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Referral and warning signs
When to refer
Referral not usually needed for routine catch-up, unless specific contraindications or adverse events occur.
Red flags
- Signs of a vaccine-preventable disease in an unimmunized/partially immunized child.
- Severe adverse reaction following immunization (AEFI).
Signs and symptoms
- Not applicable - This is a status check.
Risk factors
- Missed health facility contacts.
- Lack of access to services.
- Caregiver lack of awareness.
- Stock-outs of vaccines/supplements.
Diagnosis
Clinical assessment
Review the child's Health Card (Road to Health Card) or ask the caregiver about received immunizations, Vitamin A doses, and deworming tablets.
Investigations
- Check Child Health Card.
- Caregiver recall.
Diagnostic criteria
Compare the child's record/history against the National Immunization Schedule and recommendations for Vitamin A and deworming. - Classification: Immunization Not Up-to-Date OR Immunization Up-to-Date.
Management
Non-pharmacological management
- Counsel caregiver on the importance of completing the immunization schedule, Vitamin A, and deworming.
- Advise on the date for the next scheduled visit/dose.
Pharmacological treatment
- If Immunization Not Up-to-Date:
- - Give ALL missed vaccine doses during the current visit, according to the national schedule (See PED017 / Immunization chapter).
- - This includes sick children unless they are being referred urgently.
- Vitamin A Supplementation:
- - Check card/history. If not received in the last 6 months:
- - Give dose: Age 6-11m: 100,000 IU (Blue capsule); Age 12m-5y: 200,000 IU (Red capsule).
- - Also give Vitamin A with Measles diagnosis.
- Deworming:
- - Check card/history. If child >=1 year and not received in last 6 months:
- - Give dose: Age 12-23m: Albendazole 200mg single dose OR Mebendazole 500mg single dose.
- - Age >=2 years: Albendazole 400mg single dose OR Mebendazole 500mg single dose.
- If Immunization Up-to-Date: Praise caregiver. Advise when next dose is due.
Monitoring
Check status at every child health contact.
Complications
- Increased risk of vaccine-preventable diseases (measles, pneumonia, meningitis, polio, TB, etc.).
- Vitamin A deficiency -> Xerophthalmia, blindness, increased infection severity.
- Intestinal worm infestation -> Malnutrition, anaemia, impaired growth.
Prevention
- Strengthening routine immunization services.
- Health education on importance of schedule completion.
- Outreach services.
- Campaigns (e.g., Child Health Days).
Patient education
- Importance of each vaccine, Vitamin A, and deworming.
- The immunization schedule - when to return for next doses.
- Keeping the Child Health Card safe and bringing it to every visit.
- Mild side effects of vaccines and how to manage them (paracetamol for fever).
- Recognizing severe reactions needing urgent care.
Uganda-specific notes
Following the UNEPI schedule is crucial. Catch-up vaccination is encouraged at any contact. Vitamin A and deworming often given during Child Health Days or routine visits. Track status using the Child Health Card.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 17, Section 17.3.8
- Uganda Clinical Guidelines (UCG) 2023
Chapter 18 (Immunization)
- National Immunization Schedule, UNEPI/MOH Uganda
(Current schedule)
- IMCI Chart Booklet, MOH Uganda
(Immunization Check Algorithm)