Adherence to Cold-Chain Management Guidelines and Influence on Stability of Live Attenuated Vaccines: Results from an Observational Study in Kisumu County, Kenya.
DOI:
https://doi.org/10.47941/ijhmnp.375Keywords:
Cold-chain system, adherence, guidelines, vaccine stability, routine immunizationAbstract
Purpose: Guidelines provide ethical frameworks to streamline processes for best outcomes. Live-attenuated vaccines in routine immunization programs in Kenya have challenges of instability despite the availability of guidelines. Diseases preventable by these vaccines are reported in Kisumu County more than others in the region. This observation is suspected to be associated with lapses in adherence to cold-chain management procedures. This study, hence purposed to assess whether there was any association between instability of vaccines and staff adherence level to the guidelines.
Method: Using analytical cross-sectional design with repeated observations, data was collected from 120 out of 170 public and non-governmental health facilities in the Kisumu County at three intervals, between October 2018 and March 2019. In each health facility, immunization manager on duty was interviewed and observations made on compliance with cold-chain protocols using a checklist. Data was summarized descriptively and regression used to identify key points of adherence levels. Qualitative information was analyzed thematically to identify evolving themes.
Result: In 40% of the facilities, staff did not transfer vaccines when the need arose; 8.3% did not defrost fridges; while 45.8% did not dispense vaccines at VVM stage 2. Transferred vaccines accounted for improved stability of both OPV (95%C.I; 3.1 – 16.8, OR 7.2, p value< 0.001) and measles-rubella vaccines (95% C.I, 2.1 – 10.4, OR, 4.7, p=value <0.001). Dispensing vaccines at VVM stage 2 ahead of FEFO had better stability of OPV (95%C.I, 6.0 - 49, OR17.2, p=value <0.001) and measles-rubella vaccines (95%C.I 3.3-17.4; OR7.6, p=value <0.001) respectively. Defrosted fridge enhanced stability of OPV (95% C.I, 1.1 – 15.5; OR 4.17, p=value 0.033), measles-rubella (95% C.I, 1.3 – 12.3, OR 4, p-value 0.0017) and ROTA vaccine (95% C.I 1.9 – 21.5; OR 6.3, p= value 0.003).
Unique contribution to practice and policy: Lapses in transferring vaccines, defrosting of fridges and use of VVM to dispense vaccines significantly destabilized live attenuated vaccines worth linking to the outbreaks of Rota diarrhea and measles outbreaks in Kisumu. Due to inadequate staff adherence level to guidelines, new innovations meant to help improve stability of vaccines, inadequately improved the situation, so calls for strengthened capacity building to staff.
Downloads
References
• Angela K. S., Rebecca F., and Mike M (Glob Health SciPract. 2014 Dec; 2(4): 381–394. Published online 2014 Dec 2. doi: 10.9745/GHSP-D-14-00137)The future of routine immunization in the developing world: challenges and opportunities
• Cambridge (2013) Advance Learners’ English Dictionary 4th Edition Cambridge University Press
• District Health Information System (“DHIS” 2014; 2015; and 2016) Kenya.URL
• Gliem, J.A and Gliem R.R. (2003) Calculating, Interpreting, and Reporting Cronbach’s Alpha Reliability Coefficient for Likert-Type Scales. Continuing, and Community Education, Columbus, 82-88.
• Israel, Glenn D. (2009). Sampling the Evidence of Extension Program Impact. Program
• Evaluation and Organizational Development, IFAS, University of Florida. PEOD-5. October.
• Karl Pearson (1895) "Notes on regression and inheritance in the case of two parents,"
• Proceedings of the Royal Society of London, 58: 240–242.
• Koskei, A., Mibei, E., Tabu, S., Malalu, P., Marete, I., & Tenge, C. (2017). Assessment of cold chain management practices in immunisation centres in Kacheliba division, Pokot County, Kenya. East African Medical Journal, 94(2), 106-110. Mercy lutukai et al.,
• Lutukai, M., Bunde E. A., Hatch, B., Zoya, M., Yavari, S. E., (2019) Global Health: Science and Practice, 7(4):585-597; URL
• Ministry of Health (2012) EPI operational level manual for service providers. Gvt. printers. KENYA
• Mugenda, A. G., (Olive) (2003), Research Methods: Quantitative and Qualitative Approaches. Nairobi. Kenya .Acts Press.
• Ministry of Public Health and Sanitation (2013) Measles vaccine second dose introduction in routine immunization. Guide for health workers. Government Printers. Kenya
• Okomo, O.M.J., Guya .B., Omondi, D.S.A, (2019) Facility Level Cold-Chain Maintenance, Temperature-Monitoring and Stability of Live Attenuated Vaccines in Kisumu County, Western Kenya. IJIRDI.
• Ram K. Panika., Amarnath Gupta (2018) Assessment of cold chain and logistics management practices: a cross sectional study in Bundelk-hand region of Madhya Pradesh: International journal of Community Medicine and Public Health. URL
• Rogie, B., Berhane, Y., Bisrat, F (2013) Assessment of cold chain status for immunization in central Ethiopia.Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
• Shen A. K., Fields R., McQuestion M (2014) the future of routine immunization in the developing world: challenges and opportunities. Glob Health Sci. Pact. 2014; 2(4):381-394. URL
• World Health Organization (2006). Temperature sensitivity of vaccines. Geneva, Switzerland at URL.
• World Health Organization (2015a) Guidelines on the stability evaluation of vaccines for use under extended controlled temperature conditions. Geneva, Switzerland
• World Health Organization,(2015b). Africa’s health monitor. Routine immunization in the WHO African Region: Progress, challenges and way forward: Joseph Okeibunor, e-mail: okeibunorj@who.int
• Yamane, Taro (1967). Statistics, An Introductory Analysis, 2nd Ed., New York: Harper and Row.
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
