NMCN Paediatric Nursing Exam: IMCI, EPI & SAM (2026)

NMCN Paediatric Nursing Exam Questions: IMCI, EPI, SAM and Child Health in Nigeria (2026)

If you are sitting the NMCN CBT — whether as a General Nursing candidate or a Post-Basic Paediatric Nursing student — paediatrics is one of the highest-yield sections you cannot afford to skip. For General Nursing candidates, child health topics appear in Paper III, alongside Community Health, Psychiatric Nursing and Research. For Post-Basic candidates, paediatric content runs through every paper. This guide breaks down the three areas most frequently tested in recent sittings: IMCI, the Expanded/National Programme on Immunisation (EPI/NPI), and Severe Acute Malnutrition (SAM) — all framed around Nigeria's specific child health context.

Why Child Health Is a High-Priority NMCN Topic

Nigeria's child health statistics are sobering, and the NMCN examiners know that qualified nurses must understand them. In 2024, Nigeria was one of only three countries in the world with an under-five mortality rate (U5MR) above 100 deaths per 1,000 live births. One in every five Nigerian children still dies before their fifth birthday, and approximately 70% of those deaths are attributed to a combination of six conditions: malaria, acute respiratory infections (especially pneumonia), diarrhoea, measles, malnutrition, and neonatal complications.

This epidemiology is not just background reading — it is directly testable. Questions in recent NMCN sittings have asked candidates to identify Nigeria's leading cause of under-five death (malaria, responsible for approximately 60% of outpatient visits and 30% of admissions), rank conditions by mortality burden, and link disease patterns to specific intervention programmes like IMCI.

The NMCN CBT is now 100% computer-based with no theory component. All 100 questions are objective. Knowing facts precisely — not just broadly — is what separates a pass from a failure.

IMCI: Integrated Management of Childhood Illness

What IMCI Is and Why Nigeria Adopted It

IMCI was developed by WHO and UNICEF in 1995 as a comprehensive clinical strategy targeting the top causes of under-five morbidity and mortality in low- and middle-income countries. Nigeria adopted IMCI in 1997. The approach shifts healthcare workers away from treating single diseases in isolation and towards an integrated, algorithmic assessment of the sick child.

IMCI trains first-level health workers — including nurses — to use simple signs, symptoms, and treatment protocols to identify, classify, treat, and refer sick children. It also promotes sound home and community management of childhood illness.

The Four Components of IMCI (Memorise These)

The NMCN has tested these components directly. IMCI comprises:

1. Improving case management skills of all healthcare staff
2. Improving overall health systems
3. Improving clinical healthcare capacity
4. Improving family and community health practices

IMCI General Danger Signs — High-Yield Exam Content

These four general danger signs must be memorised word-for-word:

• Convulsions
• Unable to drink or breastfeed
• Vomits everything
• Abnormally sleepy or difficult to awaken

Any child presenting with one or more general danger signs requires urgent referral (pink classification in the colour-coded system). The IMCI classification triage is:

IMCI Assessment Categories

IMCI assesses and classifies the child across these domains:

• Cough or difficult breathing → Severe pneumonia / Pneumonia / No pneumonia
• Diarrhoea → Severe dehydration / Some dehydration / No dehydration
• Fever → Severe febrile disease / Malaria / No malaria
• Ear problems
• Nutritional status and anaemia
• Immunisation status

IMCI in Nigeria: Implementation Challenges (Also Testable)

Despite adoption in 1997, national uptake remains low — fewer than 25% of first-level facilities in Nigeria have staff trained in IMCI. Studies in Southwest Nigeria found that while over half of paediatric nurses had fair IMCI knowledge, proper completion of the guidelines was limited. Barriers include lack of training, time constraints, and insufficient institutional support. These implementation realities have appeared in NMCN exam questions framed as community health nursing scenarios.

Exam tip: Nigeria's Community-based Management of Acute Malnutrition (CMAM) guidelines explicitly link SAM management with IMCI. Expect questions that test this connection.

EPI/NPI: Nigeria's Immunisation Programme

From EPI to NPI — The Naming History

The Expanded Programme on Immunisation (EPI) was launched by WHO in 1974, initially targeting six childhood killer diseases: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. Nigeria introduced EPI in 1978. In 1996, the programme was renamed the National Programme on Immunisation (NPI). Today, EPI itself has been rebranded as the Essential Programme on Immunisation to reflect its expanded scope.

Under the NPI, all vaccines are provided free to Nigerian children. This is a frequently tested fact.

Nigeria NPI Vaccine Schedule 2025/2026 — Must-Know for NMCN

This schedule is highly testable. Learn the vaccine, disease, route, site, and dose.

At Birth:

• BCG — Tuberculosis — Intradermal, left upper arm — 0.05 ml (given within first 48 hours; can be given up to 11 months)
• Hepatitis B Vaccine 1 (HBV-1) — Intramuscular, upper arm or outer thigh — 1 ml
• OPV0 — Oral — 2 drops (must be given before 2 weeks of age)

At 6 Weeks (repeated at 10 and 14 weeks):

• Pentavalent 1 (Diphtheria, Tetanus, Pertussis, Hepatitis B, Hib) — Intramuscular, left outer thigh — 0.5 ml
• PCV-1 (Pneumonia) — Intramuscular, left outer thigh — 0.5 ml
• OPV1 — Oral — 2 drops
• Rotavirus Vaccine 1 — Oral (protects against diarrhoeal disease; rotavirus is the commonest cause of diarrhoeal death in Nigeria)

At 9 Months:

• Measles Vaccine — Subcutaneous, left upper arm — 0.5 ml
• Yellow Fever Vaccine — Subcutaneous, right upper arm — 0.5 ml

At 12 Months:

• Meningococcal Conjugate Vaccine — Intramuscular, outer thigh — 0.5 ml
• PCV Booster — Intramuscular, outer thigh — 0.5 ml
• Vitamin A (200,000 IU) — Oral
• Shancol (Cholera vaccine) — Oral — 1.5 ml

At 13 Months:

• MMR (Measles, Mumps, Rubella) — Subcutaneous, outer thigh or upper arm — 0.5 ml

Cold Chain — An Emerging NMCN Exam Trend

Based on the March and May 2026 NMCN sittings, examiners have introduced a new category of questions on drug storage, cold chain management, and the Vaccine Vial Monitor (VVM). Candidates must understand:

• Recommended storage temperatures for each vaccine category
• How the VVM works and what a compromised VVM means for vaccine use
• The role of the nurse in maintaining cold chain integrity at facility level

NPI coverage in Nigeria remains critically low — a 2016/2017 national survey showed only 1 in 4 children received all recommended vaccines, and as of 2018, Nigeria accounted for approximately 4.3 million of the world's unvaccinated children. Expect questions on barriers to immunisation coverage, including religious and cultural factors.

SAM: Severe Acute Malnutrition in Nigerian Children

The Scale of the Problem

Nearly 5.4 million children aged 0–59 months in northwest and northeast Nigeria are currently suffering from acute malnutrition, including approximately 1.8 million cases of Severe Acute Malnutrition (SAM). Malnutrition is both a direct cause of death and a potentiating factor for the other leading killers — a malnourished child is significantly more vulnerable to malaria, pneumonia, and diarrhoea.

Classifying and Identifying SAM

SAM is diagnosed when a child meets any one of these criteria:

• Weight-for-height Z-score (WHZ) below −3 of the WHO median
• Mid-Upper Arm Circumference (MUAC) below 11.5 cm in children 6–59 months
• Presence of bilateral pitting oedema (kwashiorkor)

MUAC is a practical, nurse-administered tool and is heavily featured in NMCN questions. A MUAC of 11.5–12.5 cm indicates Moderate Acute Malnutrition (MAM); below 11.5 cm indicates SAM.

SAM Management: CMAM Framework

Nigeria uses the Community-based Management of Acute Malnutrition (CMAM) protocol, which classifies SAM management into two pathways:

• Inpatient care (Stabilisation Centre / SC): For SAM with medical complications — severe oedema, poor appetite, or clinical danger signs. The F-75 therapeutic milk is used in the stabilisation phase, transitioning to F-100 in the rehabilitation phase.
• Outpatient Therapeutic Programme (OTP): For SAM without medical complications. Children receive Ready-to-Use Therapeutic Food (RUTF) — Plumpy'Nut being the most common formulation — on a weekly or bi-weekly outpatient basis.

Know the appetite test: before a child with SAM is enrolled in OTP, the nurse must confirm the child can eat RUTF voluntarily. Failure of the appetite test = inpatient referral.

The F-75 vs F-100 distinction, RUTF dosing calculations (based on weight), and the 10 steps of SAM management (according to WHO/Nigeria guidelines) are all testable NMCN content. Weight-based calculation questions involving SAM have appeared in recent General Nursing papers, a trend that began in 2024 and has continued into 2026.

Frequently Asked Questions (FAQs)

1. Is paediatrics a major section in the NMCN General Nursing CBT?

Yes. Paediatrics is examined in Paper III alongside Community Health Nursing, Psychiatric Nursing, Research and Ethics. While it shares space with other subjects, child health topics — especially IMCI, immunisation, and nutrition — account for a significant proportion of Paper III questions. Post-Basic Paediatric Nursing candidates are examined even more extensively.

2. What are the four IMCI general danger signs I must memorise?

The four IMCI general danger signs are: (1) convulsions; (2) unable to drink or breastfeed; (3) vomits everything; and (4) abnormally sleepy or difficult to awaken. Any child with one or more of these signs requires urgent referral.

3. What is the difference between EPI and NPI in Nigeria?

EPI (Expanded Programme on Immunisation) is the WHO's global immunisation framework, introduced in 1974. Nigeria adopted it in 1978 and renamed its national version the National Programme on Immunisation (NPI) in 1996. Under the NPI, vaccines are provided free of charge to all Nigerian children.

4. What MUAC reading indicates SAM in a child aged 6–59 months?

A MUAC reading below 11.5 cm in a child aged 6–59 months indicates Severe Acute Malnutrition. A reading between 11.5 cm and 12.5 cm indicates Moderate Acute Malnutrition (MAM). These thresholds are commonly tested in NMCN CBT questions.

5. Are cold chain and vaccine storage questions now in the NMCN CBT?

Yes. Based on the March and May 2026 NMCN sittings, questions on cold chain management, vaccine storage temperatures, and the Vaccine Vial Monitor (VVM) have become a distinct exam category. Candidates should study these topics as part of their NPI/EPI preparation. Confirm the latest exam syllabus directly with the Nursing and Midwifery Council of Nigeria (NMCN) at nmcn.gov.ng.

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