The challenges to storage temperature adherence at district vaccine stores in Malawi

Abstract

Background: Over the years new vaccines have been introduced in the EPI program since its initiation in 1979. The EPI program has been introducing new antigens since reception in 1979 from4 to 13 in 2019.Vaccines are kept at national,regional and district vaccine stores apart from service delivery points. While these stores are known to have available human resource, standard operation procedures and connection to national power grid, adherence to temperature requirements is still one of major challenges. This research aimed at examining the factors that contribute to non-adherence to temperature ranges at district vaccine stores (DVS) in order to contribute towards a reduction in vaccine wastage due to temperature excursions. Methods: Thisstudy wassequential mixed method design where qualitative and quantitative data were collected. The study sample size was 67 cold chain technicians and 101 refrigerators. Data Collection was done using three tools namely; structured questionnaires for cold chain technicians for quantitative. structured checklist for cold chain equipment and Fridge Tag2 temperature data was downloaded. On qualitative data, a question guide for an in-depth interview was used. Data analysis for correlation was done using Statistical Package for Social Scientists (SPSS) Version 23.0 while MicrosoftExcelpackage was used for descriptive statistics. Thematic analysis was used for qualitative data. Results: It was observed that, 13 (46%) districts were found to have at least one refrigerator operated at temperatures above 8oC for a period of more than 10 hours and -0.5 oC and below for an hour or more. Furthermore, it was found that there was a significant correlation [p = 0.004, r (47) = 0.417] between alarms and average temperature. Out of 28 districts, 22 (79%) districts had their temperature charts completed correctly and 82% recorded it twice a day. However, lack of power back up, fuel, maintenance tools and lack of refresher training were amongst the major challenges that were being reported. Conclusion: There was a relationship between temperature and alarms recorded. Lack of power back up, maintenance tools and fuel were the major challenges which were revealed. There is need to provide power back up and maintenance tools to DVSs in order to improve cold chain management.