Evaluation of the Storage and Cold Chain Management of Vaccines in the Primary Health Facilities in Arusha City, Northern Tanzania

Abstract

Background: Immunization a process by which a person becomes protected against a disease through administration of vaccine into the body to induce immunity against the disease. Vaccines are stored and distributed in a temperature controlled system called Cold Chain System. This system comprises of personnel; specialized cooling equipment for safe storage and transportation of vaccines; and the procedures to manage the system and control distribution and use of the vaccines. If this system is compromised, vaccines become exposed to unacceptably high or low extremes of temperature outside the manufacturer‟s recommended range. Study Objective and Rationale: The main objective of this study was to evaluate the quality of the storage and cold chain management of vaccines in the primary health facilities in Arusha City, Northern Tanzania in 2020. In addition, the knowledge, attitude and practices of personnel working in the vaccine cold chain were evaluated. Understanding the existing cold chain problems will support to improve vaccine cold chain management of the handlers; quality of immunization and strategic planning of The National Immunization and Vaccine Development Program and Vaccines regulations by the National Drug Regulatory Authority (The Tanzazia Medicines and Medical Devices Authority). Study Methodology: A cross-sectional study design was applied. The study was conducted in 50 primary health facilities (4 hospitals, 18 health centres, 28 dispensaries). Census (universal) sampling was done. Checklist and structured questionnaires were used to collect data. Data analysis involved both descriptive, inferential and regression methods. The level of significance was set at 0.05. Results: Dedicated rooms for cold chain were available in 45 (90%) facilities. All facilities had refrigerators, vaccine carriers and ice packs. There were 8 (16%) refrigerators with damaged inner compartments. A total of 43 (86%) refrigerators were not installed with voltage stabilizers. Fridge tags and freeze tags were available and working in 40 (80%) and 38 (76%) facilities respectively, freeze tag were in alarm states in 8 facilities. A total 28 facilities had improperly arranged vaccines. Refrigerators temperature readings were outside the recommended range (2 - 8 °C) in 12 (24%) of the facilities. Twelve (24%) of surveyed health facilities kept products not related to vaccines inside the refrigerators. Preventive maintenance of equipment had not been done in 49 (98%) facilities. A total of 23 (46%) of facilities had some vaccines at vaccine vial xiv monitors (VVM) stage 2 and 1(2%) facility had one vaccine at deteriorated VVM stage 3. There was no formal appointment of designated cold chain handlers. Poor knowledge was observed with regard to use of VVM and shake test technologies and on which vaccines are heat and freeze sensitive. Training out of the working station and the increase in the duration of years worked increased the knowledge of respondents. All (100%) respondents scored above 80% (94.5% average) on attitude toward the quality of vaccines; nearly 80% respondents scored above 80% (88.2% average) on attitude towards self efficacy and motivation to work in the cold chain. Only ten (10%) respondents scored ≥ 80% (52.8% average) on attitude towards satisfaction with availability of resources and need for training. Training at the working station, higher level of education qualification, working experience (years) and working at health centre (compared to hospitals and health centres) had positive impact on the attitude toward self efficacy and motivation to work as cold chain handler. The availability and use of inventory records (ledger, requestion/issue voucher and vaccine register) and temperature charts was good. Unfortunately, operational records were rarely available in the facilities. These included, contingency plans (28%), standard operating procedures (14%), cleanliness and defrosting records (6%), dos and don‟ts stickers (6%) and maintenance and calibration records (1%). Surprisingly, no facility had equipment breakdown and power outage records. Conclusion: This study identified several gaps in the storage and cold chain management of vaccines in the primary health facilities studied. This poses risk to preventive care provided to the public. The state of equipment used for storing of vaccines is unsatisfactory. Preventive maintenance of equipment and supply of voltage stabilizers should be done as soon as possible. Training and supportive supervisions needs to strengthened. The city vaccination department should ensure adequate supply and use of all the essential documents and records.