Assessment of factors affecting vaccine cold chain management practice in public health institutions in east Gojam zone of Amhara region

Vaccine storage and stock management practices in Vihiga County, Kenya

Background

Effective vaccine management is crucial to maintain vaccine potency. To achieve this, elements, such as temperature management, stock management, infrastructure, cold chain equipment and waste management, need to be properly implemented. Therefore, this study was conducted to assess the vaccine storage and stock management practices in public health facilities within Vihiga County.

Methods

A descriptive cross-sectional design was used. Eighty-six public health facilities were selected and one staff involved in handling vaccines from each facility participated in the study. The study utilised survey questionnaires and observational checklists to collect data.

Results

All facilities visited use standard vaccine requisition forms for ordering and receiving vaccines and physical stock counts are done in all facilities. The majority of immunising healthcare workers knew how to condition icepacks 88.4%; however, 57.0% did not know all the heat-, cold- and light-sensitive vaccines. Status of vaccine equipment, knowledge of healthcare workers and stock management practices were positively associated with vaccine cold chain management at 52.8%.

Conclusion

Knowledge of vaccine handlers and stock management practices should be improved to enhance effective vaccine management. Besides, there is a need for the County Government of Vihiga to purchase sufficient WHO-recommended refrigerators.

Health professionals' knowledge on vaccine cold chain management and associated factors in Ethiopia: Systematic review and meta-analysis

BACKGROUND

Vaccines are playing a great role in prevention of many infectious diseases worldwide. Health professionals' knowledge towards vaccine cold chain management is an essential element of maintaining vaccine's potency at shelf and during transportation. Studies on health professionals' knowledge on vaccine cold chain management system and associated factors in Ethiopia have inconclusive findings. This systematic review and meta-analysis is aimed to produce the overall level of health professionals' knowledge on vaccine cold chain management system and to identify its associated factors in Ethiopia.

METHODS

Systematic review and meta-analysis was conducted on health professionals' knowledge on vaccine cold chain management in Ethiopia. It is registered under PROSPERO website with registration number CRD42023391627. Literature search was made on international data bases using medical subject heading and key words. Data were extracted using Microsoft excel and imported to STATA version 17 for analysis. Heterogeneity was checked using Cochrane Q test and I2 statistics. Weighted Inverse variance random effect model was used to estimate the pooled level of health professionals' knowledge on vaccine cold chain management. Publication bias was checked using funnel plot and using Egger's test.

RESULTS

A total of nine studies were included in the review. The pooled health professionals' good knowledge on vaccine cold chain management in Ethiopia is 49.92% with 95% CI (48.06-51.79). Having five years or more experience AOR 2.27 95% CI (1.72-2.99), being nurse AOR 3.03 95% CI (1.47-6.27), received on job training AOR 6.64 95% CI (4.60-9.57), EPI guideline available at facility AOR 2.46 95% CI (1.75.-3.48) are factors positively associated with health professionals' knowledge on vaccine cold chain management in Ethiopia.

CONCLUSION

The pooled prevalence of good knowledge on vaccine cold chain management among health professionals is much lower than the expected level. There is a need to plan on job trainings for all vaccine handlers and other health professionals supposed to work on vaccination program.

Assessment of immunization session practices in primary health care centers in Al-Najaf province

Immunization has played a vital role in improving global health by reducing the transmission of infectious diseases. To ensure the successful implementation of immunization programs, it is crucial to thoroughly examine various elements within the Primary Health Care Centers, including immunization session management, cold-chain and logistics management, supervision, and reporting. The study aims to assess the immunization session practices in selected primary healthcare centers in Al-Najaf governorate. A descriptive cross-sectional study was conducted at 26 primary healthcare centers, selected using simple random sampling, across six districts in Najaf governorate. A total of 143 healthcare workers, comprising 122 vaccinators and 21 doctors, were included in the study. questionnaires were utilized to assess immunization session practices. Data collection commenced on December 2, 2022, and concluded on March 2, 2023. Immunization session practices were evaluated as having poor vaccine and diluent management, fair cold chain management, communication with clients and caregivers, vaccine preparation and administration practices, and waste management practices. However, immunization session equipment availability, as well as card review and registration during immunization, received good evaluations. The overall assessment of immunization session practices was determined to be fair. In addition, the study identified significant associations between immunization practices and the number of non-vaccinators working in the immunization unit (P=0.035), and the average number of daily vaccine recipients in primary healthcare centers (P=0.046). The immunization session practices achieved a fair level of assessment, The increased number of daily visitors to the immunization unit and the number of health workers who are non-vaccinator in the unit affected negatively the immunization session practices.

Vaccine cold chain management practices in primary health centers providing an expanded immunization program in Northwest Ethiopia: self-reported and actual practice observational study

Background

Vaccines are vital health commodities that need an appropriate supply chain system. They could be transported, stored, and used at appropriate temperatures. The purpose of this study was to assess vaccine cold chain management practices in primary health centers offering an expanded program of immunization (EPI) in Bahir Dar, Northwest Ethiopia.

Methods

A self-reported and actual practice observational cross-sectional study was conducted at primary public health centers in the Bahir Dar city administration from August 15 to 30, 2021. A simple random sampling method was used to select study participants. An interview-administered questionnaire and direct actual practice observation were used to collect data. The data was entered into the Epi-data 4.6 program and analyzed using SPSS version 25. Participants' knowledge, storage and transport conditions, IPLS management, and vaccine cold chain management practices were examined using independent samples t-tests and one-way ANOVA tests.

Findings

A total of 50 respondents from ten health centers were enrolled in the study. Most of the EPI service providers had good knowledge (60%) and good practice in vaccine storage and transport (74%). However, more than two-thirds (68%) of EPI service providers had poor integrated pharmaceutical logistics system (IPLS) management. Only half (50%) of the health centers had good actual vaccine cold chain management practices. Higher educational background, longer work experience, and receiving training and supervision in EPI services, IPLS management, and vaccine inventory management resulted in higher knowledge, storage and transport management, IPLS management, and vaccine cold chain management practices.

Conclusion

Although most EPI service providers in an interview assessment reported having good knowledge and good vaccine storage and transport management, only half of the health facilities followed the standard. Stakeholders are recommended to play a vital role in improving practices related to EPI services.

Reduced protective efficacy of hepatitis B vaccine among fully vaccinated children in Ethiopia

BACKGROUND

Hepatitis B vaccination is recommended for all children at birth within 24 hours or during childhood.

OBJECTIVE

This study was aimed to evaluate protective efficacy of hepatitis B vaccine and estimate the sero-prevalence of hepatitis B virus infection among vaccinated children.

MATERIALS AND METHODS

A community-based cross-sectional study was conducted from March, 2021 to October, 2021 in Debre Markos town. A simple random sampling technique was used to select 165 fully vaccinated children aged 5-12 years old. A serum sample was used to determine hepatitis B surface antigen (HBsAg), anti-hepatitis B core antibody (anti-HBc), anti-hepatitis B surface antibody titer (anti-HBs) using ELISA.

RESULTS

The seroprevalence of HBsAg and anti-HBc anti-body was found to be 4.2% and 4.8% respectively. Of 165 fully vaccinated children, 129 (78.2%) had anti-HBs titer ≥ 10 mIU/ml. Among 129 sero-protected children, 76 (58.9%) were hypo-responders whereas the rest 53 (41.1%) were good responders. Those children within the age group of 5-7 years were 2.9 times (AOR: 2.873, 95% CI: 1.156, 7.141) (P<0.023) more likely to respond to HBV vaccine. Multivariate logistic regression revealed that children who were born from HBV positive mothers (AOR 3.917, 95% CI: 1.456, 5.365, P<0.027) and those who had history of injectable medications (AOR 9.232, 95% CI: 1.503, 11.697, P<0.016) were more likely to be HBsAg positive. Children who had history of hospital admission (AOR 6.973, 95% CI: 1.495, 8.530, P<0.013) were more likely to be anti-HBcAb positive.

CONCLUSIONS

There was an intermediate prevalence of childhood HBV infection despite being vaccinated suggesting low protective efficacy of hepatitis B vaccine in the study area.

Vaccine cold chain management practice and associated factors among health professionals in Ethiopia: systematic review and meta-analysis

BACKGROUND

Administration of potent vaccine in a manner of well-maintained cold chain system is one of the public health focus areas in developing regions of the world. Health professionals' adherence towards good vaccine cold chain management practices is an important element to ensure potent vaccine reached to users. Studies on health professionals' practice on vaccine cold chain maintenance and associated factors in Ethiopia have shown wide variations. The aim of this systematic review and meta-analysis is to produce the overall/pooled prevalence of health professionals' good vaccine cold chain management practice and to identify its associated factors in Ethiopia.

METHODS

Systematic review and meta-analysis was conducted on vaccine cold chain management practice and associated factors among health professionals in Ethiopia. Literature search was made on international data bases using medical subject heading and key words. Data were extracted using Microsoft excel and imported to STATA version 17 for analysis. Heterogeneity was checked using Cochrane Q test and I² statistics. Weighted inverse variance random effect model was used to estimate the pooled level of good vaccine cold chain management practice among health professionals. Publication bias was checked using funnel plot and using Egger's test.

RESULTS

A total of ten studies were included in the review. The overall/pooled prevalence of good vaccine cold chain management practice in Ethiopia is 27.48% with 95% CI (25.70-29.26). Having good knowledge on vaccine cold chain management AOR 2.27 95% CI (1.72-2.99), and have received on-job training AOR 6.64 95% CI (4.60-9.57) are factors positively associated with vaccine cold chain management practice among health professionals in Ethiopia.

CONCLUSION

The overall/pooled prevalence of good vaccine cold chain management practice is much lower than the expected level. There is a need to plan on-job trainings for all vaccine handlers and other health professionals supposed to work on vaccination program.

Assessment of medicines cold chain storage conformity with the requirements of the World Health Organization in health facilities of the Eastern Province of Rwanda

BACKGROUND

Despite the prominent evidence of cold chain monitoring in the health system to reduce wastage and maintain product potency, there are still inefficiencies in the storage and transportation of cold chain products. This study assessed medicine cold chain storage conformity in health facilities in the Eastern Province of Rwanda.

METHODS

A cross-sectional and prospective with quantitative and qualitative approaches study was approved, and 44 health facilities (public, faith-based and private) were selected using both convenience, stratified, and purposive sampling techniques. Temperature data loggers were mounted in refrigerators to measure the Mean Kinetic Temperature (MKT).

RESULTS

The overall performance of cold chain storage conformity of refrigerators assessed was 54 (73.0%). The conformity found in refrigerators of pharmacy stock in public health facilities was 22 (56.0%), in vaccination program was 25 (100.0%), and in private retail pharmacies was 7 (70.0%). The MKT measured fit the required cold chain storage at this rate. Most refrigerators used in pharmacy stock (27.0%) were aged between 8 and 10 years, while those used in vaccination programs were less than 4 years. Regular calibration of refrigerator and temperature monitoring device (TMD) was 39.0% and 24.0%, respectively. Most respondents, 44 (80.0%), knew the proper cold chain storage. However, few identified the impact of storing cold chain products with vaccines at 16 (29.1%). The transportation of cold chain products from two central medical stores assessed showed inefficiencies as only one of them uses temperature data loggers during transportations of the products mentioned above.

CONCLUSIONS

The medicines cold chain storage conformity investigated in seven districts of the Eastern Province in Rwanda was better than reported previously in other LMICs. However, cold chain storage for pharmacy stock often did not meet the requirements. The observed drawback represented a serious risk to public health. Calibrating cold chain equipment, regular maintenance, and commissioning new cold chain equipment should be done to improve cold chain storage.

Evaluation of vaccine storage and distribution practices in rural healthcare facilities in Kenya

BACKGROUND

Vaccines require cold chain storage conditions, and good distribution practices throughout the supply chain to maintain their quality and potency. However, in the last mile of the vaccines supply chain, these requirements may not be guaranteed resulting in reduced effectiveness which could lead to an upsurge in vaccine preventable morbidity and mortality. The aim of this research was to evaluate vaccine storage and distribution practices in the last mile of vaccine supply chain in Turkana County.

METHODS

A descriptive cross-sectional study was conducted from January 2022 to February 2022 across seven sub-counties in Turkana County, Kenya, to assess vaccine storage and distribution practices. The study sample size was 128 county health professionals across 4 hospitals, 9 health centers, and 115 dispensaries. The respondents were selected using simple random sampling within the facilities strata. Data were collected using a structured questionnaire, adapted, and adopted from a standardized WHO questionnaire on effective vaccines management and administered to one healthcare personnel working in the immunization supply chain per facility. Data were analyzed using excel and presented as percentages in table forms.

RESULTS

A total of 122 health care workers participated in the study. Most respondents (89%, n = 109) had utilized a vaccine forecasting sheet, but only 81% did have an established maximum-minimum level inventory control system. Many of the respondents had sufficient knowledge of ice pack conditioning although 72% had adequate vaccine carriers and ice packs. Only 67% of respondents had a complete set of twice-daily manual temperature records at the facility. Most refrigerators complied with the WHO specifications but only 80% of them had functional fridge-tags. The number of facilities that had a routine maintenance plan was below average while only 65% had an adequate contingency plan.

CONCLUSION

Rural health facilities have suboptimal supply of vaccine carriers and icepacks for effective storage and distribution of vaccines. In addition, some vaccine fridges lack functional fridge-tags for proper temperature monitoring. Routine maintenance and contingency plans remain a challenge to ensure optimal service delivery.

Vaccine Cold Chain Management and Associated Factors in Public Health Facilities and District Health Offices of Wolaita Zone, Ethiopia

Background

Vaccines are medical products with a short shelf life and are easily damaged by deviations in temperature from the recommended ranges. Vaccines lose their quality if the cold chain system is not properly managed. Cold chain management is still a major challenge in developing countries, including Ethiopia. Thus, this study aimed to assess vaccine cold chain management and associated factors at public health facilities and district health offices.

Methods

A facility-based cross-sectional study design was applied from March 1-28, 2021. One hundred and thirty-six health institutions were selected by simple random sampling method. Data was collected using the observation check list and interviewer-administered pre-tested structured questionnaires. Data was analyzed using SPSS version 25. The binary logistic regression was employed and those variables with a p-value less than 0.25 in the bivariate analysis were used for multivariable logistic regression. Then multivariate analysis at a p-value <0.05 and AOR with 95% CI was used to measure the degree of association between independent variables and the outcome variable.

Results

The study indicates that 83 (61%) public health facilities had good cold chain management practice at 95% CI (52.2-68.4). Experience greater than 2 years (AOR=2.8, 95% CI=1.13-6.74), good knowledge on cold chain management (AOR=3.02, 95% CI=1.2-7.4), training on cold chain management (AOR=1.86, 95% CI=1.36-9.84), and supportive supervision on cold chain management (AOR=2.71, 95% CI=1.1-7.14) were statistically significantly associated with good cold chain management practice.

Conclusion

The result of the study indicated that there was low cold chain management practice in the study area. Strengthening the knowledge of healthcare workers and supportive supervision on cold chain management by giving training and monitoring their practice toward cold chain management may help to improve the cold chain management practice.

Adherence to WHO vaccine storage codes and vaccine cold chain management practices at primary healthcare facilities in Dalocha District of Silt'e Zone, Ethiopia

Background

The main elements of effective vaccine cold chain management at the immunization service delivery point are well-trained vaccine cold chain handlers, vaccine storage equipment, and appropriate vaccine management procedures. Vaccine cold chain handlers must have enough expertise to provide the correct vaccine at the right time, maintain vaccine potency, and minimize vaccination failures. The study assessed knowledge of vaccine cold chain handlers on vaccine cold chain management, adherence to the WHO vaccine storage codes and vaccine cold chain management practice at primary health facilities in Dalocha district of Silt'e zone.

Method

Institutional-based cross-sectional study was done at twenty-eight primary health facilities. One hundred forty primary health workers were drawn from four health centers and twenty-four health posts operating in Dalocha woreda of Silt'e zone, SNNPR, Ethiopia. A self-administered questionnaires and on-spot observation checklists were adapted from the WHO and WHO-UNICEF-effective vaccine management assessment tools to collect data from cold chain unit of the primary healthcare facilities. Data were entered to EPI data version 3.1; exported and analyzed using SPSS version 22. Statistical analysis was carried out to determine the level of knowledge, adherence to WHO cold chain management guideline and vaccine handling practice. The relationship that the knowledge of primary healthcare workers, primary healthcare workers training status, primary healthcare facilities' adherence to WHO vaccine storage codes, and length of work experience of primary health care workers have with the vaccine management practice were also explored

Result

Above Half (54%) of the respondents have satisfactory knowledge of vaccine cold chain management. One hundred (71.4%) vaccine cold chain handlers did point correctly to the recommended range of temperature (2°C -8°C) for vaccine storage. Around two-thirds (63.6%) of them were aware of the twice-daily temperature recordings. Nearly half, (46.2%) of primary healthcare facilities have experienced poor adherence to the WHO storage practice codes. Around three-fifths of the observed primary healthcare facilities have registered undesirable vaccine management practices. The primary healthcare workers who received training on vaccine cold chain management (χ2 = 0.058, p=0.015), served at primary health care facilities for more five years (χ2 =18.545, p≤0.001), shown good adherence to WHO vaccine storage code (χ2 =18.545, p≤0.001), have sufficient knowledge on vaccine cold chain management (χ2=4.210, p≤0.031) were all significantly associated with desirable vaccine cold chain management practice.

Conclusion

There is a gap in vaccine cold chain handlers’ knowledge about vaccine cold chain management and less than desirable adherence to WHO vaccine storage codes at primary healthcare facilities in Dalocha district. The majority of the observed primary health facilities have registered poor vaccine management practices. Everyone who has a stake in the cold chain management of vaccines should do their share, individually and collectively, to guarantee that everyone reaps the benefits of an effective cold chain.

Vaccine management practices among healthcare workers in Morogoro, Tanzania: a cross-sectional study

BACKGROUND

Effective vaccine management is essential to maintain the quality of vaccines, minimise wastages, and prevent missed opportunities for vaccination at service delivery points.

OBJECTIVES

This study aims to assess vaccine management practices among vaccinators at health facilities in the Morogoro region, Tanzania.

METHODOLOGY

A descriptive cross-sectional study design involved health workers from 77 health facilities offering vaccination services. The study population consisted of vaccine handlers and vaccinators working in public health facilities in the Morogoro region. The vaccine management practices were assessed using data collected from ledgers and the Vaccine Information Management System (VIMS). The temperature records were downloaded from the Fridge-tag® 2 and Coldtrace5 devices.

RESULTS

The findings indicated that 65 (84%) health facilities had functional refrigerators and are using power from 26 (34%), 28 (36%), and 23 (30%) of grid electricity, solar, and Liquefied Petroleum Gas (LPG), respectively. Besides, 27 (35%) health facilities have an alternative energy source as a backup. In general, healthcare workers had a good knowledge of cold chain management, including the World Health Organization recommended storage temperatures for vaccines. Furthermore, vaccine stockout was found in 12 (15.6%) health facilities for at least one antigen and 4 (5.1%) health facilities for all five antigens under observation. This current study also revealed that the average calculated vaccine wastage rates for DTP, Measles-Rubella and Rotavirus vaccines were 7%, 19%, and 15%, respectively. More than half of health workers did not perform monthly temperature data reviews. In addition, poor performance led to high wastage rates, including the Rotavirus vaccines, and a change in VVM to discard points. Finally, a small number of 5 (6.5%) health facilities consecutively reported temperature exposure beyond + 8 Celsius (between 5.9 and 281 h).

CONCLUSIONS

Healthcare workers' vaccine and cold chain management knowledge were good for temperature data reading and documentation. However, the practices were poor for some health facilities. The gaps observed in this study inform health managers and policymakers toward establishing interventions to improve health workers' knowledge and practice, including mentorships, supervision, and training to guarantee that each child in all communities reaps the benefits of immunisation services.

Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs

The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.

Application of Failure Mode, Effects, and Criticality Analysis to the Medication-Use Process for Temperature-Sensitive Drugs in a University Hospital

Background

In the hospital setting, the medication-use system for temperature-sensitive drugs is a high-risk process.

Objectives

To analyze the risks associated with the hospital-based medication-use process and to propose corrective and preventive actions for the most critical failure modes.

Methods

A multidisciplinary team was trained to analyze the medication-use process for temperature-sensitive drugs and to identify potential failures using a risk analysis method known as failure mode, effects, and criticality analysis (FMECA). The medication-use process, from initial supply to administration to patients, was investigated using "the 5 Ws and How" method (Who? What? Where? When? Why? How?), and the causes of the failure modes were analyzed using Ishikawa diagrams. The most critical failure modes were selected using the Pareto law, and relevant improvement actions were proposed.

Results

This analysis identified 41 failure modes for the 9 stages of the medication-use process, of which only 36 were deemed assessable by the participants. Eighteen (50%) of these failure modes were critical, according to the Pareto law, with criticality indices between 12 and 60. The stage of tidying up and storage in patient care units had the highest number of critical failures (n = 5). A total of 48 corrective actions were proposed.

Conclusion

The proposed action plan prioritized 3 areas for improvement: the documentation system, staff training, and equipment acquisition. A second FMECA should be carried out to reassess the medication-use process after implementation of these improvement actions. The second FMECA, allowing detection of residual risks and identification of new risks, will be part of a continuous improvement process.

Knowledge of vaccine handlers and status of cold chain and vaccine management in primary health care facilities of Tigray region, Northern Ethiopia: Institutional based cross-sectional study

Background

Ethiopia federal ministry of health has been working on increasing access to immunization service by deploying solar refrigerators to primary health care facilities. However, there is limited evidence on cold chain and vaccine management status. Therefore, the objective of this study was to assess knowledge of vaccine handlers and status of cold chain and vaccine management and their associated factors in primary health care facilities of Tigray region Northern Ethiopia.

Methods

Institutional based cross-sectional study was conducted in four randomly selected districts of Tigray region, Northern Ethiopia. In each selected district, all primary health care facilities with functional vaccine refrigerators were included in the study. Data were collected using a pre-tested semi-structured questionnaire. The collected data were entered into Epi-data version 3.1 and then exported to Statistical Package for Social Sciences (SPSS) version 21 for analysis. All variables with p-value of < 0.25 in bivariate logistic regression analysis were included in multi-variable model to identify predictors of the dependent variables.

Results

In this study, fifty Primary Health Care Facilities (PHCFs) were included with a response rate of 94.4%. The overall level of good knowledge of vaccine handlers and good status of cold chain and vaccine management were 48% (95% CI; 30.7%-62%) and 46% (95%CI; 26.1%-61.3%) respectively. Receiving training on cold chain and vaccine management (AOR = 5.18; 95%CI: 1.48–18.18) was significantly associated with knowledge of vaccine handlers. Furthermore, receiving supportive supervision (AOR = 4.58; 95%CI: 1.04–20.17) and good knowledge of vaccine handlers (AOR = 10.97; 95%CI: 2.67–45.07) were significant associated with cold chain and vaccine management.

Conclusions

This study showed that knowledge of vaccine handlers on cold chain and vaccine management was poor. Similarly, the cold chain and vaccine management status was also poor. Therefore, on-site training should be provided to vaccine handlers to increase their knowledge, so as to improve their practices on cold chain and vaccine management. In addition, Programme based supportive supervision is needed to improve cold chain and vaccine management.

Stability Modelling of mRNA Vaccine Quality Based on Temperature Monitoring throughout the Distribution Chain

The vaccine distribution chains in several low- and middle-income countries are not adequate to facilitate the rapid delivery of high volumes of thermosensitive COVID-19 mRNA vaccines at the required low and ultra-low temperatures. COVID-19 mRNA vaccines are currently distributed along with temperature monitoring devices to track and identify deviations from predefined conditions throughout the distribution chain. These temperature readings can feed into computational models to quantify mRNA vaccine critical quality attributes (CQAs) and the remaining vaccine shelf life more accurately. Here, a kinetic modelling approach is proposed to quantify the stability-related CQAs and the remaining shelf life of mRNA vaccines. The CQA and shelf-life values can be computed based on the conditions under which the vaccines have been distributed from the manufacturing facilities via the distribution network to the vaccination centres. This approach helps to quantify the degree to which temperature excursions impact vaccine quality and can also reduce vaccine wastage. In addition, vaccine stock management can be improved due to the information obtained on the remaining shelf life of mRNA vaccines. This model-based quantification of mRNA vaccine quality and remaining shelf life can improve the deployment of COVID-19 mRNA vaccines to low- and middle-income countries.

Health Extension Workers Knowledge and Associated Factors on Child Immunization in Bako Tibe, West Shewa, Oromia, Ethiopia: A Cross-Sectional Study

Purpose

To assess health extension workers knowledge of child immunization schedules and associated factors.

Methods

A cross-sectional study design was conducted among health extension workers working in Bako Tibe Woreda. The data were collected by using semi-structured questionnaires, and descriptive statistics were used to summarize the data. Chi-square (χ ²) was used to identify factors associated with the knowledge of health extension workers on the immunization schedules.

Results

The response rate of the study was 92.1% (58/63). All of the health extension workers included in the study were females. The majority of health extension workers 45 (77.59%) had satisfactory knowledge of the child immunization schedule. Educational status (χ ² = 11.05; P= 0.001), work experience of as health extension workers (χ ² = 6.22; P= 0.045), on job training on immunization (χ ² = 11.12; P= 0.002), marital status (χ ² = 6.30; P= 0.019) were factors associated with health extension workers knowledge.

Conclusion

The majority of health extension workers had satisfactory knowledge of the child immunization schedule. Educational status, work experience as health extension worker, on job training on immunization, and marital status were factors associated with the knowledge of health extension workers on the child immunization schedule.

Evaluation of Cold Chain Management Performance for Temperature-Sensitive Pharmaceuticals at Public Health Facilities Supplied by the Jimma Pharmaceuticals Supply Agency Hub, Southwest Ethiopia: Pharmaceuticals Logistic Management Perspective Using a Multicentered, Mixed-Method Approach

Background

Effective and efficient cold chain management maximizes utilization of healthcare resources, reduces cold chain products wastage, and improves the quality of health services. It eventually guarantees that clients receive cold chain products they need at service delivery points. The objective of this study was to evaluate cold chain management performance for temperature-sensitive medicines at public health facilities in Southwest Ethiopia supplied by the Jimma Pharmaceuticals Fund and Supply Agency hub. Method and Materials. The study used an institution-based cross-sectional study design. Forty-seven (47) public health facilities in Southwest Ethiopia were evaluated using checklists adopted from the Logistic Indicators Assessment Tool, Vaccine Management Assessment Tool, and Logistic System Assessment Tool.

Results

The study revealed that the mean availability of essential cold chain products was 72.1 ± 14.8% while the average stock-out rate was 26.2 ± 8.6%. The median stock-out duration was 23 ± 21 days for all visited public health facilities. Two hundred and sixty-three (43.06 ± 15.3%) of the public health facilities' stock records were found accurate, and the wastage rate due to expiration was 9.2 ± 7.8% for all visited health facilities. Thirty public health facilities (63.8 ± 36.2%) had acceptable storage conditions. Conclusions and Recommendations. Supply chain performance at the study facilities was not adequate overall, and focused efforts need to be directed at managing the availability of critical cold chain medicines. Some cold chain management challenges demand the attention of the top management, while the rest can be addressed by operational management at the facilities through provision of appropriate training and supervision of the cold chain pharmaceutical handlers.

Cold Chain Management by Healthcare Providers at a District in Ghana: A Mixed Methods Study

Background

Despite the relevance of cold chain management in maintaining the potency of vaccines, gaps still exist in the ability of healthcare practitioners to maintain the cold chain system effectively. Thus, the current study sought to assess healthcare providers' knowledge, attitudes, practices, and challenges regarding cold chain management.

Methods

A concurrent mixed methods study was conducted at twelve facilities in the Sekyere Central District of Ghana. Eighty-six (86) participants took part in a survey that assessed their “cold chain management” knowledge and attitudes. Twelve (12) cold chain sites within the district were also observed in respect of their cold chain management practices. Eleven key informants were additionally interviewed to explore their challenges on cold chain management. Quantitative data were analyzed using descriptive (frequencies, percentages, means, standard deviations, ranges) and inferential statistics (Spearman's rho correlation). Qualitative data were inductively analyzed into themes which described participants' challenges on cold chain management.

Results

Majority of the participants scored ≥70% on knowledge (68.6%) and attitudes (67.4%) toward cold chain management. However, there was a very weak positive and statistically insignificant relationship between participant's knowledge and attitudes toward cold chain management (r = 0.109, p = 0.317). Regarding cold chain management practices, majority of the facilities had their vaccine vial monitors attached to the vaccines (8/12, 66.7%), had functional fridge tags (8/12, 66.7%), and an appropriate refrigerator to store vaccines (7/12, 58.3%). However, the study observed that 91.7% (11/12) of the facilities did not have policies and guidelines on cold chain management while all 12 facilities (100%) did not have a contingency plan in place for equipment. With regards to the cold chain management challenges, participants raised concerns about inadequate personnel, erratic power supply, logistical constraints, and transportation difficulties.

Conclusion

Although majority of the participants had good knowledge and attitude towards cold chain management, there was a weak association between them. This implies that good knowledge may not necessarily influence good attitudes towards cold chain management and vice versa. The extent to which facilities support cold chain management practices was suboptimal. Participants encountered a number of challenges which prevented them from managing the vaccine cold chain system effectively. We recommend continual professional education for cold chain practitioners, provision of adequate human and material resources for cold chain management, and enhanced monitoring and evaluation of cold chain activities. Future studies should quantitatively measure individual participants' knowledge, attitudes, practices, and challenges on cold chain management so that we can establish the relationships that exist between these components.

Adequacy assessment of immunobiological agent conservation in the Western Health macro-region of Minas Gerais State, Brazil: a descriptive study, 2017

OBJECTIVE

To describe the adequacy of immunobiological agent conservation in vaccination rooms in the municipalities of the Western health macro-region of the state of Minas Gerais, Brazil.

METHODS

This was a descriptive study, based on a validated scale, with a maximum score of 15 points. A descriptive analysis and an association test between the scores obtained by the municipalities and variables of the external context were performed.

RESULTS

275 out of a total of 295 existing vaccination rooms were evaluated. Immunobiological agent conservation in the West macro-region obtained an average score of 4 points (standard score, 0 to 15). There was a poor availability of immunization supplies aimed at immunobiological agent conservation, and work processes, that require improvement. Small municipalities presented better immunobiological agent conservation (p=0.011).

CONCLUSION

Immunobiological agent conservation in vaccination rooms in the Western health macro-region of Minas Gerais State was considered inadequate.

Cold Chain Maintenance and Vaccine Stock Management Practices at Public Health Centers Providing Child Immunization Services in Jimma Zone, Oromia Regional State, Ethiopia: Multi-Centered, Mixed Method Approach

Background

Cold chain maintenance is the spine of an immunization program.

Objective

To examine the status of cold chain maintenance and evaluate knowledge of cold chain handlers and practices of vaccine management at public health centers providing immunization services in Jimma zone.

Methods

An institutional-based cross-sectional study supplemented with a qualitative method was conducted in 41 randomly selected health centers providing immunization service in districts of Jimma zone from October 31 to November 30, 2019. Pre-tested self-administered questionnaires and observation checklists developed from an effective vaccine management assessment tool (EVMAT) were used to collect quantitative data. Key informants were selected using the purposive sampling technique and an in-depth interview was conducted. Quantifiable data were analyzed using SPSS version 20 and chi-square was used to test the presence of association (p-value <0.05). Qualitative data were analyzed by thematic analysis and triangulated with quantitative findings.

Results

All public health centers had at least functional ice-lined refrigerators while 28 (68.3%) public health centers had functional deep freezers. Of the cold chain handlers, 120 (82.9%) had fair knowledge. Vaccine storage was appropriate per the World Health Organization's vaccine storage code in ice-lined refrigerators in 11 (24.4%) public health centers. Cold chain handlers’ years of service, types of training, availability of funds for cold chain maintenance, and availability of cold chain equipment at public health centers showed the presence of significant association with vaccine cold chain management practice.

Conclusion

The majority of cold chain handlers showed inadequate knowledge while a significant number showed poor practice of preserving the vaccines’ cold chain. Cold chain maintenance was not adequate in public health centers, necessitating attentive efforts of providing proper management of vaccine cold chains at immunization delivery points.

Application of the remaining vaccine vial monitor life calculation to field temperature monitoring data to improve visibility into cold chain equipment performance

Vaccine Vial Monitors (VVM) are used to estimate if a vaccine has been exposed to excessive hot temperatures. This endpoint measurement is useful in determining if a vaccine is safe to be administered to a patient, but it does not pinpoint where in the cold chain a vaccine was exposed to excessive heat. With the expansion and technological advancement of cold chain equipment temperature monitoring, it is now possible to remotely estimate VVM status as a vaccine moves through the cold chain. In the present study, we examine the application of the mathematical principles backing VVMs on real, continuous, temperature monitoring data in Africa. Results suggest that exposure to short bursts of hot temperature or long power outages may still allow for safe distribution of affected vaccines. The remaining VVM life calculation could improve managerial visibility into cold chain equipment performance allowing for better data-driven planning and maintenance decisions.

Programmatic assessment of electronic Vaccine Intelligence Network (eVIN)

eVIN is a technology system that digitizes vaccine stocks through a smartphone application and builds the capacity of program managers and cold chain handlers to integrate technology in their regular work. To effectively manage the vaccine logistics, in 2015, this technology was rolled-out in 12 states of India. This study assessed the programmatic usefulness of eVIN implementation in the areas of vaccine utilization, vaccine stock and distribution management and documentation across selected cold chain points. A pre-post study design was used, where cold chain points (CCPs) were selected using two-stage sampling technique in eVIN states. Pre-post comparative analysis was carried out on the identified indicators using both primary and secondary data sources. The vaccine utilization data reflects that the utilization had reduced from 305.3 million doses in pre-eVIN period to 215.0 million doses in post-eVIN period across 12 eVIN states, resulting into savings of approximately 90 million doses of vaccines. Number of facilities having stock-out of any vaccine showed a significant reduction by 30.4% in post-eVIN period (p<0.001). There was a 4.0% drop in facilities reporting minimum stock of any vaccine after implementation of eVIN. Facilities with maximum stock of any vaccine had increased from 37.4% in pre-eVIN to 39.2% in post-eVIN. During the pre-eVIN period, only 38.6% facilities updated vaccine stock on a daily basis, while in post-eVIN period, 53.5% facilities updated vaccine stock on daily basis. The completeness of records in the vaccine stock registers, indent form and temperature logbook have been substantially improved in the post-eVIN period (p<0.001). eVIN had helped in streamlining the vaccine flow network and ensured equity through better vaccine management practices. It is a powerful contribution to strengthen the vaccine supply chain and management. Upscaling eVIN in the remaining states of India will be crucial in improving the efficacy of vaccines and cold chain management.

Validity of an instrument to evaluate the immunobiological cold chain

Objective: To develop and to test the validity of content and layout of a multidimensional tool to evaluate maintenance of the cold chain for immunobiological conservation.Method: A methodological study carried out in three steps: integrative review; development of theoretical and logical model for the development of the tool; implementation of the Delphi Technique to test the validity of content and layout. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated considering appropriate those values greater than or equal to 75% and 0.4, respectively.Results: The instrument consisted of 7 questions about structure and 20 about process, subdivided into three components: Transportation/Reception (n=3); Storage/Handling (n=13); Supervision/Permanent education (n=4). The CVI value was 87.4%, with values equal to 85.7% and 89% in the structure and process dimensions, respectively. The process components obtained CVI values equal to 88.9, 88.9 and 89.2%, respectively. The CVR was 0.8, with values equal to 0.7 and 0.8 in the structure and process dimensions. As for the layout validation, the questionnaire was considered intelligible.Conclusion: The study provides an instrument with validity of content and layout for health professionals in charge of the supervision of activities of immunobiological conservation, ensuring the maintenance of the immunogenic quality of the products offered to the population.