C from 4-degree C will be holdover time for that ILR. 

Que. 179. What are the factors that affect holdover time of ILR?

Ans. 179. The factors that affect holdover time of ILR are as follows – 

1)     Ambient temperature – more the ambient temperature, less will be holdover time.

2)     Frequency of opening of lid and use of basket

3)     Quantity of vaccine kept inside with adequate space between the containers

4)     Condition of the pack lining the cold chain equipment 

Que. 180. What do you mean by ILR point or cold chain point?

Ans. 180. An ILR point or cold chain point (CCP) is located at a health facility (usually PHC/ UHC/ CHC) with an ice-lined refrigerator for storage of vaccines & a deep freezer for preparation of frozen ice packs.

Que. 181. What is the function of cold chain point?

Ans. 181. The function is to receive, store and further distribute vaccines, diluents & other logistics to another ILR point or directly to the session site.

Que. 182. What is a vaccine van?

Ans. 182. A vaccine van is an insulated van used for transporting of vaccines in bulk.

Que. 183. What are the uses of cold box?

Ans. 183. The uses of cold box are as follows – 

1)     Collect & transport large quantities of vaccines 

2)     Store vaccines for transfer up to 5 days

3)     Store vaccines in case of breakdown of ILR, as a contingency measure

4)     Also used for storing frozen ice packs. 

Que. 184. What is the volume/capacity of standard ice packs used for cold box & vaccine carrier in UIP?

Ans. 184. 0.4 liter.

Que. 185. Which are the most heat & light sensitive vaccines?

Ans. 185. BCG, Measles/MR & JE vaccines.

Que. 186. Which are the vaccines that fall under open-vial policy?

Ans. 186. Hepatitis B, OPV, DPT, Pentavalent, TT & IPV.

Que. 187. Which are the vaccines, not damaged by freezing?

Ans. 187. OPV, Measles/MR, BCG, Rota virus vaccine & JE.

Que. 188. Which are the vaccines, most sensitive to freezing?

Ans. 188. From most sensitive to least sensitive order –

Hepatitis B, PCV, Pentavalent, IPV, DPT & TT.

Que. 189. What do you mean by float assembly?

Ans. 189. A float assembly is a stock of spare ILR/DF units kept at district/ state headquarters for immediate replacement of defective units brought from cold chain points. 

Que. 190. Which are the stocks that should be available in float assembly to ensure timely replacement?

Ans. 190. – 5% of total ILR & DF installed in the district

–        20% of voltage stabilizer (1 KVA)

–        20% of stem alcohol thermometers  

Que. 191. What do you mean by Surveillance?

Ans. 191. It is data collection for action.

Que. 192. What is the maximum stock of vaccines allowed at PHC & district level?

Ans. 192. PHC level – 1.5 months, district level – for 2.75 months. 

Que. 193. What do you mean by Electronic Vaccine Intelligence Network (eVIN)?

Ans. 193. eVIN is India’s solution for ensuring effective management of the immunization supply chain. It answers 3 crucial questions for cold chain handlers – 

1)     Where are the vaccines?

2)     Are they available in adequate quantities?

3)     Are they being stored in appropriate conditions?   

Que. 194. Which are the vaccines that are not recommended for open vial policy?

Ans. 194. BCG, JE, Measles/MR & Rotavirus vaccines. 

Que. 195. How will you define Adverse Events following Immunization (AEFI)?

Ans. 195. AEFI is defined as any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the uses of vaccines. 

Que. 196. What is the cause specific categorization of AEFIs?

Ans. 196. The cause specific categorization of AEFIs are as follows – 

1)     Vaccine product related reaction

2)     Vaccine quality defect related reaction

3)     Immunization error related reaction

4)     Immunization anxiety related reaction

5)     Coincidental events.

Que. 197. Which are the 4 key messages to be given to caregivers?

Ans. 197. The 4 key messages to be given to caregivers are as follows – 

1)     What vaccine was given & what disease it prevents.

2)     What minor adverse events could occur and how to deal with them

3)     When & where to come for the next visit

4)     To keep the immunization card safe and to bring it along for the next visit

Que. 198. Which are the key elements of an effective surveillance system?

Ans. 198. The key elements of an effective surveillance system are as follows – 

1)     Detection & notification of disease conditions

2)     Investigation & confirmation of diagnosis

3)     Collection, analyses and interpretation of data

4)     Feedback and dissemination of results

5)     Prevention and control responses.  

Que. 199. What is the colour of light sensitive vaccine vials?

Ans. 199. Amber coloured.

Que. 200. When is generally RI micro-plan updated?

Ans. 200. Quarterly.

Que. 201. Which base line worker is equipped with anaphylactic kits?

Ans. 201. ANMs.

Que. 202. Why is BCG given only up to one year of age?

Ans. 202. Because most children acquire natural clinical/subclinical infection by that time.

Que. 203. Why is hepatitis B birth dose given within 24 hours of birth?

Ans. 203. If given within 24 hours of birth to newborn, can prevent perinatal transmission of hepatitis B.

Que. 204. How many prophylactic doses of vitamin A is given to a child till 5 years of age?

Ans. 204. 9 prophylactic doses.

Que. 205. How long one can use vitamin A bottle, once it is opened?

Ans. 205. 4 weeks after opening the bottle of vitamin A.

Que. 206. Where all vaccines are kept at PHC level?

Ans. 206. All vaccines are kept in the Ice lined refrigerator (ILR) for a month at temperature +2 to +8 degree Celsius.

Que. 207. What are the guidelines for cooling of diluents of vaccines?

Ans. 207. Diluents must be cooled for at least 24 hours before use to ensure that vaccines and diluents are at same temperature when being reconstituted.

Que. 208. Which test will you perform to find out whether vaccines are frozen or not?

Ans. 208. Shake test.

Que. 209. What will you do if you find a frozen vaccine?

Ans. 209. Discard the vaccine.

Que. 210. How many ice packs can be prepared by small deep freezer (140 liter) in 24 hours?

Ans. 210. 20-25 ice packs.

Que. 211. What inside temperature is maintained by a vaccine carrier with 4 ice-conditioned packs?

Ans. 211. +2 to +8 degree Celsius for 12 hours if not opened frequently.

Que. 212. What do you mean by alternate vaccine delivery (AVD) mechanism?

Ans. 212. It ensures delivery of vaccines & logistics to & return of unused vaccines from session site to PHC on the same day in the cold chain.

Que. 213. What is the temperature that stem or alcohol thermometer measure?

Ans. 213. -50 to +50 degree Celsius.

Que. 214. What is the use of stem or alcohol thermometer in UIP?

Ans. 214. To measure inside temperature of Ice Linked Refrigerators (ILRs) & deep freezers.

Que. 215. What is the recommended down time for plains and hilly areas?

Ans. 215. 2 weeks for plains & 3 weeks for hilly areas.

Que. 216. What is the recommended response time for plains and hilly areas?

Ans. 216. 48 hours for plains & 72 hours for hilly areas.

Que. 217. What is the preferred sequence for administration of vaccines to an infant at 6 weeks?

Ans. 217. The preferred sequence is as follows – 

1st to give – OPV (2 drops orally)

2nd to give – Rotavirus vaccine (5 drops/2.5 ml orally)

3rd to give – fIPV (0.1 ml, intradermally)

4th to give – PCV (0.5 ml, intramuscularly)

Lastly – Pentavalent vaccine (0.5 ml, intramuscularly).

Que. 218. In above sequence of vaccine administration why pentavalent vaccine is given in the last?

Ans. 218. Because it is painful.

Que. 219. Which vaccine should be given to a 7-month-old child who has not been vaccinated?

Ans. 219. BCG, OPV 1, RVV 1, fIPV 1, PCV 1 & Pentavalent vaccine 1.

Que. 220. A child is born at PHC, but OPV stock is unfortunately not available. Up to what time period one can give zero dose OPV to the newborn?

Ans. 220. 15 days.

Que. 221. Up to what time period, BCG vaccine may be given to infant if due to some reason not given at birth?

Ans. 221. Up to 1 year. 

Que. 222. At what angles intramuscular, subcutaneous & intradermal injections should be given?

Ans. 222. Intramuscular – 90 degree, subcutaneous – 45 degree & intradermal – 15 degree.

Que. 223. How will you assess conditioning of ice packs?

Ans. 223. By looking at beads of water over surface of ice packs or by shaking the ice packs to listen the sound of water.

Que. 224. What are the types of Vaccine Vial Monitor (VVM)?

Ans. 224. 4 types in use which are – VVM 2, VVM 7, VVM 14 & VVM 30.

VVM 30 – for high heat stability vaccines

VVM 14 – for medium heat stability vaccines

VVM 7 – for moderate heat stability vaccines

VVM 2 – for low heat stability vaccines

Que. 225. What do you mean by Shake test?

Ans. 225. The shake test checks whether T series (DPT, DT, TT or hepatitis B) vaccines have been frozen in the cold chain or not. Shake test is not applicable for IPV. Once the vaccine is frozen, it should be discarded.

Que. 226. Which vaccine vials should not be placed in direct contact with conditioned ice packs?

Ans. 226. DPT/TT/Td & hepatitis B vaccine vials.

Suggested Further Readings: 

1)     Government of India (GoI) Guidelines for Enhancing Optimal Infant & Young Child Feeding Practices; Ministry of Health & Family Welfare, GoI, 2013 

2)     K. Park; Park’s textbook of Preventive & Social Medicine, 26th edition, 2021

3)     Government of India; Immunization Handbook for Medical Officers, Ministry of Health & Family Welfare, GoI, 2010

4)     Government of India; Immunization Handbook for Medical Officers, Ministry of Health & Family Welfare, GoI, 2017

5)     Government of India; Home based care for young child (HBYC); operational guideline; MOHFW & MWCD, Government of India, April 2018

6)     Government of India; Anaemia Mukt Bharat Guidelines; Ministry of Health & Family Welfare, GoI, 2018

7)     Government of India; Revised Guidelines for Management of Diarrhea in children for Medical Officers & Health workers, Ministry of Health & Family Welfare, Government of India; August 2007

8)      Government of India; IMNCI Facilitator guide II for sick child, Ministry of Health & Family Welfare, Government of India.