Assessment of vaccines cold chain management practices in public health facilities of Rwanda. A case of Gasabo District, Kigali City

Abstract

Background: Immunization program faces many challenges including maintaining vaccines potency. To maintain vaccines quality, cold chain guidelines as recommended by World Health Organization (WHO) should be followed. In Rwanda, healthcare workers are supposed to use fridge tags as temperature monitoring devices used in the management of vaccines cold chain in health facilities. However, health providers may not follow the recommended practices in their routine work due to several reasons. Objective: The main objective of this study was to explore the vaccines cold chain management practices. Method: This was descriptive cross-sectional design using a mixed-method approach. Data were collected among vaccinators handling vaccines in health centres located in Gasabo district, Kibagabaga hospital’s catchment area. The data were collected from downloaded reports from fridge tags; qualitative and quantitative data were collected using a structured questionnaire in Kobo toolbox software. The analysis has been done using STATA and Excel. Results: In this study, most of the respondents (94%) had received a formal training on cold chain management and all of them received supervision on vaccine and cold chain management. All (100%) visited health facilities had functional refrigerators exclusively reserved for vaccines as well as fridge tags devices for temperature monitoring. Generally, this study revealed good knowledge on vaccine cold chain management among vaccinators. The main cold chain management challenges revealed by this study include the lack of maintenance plan (77%), untrained assistant vaccinators (59%), lack of power backup generators (23.5%), irregularity of power supply (11%) and fridge tag alarm (11%). Conclusion: Best practices are the backbone of effective cold chain system as they prevent loss of vaccines and preserve cold chain equipment. In this study, data downloaded from the fridge tags have shown high temperatures above the recommended range in all the visited health facilities, however most of respondents had good knowledge, attitudes and practices towards vaccine cold chain management. Although, there are challenges in cold chain management, vaccinators had managed to find temporal and long term solutions towards those challenges. Regular supportive supervision, trainings and availability of functional cold chain equipment contribute to the sustained and effective cold chain system.