Knowledge And Practice Of Health Workers On The Management Of Vaccine Cold Chain System In Ilorin West Local Government Area, Kwara State

1.1 Background of the Study 

Vaccines are Immunogens consisting of suspension of weakened or dead pathogenic cells injected in order to stimulate the production of antibodies. It is used to improve immunity to a particular disease. Vaccination is the intervention used to prevent or eradicate childhood diseases. It is the most cost-effective health intervention. A set of practice guidelines for different service levels were created by the World Health Organization (WHO), which include vaccine monitoring, immunization techniques, cold chain management and reporting systems [Yakum, et al 2015]. 

Immunization is the most powerful cost-effective means of preventing some of the deadly diseases of childhood as well as being one of the eight components of primary health care. A child who is immune to a disease is protected against the disease by means of antibodies. The antibody can be passive, that is given to the child ready-made as in serum or from the mother to the child through the placenta (Chinawa, 2014).

The prevention of diseases by immunization, conventional public health measures is today the best known, practical, low cost, community based way of protecting children against the major killer childhood diseases. Primary Health Care (PHC) according to World Health Organization (WHO) has become the accepted key to reaching the social target of attainment by all people of the world by the year 2020, of a level of health that will permit them to lead a socially and economically productive life (Ayodele, 2018).

United Nations Children’s Fund (UNICEF), in a world view of the existing high infant and child mortality rates in developing countries, has formulated a package of priority activities, which are synergistic, cost effective and simple. They are growth monitoring, oral, rehydration, breast feeding, immunization, family spacing, female education and food supplementation (GABI –FFF). This combination of activities has been publicized and survival and development resolution, which will receive political support and help change the world’s response to the plight of children from one of resignation to one of refusal to allow the present state to continue. The daily unnecessary loss of forty thousand children from measles, peruses and tuberculosis must be placed on people’s consciences and nations must make accessible to all parents the simple intentions that prevent not only death of their infants but also a heave burden of morbidity, retarded development as disability. Following the success of small pox vaccination, the World Health Organization (WHO) in 1974 launched a series of country-based initiatives entitled ‘Expanded Program on Immunization (EPI). 

The long term objectives are: 

(i) Reducing the morbidity and mortality of six childhood diseases: diphtheria, pertussis, tetanus (neonatal tetanus) poliomyelitis, measles, and tuberculosis.

(ii) Immunizing all children by the year 1990.

Immunization of children against the killer diseases has proven effective in reducing the morbidity and mortality from those diseases. For this reason, World Health Organization (WHO) recommends that all children receive one dose of bacilli calmette-gueria vaccine, three doses of PENTAVALENT vaccine, three doses of either oral polio vaccine or inactivated polio vaccine, three doses of hepatitis B vaccine and one dose of a measles virus-containing vaccine, either anti-measles alone or in combination with other antigens. It also recommends three doses of vaccine against infection with Haemophilus influenza type B. To boost immune at older ages, additional immunization are recommended for healthcare workers, travelers, high-risk groups and people in areas where the risk of specific vaccine-preventable diseases is high. These achievements are partly attributable to the training of staff in the proper storage and transport of vaccines and partly to improvements in the cold chain. (Chinawa, 2017).

Immunity to vaccine preventable diseases only result when active and effective vaccines are used. Active and effective vaccines can be sustained by harnessing the essential elements in the cold chain namely the vaccines, manpower, equipment and transportation.

The cold chain refers to the continuum of safe handling practices, including materials, equipments and procedures that maintain vaccines within a temperature range from time they are manufactured to the time they are administered to the person being immunized. The cold chain still remains a highly vulnerable element of any immunization programme both in developing and in developed countries. Cold chain is system for storing and transporting vaccines in a potent state (within an acceptable temperature range) from the manufacturer to users. Throughout the chain, primary health care providers must have adequate knowledge to manage the cold chain. The cold chain guidelines recommend the following: the vaccine storage should be maintained in the temperature range of 2–8 °C, the use of minimum/maximum thermometers, temperature charts, and the shake test [WHO, 2015]. 

Research has shown that difficulty in maintaining the cold chain is aproblem of developing countries and a concern of industrialized nations as well.In third world countries where ambient temperatures are high the monitoring of the “cold chain” from production to delivery of vaccines to patients is given high priority.However, the efficacy of vaccines can be compromised by faulty transport, storage and handling. [PATH, 2015]

The sensitivity of various vaccines to higher storage temperatures has been reported, and the adverse effects of elevated temperature on vaccine potency are believed to be cumulative. Not only are vaccines sensitive to temperature, but some, such as measles, mumps, and rubella, must always be protected from light.All vaccines should be stored and handled under recommended conditions to ensure optimal potency when they are administered. [WHO, 2016]

The cold chain has been extensively studied in non-industrialized countries because of concerns about limited refrigeration facilities, power shortages and inadequate transportation system. To improve management, the world health organization (WHO) has created a set of practice guidelines for different service levels, which include immunization techniques, vaccine monitoring, cold chain management and reporting system. This guideline recommend that the vaccine storage in remote sites should be maintained in the temperature range of 2 – 8oC, the use of maximum/ minimum thermometers temperature charts and the shake tests. The national guidelines recommend that a nominated, trained person should be responsible for vaccine storage. This person should be able to work to a written procedure developed to meet local needs. Written procedures should indicate the action to be taken if the temperature goes outside the specified range.[ Iwu, 2020]

Unfortunately these guidelines are not followed in this country due to a certain level of corruption and limited human resource capacity. Major work force at the immunization centers in this country have no pre-service training, most of them had to cope with these newly assigned jobs without adequate training such as in cold chain management and hence the justification for this study. An increased concern over the potential for vaccine storage errors surfaced in a study that estimated that cold chain errors from 1995-2002 affected up to 44 million doses costing between $433 and $481m. [Arevshatian et al, 2017]. 

Therefore this study investigated the adequacy of the vaccine cold chain in immunization centers in Ilorin West Local Government Area, Kwara State. It also assessed the knowledge and the practices of cold chain personnel regarding cold chain management in order to understand to what extent this gap in cold chain management can be a contributing factor to the paradox between high immunization coverage rates and the appearance of vaccine preventable diseases. Furthermore, the effect of break in the cold chain on the vaccines using vaccine vial monitor (VVM) were looked into.

The importance of the cold chain cannot be over emphasized because globally, the expanded programme on immunization (EPI) now known as National Programme on Immunization (NPI) in Nigeria is the entry point into primary health care (PHC) system and without efficient and effective cold chain system, the National Programme on Immunization will crumble and the aim of protecting the Nigerian child against the six killer childhood diseases using potent vaccines will be unachievable. [WHO, 2019]

1.2 Statement of Problem

The efficacy of a vaccine in preventing disease depends largely on the quality of the immunizing agent. Failure to adhere strictly to recommended specifications for vaccine handling and storage can render vaccines useless. Inactivation of a vaccine may become evident only after immunized individuals acquire the disease the vaccine was designed to prevent. The identified cases are often considered primary or secondary vaccine failures, thereby obscuring the role that improper vaccine handling may have played in the failure.

Poor handling and storage, cold chain deficiencies such as inadequate infrastructure, power shortages and poor maintenance are associated with vaccine wastage. Though there are very few countries reporting vaccine wastage to World Health Organization, WHO (19 of the 72 Global Alliance for Vaccine Initiative, GAVI eligible countries), developing countries have been found to incur cost of vaccine wastage in excess of $4 million and $6 million for pentavalentvalentvalent and pneumococcal vaccines respectively. It is noteworthy that Nigeria is among the 74% of GAVI eligible countries that do not report vaccine wastage. [WHO, 2015]

Periodic assessment of vaccine handling and storage practices is instrumental in correcting wrong vaccine management practices and improving level of knowledge on vaccine management. In addition, it identifies various capacity gaps (personnel and equipment), which when duly addressed strengthens the nation’s immunization service delivery, increases vaccination coverage and ensures the administration of potent vaccines to clients. This study was therefore conducted to assess the factors associated with vaccine handling and storage practices among immunization service providers in Ilorin West Local Government Area, Kwara State, Nigeria.

1.3 Significance of the study

An assessment of the knowledge and practice of health workers in the management of vaccine cold chain system in Ilorin West Local Government Area, Kwara State would provide a lead way to promoting immunization services in the state in particular and country as a whole. The findings would provide useful information that could assist relevant ministry and agencies in performing their statutory responsibilities of maintaining the quality of vaccine through optimal vaccine cold chain system. In same vein, the donor agencies and partner would leverage on the findings to determine more areas of assistant in order to improve the effectiveness of vaccines.

1.4 General Objectives

To assess the knowledge and practices of health workers in the management of vaccine cold chain system in Ilorin West Local Government Area, Kwara State, Nigeria.

1.4.1 Specific Objectives

1. To determine the knowledge of health workers at immunization centers as regards vaccine storage and handling.

2. To assess the practices of health workers in cold chain management.

3. To Assess the availability and the level of effectiveness of cold chain equipments and their maintenance in Ilorin west Local Government Area.

4. To determine number of trained personnel on Cold Chain System management and fund availability.

1.5 Research Questions

1. What are the knowledge of health workers in vaccine cold chain management in the health facilities in Ilorin West LGA?

2. What is the mode, time and distance of vaccine supply to the healthcare unit?

3. How many staff has been trained to manage vaccine cold chain system in the healthcare facility?

4. How often are vaccines supplied to the healthcare facility?

5. What are the sources of power supply to the health facility?

6. What are the regularity of financial support for vaccine cold chain system?

1.6 Scope of the study

The study focuses on the assessment of the knowledge and practice of health workers in the management of vaccine cold chain system in vaccine storage and immunization centers in Ilorin west Local Government Area of Kwara State and respondents were drown among local government immunization office team management, focal Persons, routine immunization (RI) in charge, house to house team vaccinators.

1.7 Operational Definition Of Terms

Cold: could mean a substance or weather with low temperature.

Chain: refers to the sense of interconnected links or rings.

System: a composed of relationships among the organs or members.

Potency:   is the ability or capacity to perform something or to be productive

Temperature: is a degree of hotness or coldness of a substance.

Vaccine: is a biological prepared that provide active acquired immunity to a particular disease. A vaccine typically contains an agent that resemble with disease causing microorganism. It is often an agent weakened or killed form of the microbe.

Immunization: is the administration of antigen in to the body to induce immunity.

Polio: is a acute paralysis disease caused by the poliomyelitis virus. It is cripple disease that can occur in adults but it is much commoner in children.

WHO: World health organization, is a United Nations Agency that connects nations, partners and people to promote health, keep the world safe and serve the vulnerable, so everyone, everywhere can attain the highest level of health.

V.P.D: Vaccine preventable disease is an infectious disease for which an effective preventive vaccine exists.

V.V.M: Means vaccine viral monitor is a chemical indicator level attach to the vaccine vial with four different stage colour.

EPI: Expanded program on immunization is a World Health Organization programme with the goal to make vaccines available for children.

USAID: United State Agency for International Development is an independent agency of the United States federal government that is primarily responsible for administering civilian foreign aid and development assistance