Vaccine cold chain management practice and vaccine stock management practice at public health facilities in Central Gondar Zone, Amhara Region, Ethiopia: Mixed Methods

Abstract

Background: Immunization programmers depend greatly on efficient and effective supply chain systems to store, transport, and distribute vaccines, which ensure that the right vaccines are available at the right place, at the right time, and in the right condition in order to provide efficient health services. Effective vaccine cold chain management practices and stock management practices are important criteria for an effective vaccine supply chain. Poor vaccine cold chain management and stock management practices lead to poor quality of vaccines and vaccine stockouts. Objective: The aim of this study was to assess vaccine cold chain management practices and stock management practices at public health facilities in the Central Gondar Zone, Amhara Region, Ethiopia. Methods: A facility-based, sequential explanatory design was conducted at public health facilities in the Central Gondar Zone, Amhara Region, Ethiopia, from August 1 to September 2, 2022. Twenty-six health facilities were selected by a simple random sampling technique. Ten key informants were selected using the purposive sampling technique based on the saturation point. The collected quantitative data was entered into Epi Data software version 4.6 and transferred to SPSS software version 26 for analysis. A chi-square test was used to identify associated factors. A P-value greater than 0.05 was considered statistically significant. The quantitative data was presented using tables and figures. Qualitative data was analyzed by thematic analysis. The result was written in narrative form under each theme, and double quotation marks ("") were used to present the direct quotes of key Results: About 20 (76.9%) vaccine handlers had satisfactory knowledge regarding cold chain management. The majority of health facilities (88.5%) had acceptable cold chain management practices. At the time of the visit, all public health facilities had functional refrigerators. Most of the health facilities (84.6%) utilized electricity as the main power source, and 9 (34.6%), 14 (53.8%), and 6 (23.1%) utilized generators, solar panels, and kerosene as alternative power sources in the absence of electricity, respectively. Work experience of vaccine handlers for more than 5 years (χ2 =4.566, p=0.046) and having satisfactory knowledge of vaccine handlers about cold chain management (χ2 =11.304, p=0.008) were significantly associated with acceptable vaccine cold chain management practice. IX Conclusions: The majority of the health facilities had acceptable cold chain management practices. Three-fourths of the parameters to assess stock management practice had better implementation in public health facilities according to WHO recommendations (≥80%). Work experience and knowledge of cold chain management of vaccine handles were significantly associated with cold chain management practice. Most key informants explored that shortage of kerosene, absence of supportive supervision, lack of trained human power, electricity interruption, shortage of storage place, and shortage of refrigerator were the challenges of cold chain management practice.