Availability and Storage of Vaccines in Community Pharmacies
CHAPTER ONE
Objectives Of Study
The specific objectives of this study are outlined as follows;
- To determine the availability of childhood vaccines in Community pharmacies.
- To determine the availability of adult vaccines in Community pharmacies.
- To determine availability and adequacy of vaccine storage facilities in Community pharmacies
- To explore variables that affect vaccine availability and storage in Delta state.
- To explore variables that affects the involvement of community pharmacists in routine vaccination in Delta State.
CHAPTER TWO
LITERATURE REVIEW
Importance of the Cold Chain
To ensure the optimal potency of vaccines, storage and handling need careful attention. Adequate electrical power and refrigeration are often lacking in developing countries, where storage, handling and heat stability of vaccines are consequently matters of great concern13. New products have been developed for safe transport and storage, while the reliability of vaccine supply has been increased by the introduction of improved management techniques. Extensive training ensures that everyone involved in the cold chain is familiar with all its facets. However, evaluations in India14, Malaysia15, Nepal16, the United Republic of Tanzania17 and Tunisia18 showed that there were still weak points in the cold chain performance and that more attention should be paid to it, especially in peripheral facilities.
The importance of maintaining the cold chain has been given little consideration in temperate countries. Although adequate refrigeration is often taken for granted, errors in vaccine handling may occur more commonly than is generally assumed 5. Substantial drops in vaccine potency caused unsatisfactory conditions of delivery and storage have been reported19.
The most common deficiencies in cold chain performance reported from developed countries are high temperatures during storage or transport,13 exposure of adsorbed vaccine to freezing temperatures,20 refrigerators without thermometer, failure to take and record temperature readings regularly,21 storage of drinks, food and pathology specimens with vaccines,22 failure to discard unused vaccine after sessions at ambient temperature.
A high prevalence of avoidable errors was found in the metropolitan area of Los Angeles in the United States of America, where little attention was given to self-monitoring of vaccine storage practices.
Studies in Hungary24, Poland 25. And the United Kingdom of Great Britain and Northern Ireland26 showed considerable weakness in the cold chain during vaccine transportation from manufacturers and from central distribution points to health clinics.
Vaccine losses and recalls have been occurring throughout the world due to improper storage and handling. “According to the CDC”, improper storage is the most common vaccine delivery problem they encountered”.
A survey in the metropolitan Los Angeles area showed that 22% of the refrigerators in the clinics were out of the appropriate storage temperature and 18% were unaware that temperature can affect the potency of certain vaccines. Furthermore, in 16% of the offices surveyed, vaccines were routinely stored outside of the refrigerator during the practice day. It was concluded that vaccine storage “errors occur in pediatric offices at an acceptably high frequency.
This problem occurred world wide as well. According to a report in the medical journal of Australia, the “high rate of infectious diseases in Australia is due, in part, to the improper storage of vaccines in many doctors’ offices”. 40% of offices surveyed were not storing vaccines in the appropriate temperature range and 50% kept vaccines stored at or below the freezing point”27.
In a study done by Thakker and Woods titled storage of vaccines in the community: weak link in the cold chain? Results of that survey showed that of the 40 respondents, only 16 were aware of the appropriate storage conditions for the vaccines; eight had minimum and maximum thermometers but only one of these was monitored daily. In six of the eight practices selected for monitoring of refrigeration temperatures the vaccines were exposed to either sub zero temperatures (three Fridays) or temperatures up to 16 degrees C28.
Result of the study done by Barber – Hueso et al in a Valencia Health department (Spain) showed that most of the refrigerators were domestic refrigerators without alarm systems to alert staff to technical failure or electrical cuts (76.7%), open door alarm (98.5%), defrosting facilities (76.5%), internal temperature sensors (85.3%). Temperatures were mostly in the correct range (83.9%) and the vaccines were correctly located (88.2%). At least 1 staff member was responsible for the vaccines in all centers, food was found in 33.8% of the refrigerators and the temperature charts was maintained in five out of every six refrigerators.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
This is a cross-sectional descriptive survey of all the health facility that offers static vaccination in various health facilities in Abraka LGA.
All the twenty seven vaccination centers in Abraka LGA were reviewed using both qualitative and quantitative approach. Qualitative data consisted of empirical observation of practices such as, the opening and closing of the fridge, the presence of temperature charts, and the presence of other products than vaccines in the fridge. It also involved assessment of the cold chain facilities by physical inspection of the equipment at the health facilities. Special attention was paid to refrigerators, vaccine carriers, standby generators, handling of vaccines including recording of the movement of vaccines. A structured questionnaire was used to gather information on the health workers knowledge regarding vaccine storage and handling. To assess the knowledge of health workers on vaccine storage and handling, the answers to the specific questions were graded and a value of 70% was attributed as good knowledge where as 69.99% to 50% were regarded as fair knowledge, below 51% were regarded as poor knowledge.
The question on funds availability was asked to only the heads of facility to ascertain whether they are receiving funds or not, how much they are receiving and the regularity.
Study Population
A study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitute of individuals or elements that are homogeneous in description (Prince Udoyen: 2019). The study included all the health workers working in various health centers that offer immunization services in Abraka Local Government area.
Sample Size Determination
All the health workers that work in immunization centers in the twenty seven health facility that offer static immunization were recruited for the study and were administered the questionnaire. According to Delta State Ministry of Health they are one hundred and fifty five. Fourteen were on leave as at the time of conducting this research.
CHAPTER FOUR
RESULTS
One hundred and forty six questionnaires were administered to all the health workers that work in health facilities that offer immunization services in Abraka Delta state. Out of the one hundred and forty six questionnaires distributed five were found unsuitable for analysis after editing, given a response rate of 96.6%.
The table above indicates that majority of the respondents are between the ages of 40 – 44years 38 (27.0%), 30 (21.3%) of the respondents are between (35 – 39years), 27 (19.1%) are more than 40 years of age.
There are 17 (12.1%) males and 124 (87.9%) females that participated in the study.
Majority of the respondents 89 (63.1%) are graduate 40 (28.4%) attained secondary school level, 12 (8.5%) attained post graduate level, none of the respondents attained primary school level.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
Conclusions
Personnel training were generally good and majority of the health workers that work in immunization centers are nurses, knowledge of vaccine storage and handling by health workers were generally good. However equipments were found lacking in some health facilities and in some where they are available they were not functional. All the OPV checked for VVM colour change were found to be within normal range. The result of the cross tabulation showed that giving in service training to the health workers will help improve their knowledge of vaccine storage and handling.
In all, the quality of vaccine cold chain in twenty seven health facilities visited were generally good but efforts need to be directed at the availability of equipments and maintenance. Also vaccine handling practices need to be looked into, as some of the health workers have poor vaccine handling practices.
Recommendations
(1) Faulty cold chain equipment should be repaired without delay by providing adequate fund to the centres.
(2) Health workers that work in immunization centers should be given in service training from time to time.
REFERENCES
- Cayne B.S, Leacher D.E. (eds). The New lexicon Websters Encyclopedic Dictionary of the English Language. Deluxe Edition. Danburry, CT, USA Lexcon Publications Inc. 1993;1085.
- Nichol K L, Lind A, Margolis K L et al. The effectiveness of vaccination against influenza in health working adults, N Engl J Med. 1995; 333: 889-93.
- WHO & UNICEF: Immunization Summary 2005; A statistical reference Geneva.
- World Health Organization. Expanded programme on Immunization EPI information system. Global Summary Geneva,1996 (unpublished documents WHO/ EPI/CEIS/96.07 available on request from the Global Programme for vaccines and immunization, World Health Organization,1996 1211 Geneva 27, Switzer land)
- Bishai DM, Bhatt S, Miller LT, et al Vaccine Storage practices in Paediatric offices .Paediatrics 1992; 89:193-6
- Stainmetz N, Furesz J, Reinhold C et al Storage conditions of live measles, mumps and rubella virus vaccines in montreal. Can Med Assoc 1983; 128:162-3.